Sleep Disorders and Migraine: Review of Literature and Potential Pathophysiology Mechanisms

Comparison of clinical features and associated comorbidities of vestibular migraine in Taiwan

INTRODUCTION

Vestibular migraine (VM) has become the most common diagnosis among patients with complicated dizziness in the last decade. Also, associated comorbidities such as sensory hyperreflexia may play an important role in affecting patient's quality of life. We reviewed a Taiwan series of patients diagnosed with VM to better understand the features and comorbidities associated with VM and also to determine whether there are regional differences in the presentation of VM.

MATERIAL AND PATIENTS

We retrospectively reviewed medical records from all patients diagnosed with VM between 2020.04 and 2023.03 and extracted data on chief complaints, interview records, and physical, laboratory and imaging results. VM was re-categorized according to the International Headache Society-Bárány (IHS- Bárány) diagnostic criteria as definite or probable VM.

RESULTS

Among 393 Taiwanese patients diagnosed with VM, 74.3 % had definite VM, and 25.7 % had probable VM. Dizziness was most frequently associated with recurrent migraine headaches (91.6 %) and phonophobia (60.3 %). Chronic cervicalgia (58.0 %) was the most common non-criteria symptom. While 36.6-54.5 % of patients had otologic symptoms suggestive of Meniere's disease, only 5.1 % had both "definite" VM and "definite" Meniere's disease by diagnostic criteria. Beyond the VM diagnostic criteria, symptoms like chronic cervicalgia, osmophobia, brain fog, and chronic or fluctuating tinnitus significantly correlated with "definite VM" in a multivariate regression model.

CONCLUSION

VM is not solely due to vestibular or central issues; it is closely linked to various systemic comorbidities that can worsen VM and significantly impact quality of life. This study aims to deepen understanding of VM symptoms in Taiwanese and identify potential gaps in interpreting diagnostic criteria, accounting for cultural and linguistic variations. By examining these aspects, we aim to gain insights into the complex nature of VM and advance more effective diagnostic and treatment approaches.

Clinical and psychological predictors of sleep quality in chronic migraine: a preliminary retrospective analysis study

BACKGROUND

Sleep disturbances are common in patients with chronic migraine, yet the clinical predictors of sleep quality in this population remain unclear. This study aimed to explore the relationship between sleep quality and clinical, psychological, and lifestyle factors in chronic migraine.

METHODS

This retrospective observational study included patients with chronic migraine at a tertiary medical center in Taiwan. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Clinical variables included monthly headache days, pain severity, and migraine-related disability. Multiple regression analyses were used to identify predictors of sleep quality.

RESULTS

Among the 56 participants (85.7% women, mean age 42.7 ± 13.3 years), 46 (82.1%) reported poor sleep quality (PSQI ≥ 6). In unadjusted analyses, higher pain severity (β = 0.94, p = 0.010), anxiety (β = 0.22, p < 0.001), and depressive symptoms (β = 0.19, p < 0.001) were significantly associated with poorer sleep quality. Adjusted analyses revealed that anxiety (β = 0.20, p = 0.001) and depressive symptoms (β = 0.17, p = 0.002) were significant predictors of poor sleep quality in their respective models, after adjusting for demographic and clinical variables. Participants with poor sleep quality had significantly higher anxiety (19.59 ± 13.28 vs. 9.50 ± 6.42, p = 0.001) and depression scores (20.59 ± 14.45 vs. 12.40 ± 7.69, p = 0.018) than those with good sleep quality.

CONCLUSIONS

Anxiety and depression are strongly associated with poor sleep quality in chronic migraine patients. Addressing psychological comorbidities is essential to improve sleep quality, highlighting the need for an integrated treatment approach.

Fixed combination of palmitoylethanolamide and melatonin in preventive therapy of migraine: results from a randomized clinical trial

Introduction

Migraines are neurological disorders which significantly impact quality of life. Current pharmacological treatments often have adverse effects, prompting the search for alternatives with fewer side effects. Several studies have described the antimigraine properties of palmitoylethanolamide (PEA) and melatonin.

Materials and methods

Our research assessed the efficacy of the association of hydrodispersible PEA (1,200 mg) and melatonin (0.2 mg) by a randomized, three-month, double-blind, placebo-controlled trial (PEATONIDE®; n = 30 patients; placebo; n = 30 patients). The participants were recruited by "I.N.B.B. Consortium" in Italy. The primary outcome was the reduction of migraine frequency, while secondary outcomes included the reduction of intensity, duration, and grade of disability. The parameters were assessed by a self-reported daily headache diary.

Results

The formulation displayed a significant reduction in frequency (T3 months: 2.2 ± 0.4 MMDs; T0 baseline: 3.4 ± 0.5 MMDs, ***p < 0.001 vs baseline T0) and duration, intensity, disability, and incidence of associated symptoms of migraine attacks after 3 months of treatment. No adverse effects were observed during the treatment. In addition, a significant mitigation of migraine-related symptomatology was observed.

Conclusion

These findings suggest that PEATONIDE® may be a promising adjunctive approach for migraine management. However, given the relatively small sample size, further large-scale and multicenter trials are needed to confirm its clinical applicability in broader migraine population.

High-risk area for migraine attacks - a new concept in migraine pathophysiology

Migraine is a common primary and often disabling neurological disorder, whose pathophysiology is still debated. It does not appear to be an isolated event of head pain but the consequence of recurrent disruption of healthy homeostasis in some brain functions. We propose a new theoretical model, focused on the existence of a "high-risk area" for migraine attacks, which can represent a potential target of non-pharmacologic treatment and prevention. We suggest that migraine arises from the combined effects of three primary factors, namely depressive or unstable mood, unrestful sleep and sympathetic-parasympathetic imbalance with parasympathetic prevalence, alongside with their temporal variability, potentially through dysfunction of homeostatic hypothalamic networks in susceptible individuals. Moreover, these three primary factors contribute to a state of low brain energy, that contains the high-risk area and represents the condition in which migraine attacks rise up. Wearable devices, self-administered questionnaires and clinical tools (i.e., polysomnography, pupillary light reflex, plasma catecholamines dosage) may be used to monitor autonomic nervous system function, mood and sleep and demonstrate the existence of the high-risk area. This will be helpful for patients to understand when they are about to enter in the high-risk area, in order to implement strategies to prevent migraine attacks. This approach would provide a significant advantage in terms of prevention and early treatment.

Association between obstructive sleep apnea and migraine: A United States population-based cohort study

OBJECTIVE

To determine the association between obstructive sleep apnea (OSA) and the incidence of migraine using a large population-based dataset, as well as to identify the at-risk target groups.

BACKGROUND

Epidemiological and biochemical studies have provided evidence for the close connection between sleep disorders and migraine. Understanding the connections between OSA and migraine, as well as their shared risk factors, may provide new perspectives on the pathophysiology of both OSA and migraine and novel approaches to managing and treating these conditions.

METHODS

This retrospective cohort study used data from the TriNetX network from 2010 to 2021. We compared 196,864 adult participants with OSA to a group of 196,864 participants who had never been diagnosed with OSA (1:1 propensity score-matching for age, sex, race, comorbidities, and body mass index [BMI] categories) in relation to the risk of incident migraine. We performed subgroup analyses based on age (18-39, 40-59, ≥60 years), sex (female, male), race (White, Black or African American, Asian), BMI categories (<18.5, 18.5-24.9, 25-29.9, ≥30 kg/m2), and the presence of hypoxemia (yes, no). Sensitivity analyses were performed to validate our findings.

RESULTS

During the follow-up period, 12,613 (6.4%) and 6356 participants (3.2%) developed migraine in the OSA and non-OSA cohorts, respectively. Patients with OSA were found to have a 1.85-fold risk (hazard ratio [HR] 1.85; 95% confidence interval [CI] 1.79-1.90) of incident migraine when compared to those without OSA, after accounting for age, sex, race, and baseline comorbidities. The results were consistent in sensitivity analyses (test-negative design: HR 1.39, 95% CI 1.28-1.49) and also cross-validated in a different dataset from TriNetX (Global Collaborative Research Network: HR 1.88, 95% CI 1.82-1.93). The results of subgroup analysis by sex, age, race, BMI categories, and the presence of hypoxemia were generally consistent.

CONCLUSION

We found OSA to be associated with an elevated risk of developing migraine using a large United States nationwide database, and the association was generalizable across sex, age, race, and BMI categories. Our results suggest that awareness of migraine should be increased among patients with OSA. The findings also encourage further research to clarify the role of obesity and overweight in the relationship between OSA and migraine, as well as the potential benefits of body weight control for those with these two comorbid conditions.

Assessment of sleep patterns in migraine sufferers using the Epworth Sleepiness Scale

BACKGROUND

Migraine, a debilitating neurological disorder, is often co-occurring with sleep disturbances. This study used the Epworth Sleepiness Scale (ESS) to explore changes in sleep quality between individuals with migraine and healthy controls. Additionally, we examined associations between ESS scores and migraine frequency, severity, and demographic factors.

METHODS

This cross-sectional study included 404 participants, 204 with chronic migraine (diagnosed using ICHD-3 criteria) and 200 controls without neurological disorders. Daytime sleepiness was assessed using the Epworth Sleepiness Scale. Demographic and clinical data were analyzed using Python3 and SPSS, using t-tests and ANOVA (P < 0.05).

RESULTS

The study analyzed demographics, clinical characteristics, and daytime sleepiness in 204 migraine participants compared with 200 controls. Individuals with chronic migraine had higher Epworth Sleepiness Scale scores, with increased sleepiness associated with higher BMI, age, and female gender. Significant differences in sleepiness levels were observed with migraine severity, highlighting the impact of migraine on sleep patterns and quality, and no significant differences were found between control and migraine groups in ESS scores, sleep duration, or physical activity. Reliability testing confirmed high ESS consistency.

CONCLUSION

This study highlights the prevalence of daytime sleepiness among individuals with chronic. Managing sleep quality emerges as an important treatment strategy. The use of standardized tools such as the Epworth Sleep Scale can guide personalized interventions, improve patient outcomes, and emphasize the role of lifestyle and overall health management.

Migraine and sleep apnea, insomnia, and sleep patterns in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

OBJECTIVE

To quantify the prevalence of migraine and examine its association with sleep disorders, patterns, and symptoms in adults in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). We hypothesized that migraine would be associated with insomnia but not sleep apnea.

BACKGROUND

Sparse research has examined migraine prevalence and sleep comorbidities in underrepresented racial and ethnic groups in the United States. Hispanic/Latino adults in the United States may be at risk for worse health outcomes due to disparities in health-care access and socioeconomic stressors.

METHODS

We analyzed data collected during the baseline examination (March 2008-June 2011) from the HCHS/SOL, a community-based cohort study of self-identified Hispanic/Latino adults in the United States. The exposure was self-reported medical diagnosis of migraine, and primary outcomes were obstructive sleep apnea (apnea-hypopnea index ≥ 15 events/h from at-home sleep testing) and insomnia (≥ 9 on the Women's Health Initiative Insomnia Rating Scale). Exploratory outcomes included self-reported sleep duration, timing, sleeping pill use, and naps. We compared weighted differences in outcomes by migraine status, adjusting for age and sex in all reported models.

RESULTS

Our analytical sample included HCHS/SOL participants who completed questionnaires on sleep and migraine (16,325). The mean age (standard deviation) was 41.1 (31.7) years, 52.2% identified as female, and 39.5% had a body mass index ≥ 30 kg/m2. Lifetime prevalence of migraine was 15.9% (95% confidence interval [CI]: 15.0, 16.8; 23.6% [95% CI: 22.2, 25.0] of females and 7.5% [95% CI:6.6, 8.5] of males). Those with migraine were more likely to be unemployed (50.8% vs. 36.2%) and to have a household yearly income of < $20,000 (50.9% vs. 45.5%). There was no association between migraine and obstructive sleep apnea (odds ratio [OR] 0.98 [95% CI: 0.76, 1.26]) or napping (OR 0.92 [95% CI: 0.81, 1.06]). Compared to individuals without migraine, those with migraine were more likely to have insomnia (OR = 1.87; 95% CI: 1.62, 2.15) and to use sleeping pills (OR = 2.16; 95% CI: 1.80, 2.60) in sex- and age-adjusted models. Individuals with migraine also had shorter mean sleep duration (7.88 ± 2.5 h vs. 8.00 ± 2.1 h, β = -0.20; 95% CI: -0.30, -0.09) and later bedtimes (11:28 p.m. ± 5.1 h vs. 11:17 p.m. ± 4.2 h, β = 16.85; 95% CI: 3.58, 30.13; weekdays) in sex- and age-adjusted models.

CONCLUSION

Self-reported medical diagnosis of migraine is common in Hispanic/Latino adults, especially females. Migraine is not associated with obstructive sleep apnea. Consistent with non-Hispanic/Latino populations, migraine is associated with insomnia in the HCHS/SOL.

Exploring the evolving frontiers of sleep deprivation research in the post-COVID-19 era

Sleep deprivation research (SDR) has undergone substantial transformations in the aftermath of the COVID-19 pandemic. This comprehensive study explores the SDR's evolving trends, hotspots, and conceptual structure in the post-COVID-19 era. Using bibliometric analysis with VOSviewer and Bibliometrix software, we examined the SDR publications from January 2020 to December 2023. Core sources were identified using Bradford law, and a dataset of 4578 English-based data-driven studies was retrieved from the Scopus database. Our analysis revealed a remarkable annual growth rate of 37.92% in SDR from 2020 to 2023, indicating a heightened research focus in this domain. Among prolific authors, Shao emerged as a key contributor, while Sleep ranked prominently as a leading publication venue. The United States and China have emerged as the most impactful countries for advancing SDR research. Uncovering the most cited documents sheds light on various focal points within SDR, including sleep duration, mental health implications, cardiovascular events, the impact of COVID-19 on sleep patterns, dementia, resilience in children, and sleep patterns among preschoolers. Noteworthy keywords that emerged from the analysis encompassed "sleep deprivation," "depression," "insomnia," "COVID-19," "anxiety," "fatigue," and "obesity." Using a thematic mapping approach, we delineated distinct themes characterized by niche, basic, emerging, and declining patterns. Clusters of SDR research were observed in areas such as "Fatigue," "Sleep apnea," "Sleep," "Sleep deprivation," "Migraine," "Caffeine," and "Recovery." Furthermore, trending themes in SDR encompassed "Sleep disturbance," "excessive daytime sleepiness," and "Gamma-Aminobutyric Acid." These comprehensive findings provide valuable insights into the current landscape of SDR, illuminating emerging trends, identifying hotspots, and offering directions for future research in this critical field.

Current Trends in Pediatric Migraine: Clinical Insights and Therapeutic Strategies

Background/Objectives: Pediatric migraine is a prevalent neurological disorder that significantly impacts children's quality of life, academic performance, and social interactions. Unlike migraines in adults, pediatric migraines often present differently and involve unique underlying mechanisms, making diagnosis and treatment more complex. Methods: This review discusses the clinical phases of pediatric migraine, key trigger factors, sex- and age-related differences, and the role of childhood maltreatment in migraine development. We also discuss episodic syndromes such as cyclic vomiting syndrome, abdominal migraine, benign paroxysmal vertigo, and benign paroxysmal torticollis, along with comorbidities such as psychiatric disorders, sleep disturbances, and epilepsy. Results: The underlying pathophysiological mechanisms for pediatric migraines, including genetic predispositions, neuroinflammation, and gut microbiota dysbiosis, are summarized. Current therapeutic strategies, including conventional and emerging pharmacological treatments, nutraceuticals, and non-pharmacological approaches, are evaluated. Non-pharmacological strategies, particularly evidence-based lifestyle interventions such as stress management, diet, hydration, sleep, exercise, screen time moderation, and cognitive behavioral therapy, are highlighted as key components of migraine prevention and management. The long-term prognosis and follow-up of pediatric migraine patients are reviewed, emphasizing the importance of early diagnosis, and tailored multidisciplinary care to prevent chronic progression. Conclusions: Future research should focus on novel therapeutic targets and integrating gut-brain axis modulation, with a need for longitudinal studies to better understand the long-term course of pediatric migraine.

Burden of hidden migraine among the Arab general population: a cross-sectional study

BACKGROUND

Migraine is a common type of primary headache which is responsible for one-third of the headache cases. It's also considered the third highest neurological disease with disability in 2021, however, underdiagnosis of migraine remains a significant health problem. This study aims to assess the prevalence of hidden migraine identified by screening among the Arab general population, describe the characteristics of headache attacks, and assess disability and distress associated with migraine.

METHODS

This cross-sectional study was conducted between April and June 2024 among the general population of eight Arab countries using a self-administered online questionnaire to collect sociodemographic data and medical history. The questionnaire also included the ten-item Kessler Psychological Distress Scale (K10), Migraine Screen Questionnaire (MS-Q), and Migraine Disability Assessment Questionnaire (MIDAS).

RESULTS

A total of 2152 individuals completed the questionnaire with a median age of 24 (21-29). Among them 683 (31.7%) individuals were screened positive by MS-Q. Using regression analysis, the independent predictors for positive screening were being Saudi Arabian, having one or more diseases, and having severe psychological distress with adjusted odds ratios of 0.622, 0.282, and 1.329 respectively. Among positive cases, 667 (97.7%) reported having headaches in the past 3 months. Phonophobia (50.97%) and photophobia (49.33%) were the most common associated symptoms. Sleep disturbance (66.72%) and noise (63.87%) were the most common triggering factors while sleep (71.81%) and self-medication (68.52%) were the most common relieving factors. Only 25.34% reported having aura with the last attack. According to MIDAS scores, 459 (67.2%) positive cases had moderate or severe disabilities. Regression analysis identified being a housewife and having one or more diseases as the independent predictors of having moderate or severe disabilities with adjusted odds ratios of 0.228 and 0.523 respectively.

CONCLUSION

Migraine is still underdiagnosed in Arab countries which causes significant disability among positive cases. Raising awareness about the importance of early migraine diagnosis is crucial for encouraging the general population to seek medical advice once they have symptoms.

Uncovering the potential of smartphones for behavior monitoring during migraine follow-up

BACKGROUND

Migraine is a neurological disorder that affects millions of people worldwide. It is one of the most debilitating disorders which leads to many disability-adjusted life years. Conventional methods for investigating migraines, like patient interviews and diaries, suffer from self-reporting biases and intermittent tracking.

METHODS

This study aims to leverage smartphone-derived data as an objective tool for examining the relationship between migraines and various human behavior aspects. By utilizing built-in sensors and monitoring phone interactions, we gather data from which we derive metrics such as keyboard usage, application interaction, physical activity levels, ambient light conditions, and sleep patterns. We perform statistical analysis testing to investigate whether there is a difference in user behavioral aspects during headache and non-headache periods.

RESULTS

Our analysis of 362 headaches reveals differences in behavioral aspects such as ambient light, use of leisure apps, and number of keystrokes during headache periods and non-headache periods.

CONCLUSIONS

This exploratory study shows on the one hand that it is possible to monitor various human behavioral aspects using the smartphone sensors and interaction data only. On the other hand it shows that we can observe difference in human behavior between headache and non-headache periods. Our work is a step towards objectively measure the effects that migraine has on people's lives.

Efficacy of oral and non-oral migraine prophylactic treatment on self-reported subjective sleep quality in migraine patients with sleep problems: A review and meta-analysis

This study aims to investigate the effects of oral and non-oral migraine prophylaxis on subjective sleep quality in migraine patients with sleep problems. A bidirectional relationship between migraine and sleep is presumed, although this relationship is not fully clarified. Possibly, prophylactic treatment of migraine aiming at a reduction of migraine attack frequency can also positively affect the quality of sleep for patients with migraine with sleep problems. PubMed, Cochrane, Embase and CINAHL databases were searched in March 2022 for studies evaluating prophylactic treatment of migraine and the impact on perceived sleep quality (Pittsburgh Sleep Quality Index or Insomnia Severity Index). A systematic review using the McMaster Tool and a random-effects meta-analysis (effect size Cohen's d) were conducted. Seven studies were identified, including 989 participants, of which 844/989 (85.3%) female, with a mean (SD) age of 41.3 (12.1) years. In 6/7 (85.7%) studies, monthly migraine days improved (p < 0.002). Five out of six (83.3%) studies presented a relevant improvement in quality of sleep (p < 0.05), and one study reported a clinically meaningful improvement in the treatment group (Insomnia Severity Index change >7, in >50% of participants). The meta-analysis showed a large effect size of 1.09 (95% confidence interval 0.57-1.62; overall p < 0.001; Cochran's Q < 0.0001) for migraine prophylaxis on improving sleep quality. In conclusion, prophylactic migraine treatment improves sleep quality in patients with migraine and sleep problems, as measured with self-reported questionnaires Pittsburgh Sleep Quality Index and Insomnia Severity Index. Unfortunately, some included studies used prophylactic treatment that is not in current (international) guidelines. The evidence for this improvement in quality of sleep is strong, and seems a generic effect of migraine prophylaxis.

Feasibility of Fish Oil Supplementation on Headache Symptoms and Blood Lipids in Migraine Patients

OBJECTIVES

Migraine is a chronic, recurring, and disabling disease. Fish oil intervention was used to investigate its effects on headache symptoms and blood lipids of migraine patients.

DESIGN

All subjects were collected at the Kuang Tian General Hospital from March 2020 to May 2021. Experimental group subjects took 1 g/time of fish oil (including EPA 900 mg/tablet) after breakfast and dinner. Placebo group subjects took 100% soybean oil twice daily. Before and after the test, the migraine improvement questionnaire was used to analyze headaches during attacks, dietary intake, and headache triggers.

RESULTS

The average age of the 47 subjects in this study was 40.3 ± 9.2 years old, the body mass index (BMI) was 24.3 ± 6.0 kg/m2. At Week 12, subjects in the fish oil group were significantly improved relative to the control group (p < 0.05). Blood lipid indexes TC, LDL-C, and TG were reduced, and the frequency, duration, and pain degree of migraine.

CONCLUSION

Fish oil may be used as an adjunctive therapeutic food for relieving migraine attack symptoms and blood lipids.

Relationship of sleep quality, chronotype, and obstructive sleep apnea with migraine in the elderly population

PURPOSE

Disturbances of sleep have frequently been reported in individuals with migraine. On top of this, an elderly patient with migraine also suffers from sleep disturbances due to changes in physiologic and mental health associated with aging. This study aimed to compare several sleep factors, namely sleep quality, chronotype, and obstructive sleep apnea (OSA) risk, between elderly people with and without migraine.

METHODS

This was a multicenter cross-sectional study conducted in 10 neurologic clinics located in Tehran, Iran, over 2 years. The sample size was calculated as 189, including 63 migraine and 126 non-migraine patients.

RESULTS

A significant difference was observed in the mean score of the global Pittsburgh Sleep Quality Index (PSQI) between migraine and non-migraine groups (p-value = 0.002), and in the individual components of the PSQI. However, there were no significant differences in the frequency of different types of chronotype (p-value = 0.125, T = 1.541) or OSA risk between the two groups (p-value = 0.568, T = -0.573). The binary logistic regression model showed that the relationship between global PSQI and migraine was significant (p = 0.002).

CONCLUSION

Sleep quality is a problem for elderly migraine sufferers. Meanwhile, certain factors such as chronotype and OSA have no significant relationship with migraine among community-dwelling seniors. Further studies are required to enhance our understanding of this observation.

Transcriptomic changes in the hypothalamus of mice with chronic migraine: Activation of pathways associated with neuropathic inflammation and central sensitization

Chronic migraine is a common central nervous system disorder characterized by recurrent, pulsating headaches. However, the extent and mechanisms of hypothalamic involvement in disease progression have not been thoroughly investigated. Herein, we created a chronic migraine mouse model using repeated intraperitoneal injections of nitroglycerin. We performed transcriptomic sequencing on the hypothalamus of mice with chronic migraine and control mice under normal physiological conditions, followed by differential gene set enrichment and functional analysis of the data. Additionally, we examined the intrinsic connection between chronic migraine and sleep disorders using transcriptomic sequencing data from sleep-deprived mice available in public databases. We identified 39 differentially expressed genes (DEGs) in the hypothalamus of a mouse model of chronic migraine. Functional analysis of DEGs revealed enrichment primarily in signaling transduction, immune-inflammatory responses, and the cellular microenvironment. A comparison of the transcriptomic data of sleep-deprived mice revealed two commonly expressed DEGs. Our findings indicate that the hypothalamic DEGs are primarily enriched in the PI3K/AKT/mTOR pathway and associated with the NF-κB/NLRP3/IL-1 β pathway activation to maintain the central sensitization of the chronic migraine. Chronic migraine-induced gene expression changes in the hypothalamus may help better understand the underlying mechanisms and identify therapeutic targets.

Impact of migraine on changes in cardiovascular health profile among Hong Kong Chinese women: insights from the MECH-HK cohort study

BACKGROUND

Previous research has shown an association between migraine and cardiovascular diseases (CVDs). However, limited studies have explored the progression of cardiovascular health (CVH) among individuals with migraine. This cohort study aimed to explore the relationship between changes in CVH and migraine among women of Chinese descent in Hong Kong.

METHOD

Data from a cohort study titled "Migraine Exposures and Cardiovascular Health in Hong Kong Chinese Women (MECH-HK)" were analysed. A total of 2,603 women, averaging 56.5 ± 8.5 years of age, were selected, all with complete data at baseline and at a follow-up occurring on average 1.27 years later. CVH profile was assessed by an adapted Life's Essential 8, comprising dietary habits, physical activity, nicotine exposure, sleep duration, body mass index (BMI), lipid levels, blood pressure, and stress. Each component was scored from 0 to 100, with overall CVH as the average. CVH levels were categorized as low (0-49), moderate (50-79), and high (80-100), representing poor to excellent health. Changes in CVH were defined as shifts between these categories from baseline to subsequent follow-up. Migraine cases were identified utilizing the International Classification of Headache Disorders 3.

RESULT

A total of 275 (10.6%) women were identified as having migraine. By follow-up, both women with and without migraine experienced significant declines in CVH profiles (all p-value < 0.05). In the fully adjusted model, women with migraine had a 1.36 times higher risk (OR 95% CI: 1.33, 1.39) of decline in overall CVH compared to non-migraineurs. They also had a higher likelihood of shifting to worse CVH levels in several individual CVH components, including physical activity (OR: 1.09), nicotine exposure (OR: 4.27), sleep quality (OR: 1.80), blood lipid levels (OR: 1.03), and stress (OR: 1.23) (all p-value < 0.05). Among women with migraine, those experiencing aura had a higher risk of poorer physical activity, greater nicotine exposure, higher BMI, and increased stress than those without aura (all p-value < 0.05).

CONCLUSION

Women with migraine exhibited worse progression in CVH compared to those without migraine. Targeted monitoring and management of CVH-related factors in this population are crucial to reducing their elevated risk of CVDs.

Endogenous pain modulation after sleep restriction in migraine: a blinded crossover study

BACKGROUND

Patients with migraine are vulnerable to insufficient sleep, but the impact of sleep restriction is largely unknown. In addition, the importance of sleep may be different in patients with migraine who mostly have attack onsets during sleep, so called sleep-related migraine, compared to patients with non-sleep-related migraine. In this study we investigate the effect of sleep restriction on endogenous pain modulation in patients with migraine and healthy controls. We also compared the effect of sleep restriction in sleep-related and in non-sleep-related migraine.

METHODS

Measurements were conducted in 39 patients with migraine between attacks and 31 controls, once after habitual sleep and once after two consecutive nights of partial sleep restriction. There were 29 and 10 patients with non-sleep-related and sleep-related migraine respectively. Test stimulus was 2-min tonic noxious heat to the left volar forearm. Temporal summation was calculated as the regression coefficient for rated pain in the late part of this 2-min stimulation. Conditioning stimulus was right hand-immersion in 7 °C water. Conditioned pain modulation was defined as the difference in rated pain with and without the conditioning stimulus and was calculated for temporal summation and mean rated pain for the test stimulus. The effect of sleep restriction on temporal summation and conditioned pain modulation was compared in migraine subjects and controls using two-level models with recordings nested in subjects.

RESULTS

Conditioned pain modulation for temporal summation of heat pain tended to be reduced after sleep restriction in patients with migraine compared to controls (p = 0.060) and, in an exploratory analysis, was reduced more after sleep restriction in sleep-related than in non-sleep-related migraine (p = 0.017). No other differences between groups after sleep restriction were found for temporal summation or conditioned pain modulation.

CONCLUSION

Patients with migraine may have a subtly altered endogenous pain modulation system. Sleep restriction may have an increased pronociceptive effect on this system, suggesting a mechanism for vulnerability to insufficient sleep in migraine. This effect seems to be larger in sleep-related migraine than in non-sleep-related migraine.

Modulating oxidative stress and neurogenic inflammation: the role of topiramate in migraine treatment

Migraine is a chronic, recurrent neurovascular disorder characterized by episodes closely associated with neurovascular hypersensitivity. Oxidative stress can worsen the hypersensitive state of the central nervous system, which in turn can trigger pro-inflammatory factors that result in neurogenic inflammation. Topiramate is frequently used as a preventative measure for migraines, but there is currently little empirical data to support its efficacy through pathways related to neurogenic inflammation and oxidative stress. This review provides an overview of current knowledge regarding the etiology, inducements, pathophysiology, and available treatments for migraine, with a focus on the clinical and experimental evidence of neurogenic inflammation and oxidative stress in migraine. It also delves into the antioxidant and anti-inflammatory qualities of topiramate, clarifying the possible ways in which topiramate affects these pathways to lessen migraine symptoms.

Migraine Prevalence and Academic Impact on Medical Students at Alfaisal University

BACKGROUND

Migraine is highly prevalent among medical students but has been understudied in Saudi Arabia. This study aimed to determine migraine prevalence, characteristics, academic impacts, and coping strategies in medical students.

METHODS

A cross-sectional survey was conducted among 352 medical students. Migraine was identified using ID-Migraine (38.8% prevalence) and International Classification of Headache Disorders 3rd edition (ICHD-3) criteria (36.8% prevalence). Analyses focused on the 130 students meeting ICHD-3 criteria.

RESULTS

The mean monthly migraine frequency was 3.5 days. Average pain severity was moderate at 6.4/10. Mean duration was 9.3 h. Exams triggered migraines for 66% and increased headache frequency/severity for most students. Headaches limited productivity ≥1 day for 86% and caused missed exams and grade point average (GPA) declines. Rest (77.7%), trigger avoidance (57.7%), and medications (56.9%) were the most common coping strategies.

CONCLUSION

Migraine prevalence exceeded general population estimates, frequently disrupted academics, and was exacerbated by exam stressors. Support services and education on coping strategies tailored to academically triggered migraines could better equip students to manage headaches.

The Glymphatic System and its Relationship to Migraine

PURPOSE OF REVIEW

We aim to critically review animal and human studies of the glymphatic system in migraine and propose a model for how the glymphatic system may function in migraine, based on the available evidence.

RECENT FINDINGS

Early studies in animal models report migraine attacks temporarily disrupt glymphatic flow. Human imaging studies suggest chronic migraine may be associated with alterations in glymphatic system function, albeit with conflicting results. Presently, it remains unknown whether repetitive migraine attacks or frequent nights of insomnia impair glymphatic system function over time in those with migraine, and whether alterations in glymphatic function could contribute to worsening migraine disability or risk for cognitive disease. Longitudinal studies of glymphatic function in patients with migraine and insomnia, with inclusion of cognitive assessments, may be informative.

Investigating the interplay of chronotypes, neuropsychiatric dimensions, demographic and clinical characteristics and disability in migraine patients: A cross-sectional assessment

The study investigated associations between chronotypes (Morning [M], Neither [N], Evening [E]), sociodemographic characteristics, body mass index (BMI), smoking habits, years with migraines, sleep quality (PSQI), anxiety (HADS-A), depression (HADS-D), migraine disability (MIDAS), headache frequency, and pain intensity (VAS) in 80 individuals with migraine. Significant age differences emerged (p < 0.001), with M-types being the oldest. BMI also varied, with M-types presenting the highest median BMI (p = 0.005). While migraine duration and headache frequency showed no significant variance, sleep quality did, with E-types reporting the poorest sleep (p = 0.030). Anxiety and depression were significantly worse in E-types (HADS-A: p = 0.002; HADS-D: p = 0.010). Differences in MIDAS levels were notable (p = 0.038); however, differences in MIDAS scores were not significant (p = 0.115). Pain intensity varied, with E-types experiencing the most severe pain (p = 0.009). Post-hoc analysis showed higher MIDAS scores in E-types compared to N-types (χ2 = 6.56, p = 0.038, ε2 = 0.0831). The findings highlight the need for thorough patient evaluations and tailored care, considering the complex interplay of factors affecting migraine severity, particularly among different chronotypes.

Volumetric analysis of the hypothalamic subunits in obstructive sleep apnea

BACKGROUND

Obstructive sleep apnea (OSA) is a prevalent sleep disorder that is associated with structural brain damage and cognitive impairment. The hypothalamus plays a crucial role in regulating sleep and wakefulness. We aimed to evaluate hypothalamic subunit volumes in patients with OSA.

METHODS

We enrolled 30 participants (15 patients with OSA and 15 healthy controls (HC)). Patients with OSA underwent complete overnight polysomnography (PSG) examination. All the participants underwent MRI. The hypothalamic subunit volumes were calculated using a segmentation technique that trained a 3D convolutional neural network.

RESULTS

Although hypothalamus subunit volumes were comparable between the HC and OSA groups (lowest p = .395), significant negative correlations were found in OSA patients between BMI and whole left hypothalamus volume (R = -0.654, p = .008), as well as between BMI and left posterior volume (R = -0.556, p = .032). Furthermore, significant positive correlations were found between ESS and right anterior inferior volume (R = 0.548, p = .042), minimum SpO2 and the whole left hypothalamus (R = 0.551, p = .033), left tubular inferior volumes (R = 0.596, p = .019), and between the percentage of REM stage and left anterior inferior volume (R = 0.584, p = .022).

CONCLUSIONS

While there were no notable differences in the hypothalamic subunit volumes between the OSA and HC groups, several important correlations were identified in the OSA group. These relationships suggest that factors related to sleep apnea severity could affect hypothalamic structure in patients.

Inflammo-immune perspective on the association of eight migraine risk factors with migraine: a multi-omics Mendelian randomization study

Background

Migraine risk factors are associated with migraine susceptibility, yet their mechanisms are unclear. Evidence suggests a role for inflammatory proteins and immune cells in migraine pathogenesis. This study aimed to examine the inflammo-immune association between eight migraine risk factors and the disorder.

Methods

This study utilized inverse variance weighted (IVW) method and colocalization analysis to explore potential causal relationships between eight migraine risk factors, migraine, 731 immune cells, and 91 circulating inflammatory proteins. Mediation Mendelian randomization (MR) was further used to confirm the mediating role of circulating inflammatory proteins and immune cells between the eight migraine risk factors and migraine.

Results

Migraine risk factors are linked to 276 immune cells and inflammatory proteins, with cigarettes smoked per day strongly co-localized with CD33-HLA DR+ cells. Despite no co-localization, 23 immune cells/inflammatory proteins relate to migraine. Depression, all anxiety disorders, and sleep apnea are correlated with migraine, and all anxiety disorders are supported by strong co-localization evidence. However, the mediating effect of inflammatory proteins and immune cells between eight migraine risk factors and migraine has not been confirmed.

Conclusion

We elucidate the potential causal relationships between eight migraine risk factors, migraine, immune cells, and inflammatory proteins, enhancing our understanding of the molecular etiology of migraine pathogenesis from an inflammatory-immune perspective.

Sleep Symptoms in Migraine

PURPOSE OF REVIEW

To review replicated and highlight novel studies of sleep in children and adults with episodic and chronic migraine.

RECENT FINDINGS

Attack-related sleep symptoms are most common in the prodrome and may represent early activation of the hypothalamus rather than migraine triggers. Interictally, patients with migraine report poor sleep quality and high rates of insomnia symptoms. Cognitive behavioral therapy for insomnia in adults and adolescents with chronic migraine and comorbid insomnia results in significant improvement on their headache burden. Thus far, objective studies report that migraine per se is a not associated with sleep apnea. At the present time, there is minimal evidence that migraine is under circadian influence. The current body of evidence suggests that the insomnia symptoms and poor sleep quality commonly reported by patients with migraine are not attack-related but occur interictally and are a marker of worsening disease. The development of clinical guidelines to approach sleep symptoms and expansion of CBT-I trials in those with episodic migraine would be clinically valuable.

Exercise in a natural environment increases program compliance in people with chronic migraine: A pilot cross-over randomized trial

Adverse side effects from pharmacological treatments cause people with migraine to delay or avoid taking medication. Exercise is effective, but the effect of environment is unknown. The purpose was to determine if a natural environment affects monthly migraine load. Sedentary individuals (8 female, 1 non-binary) who experienced migraines participated. Participants completed one month of exercise (3 x week, 30-min, 60-70% estimated HRmax) indoors as well as in a natural outdoor environment in a randomized counterbalanced order. Migraine load was determined using the Headache Impact Test (HIT-6) and Migraine Disability Assessment (MIDAS) at the beginning and end of each month. Data were analyzed using repeated measures ANOVA. No interactions were evident for HIT-6 (p = 0.80), MIDAS (p = 0.72), migraine days (p = 0.508), or pain intensity (p = 0.66). No main effects were noted. Compliance was greater in the outdoor environment, with more exercise sessions completed in nature (Indoor = 72%, Outdoor = 90%, p < 0.001). Exercise environment did not impact MIDAS or HIT-6 questionnaire results, number of migraine days, or pain intensity. While there was no reduction in migraine load, it is possible that other health benefits were experienced due to greater compliance in a natural environment.

Migraine incidence and coffee consumption among child-bearing age women: the Korea Nurses' Health Study

This longitudinal study aimed to identify factors that influence migraines in Korean women nurses using data from the Korea Nurses' Health Study. Among those who participated in Survey 1 (2013-2014) and the follow-up survey (2015-2019), we selected 2605 participants for Cox proportional hazard regression analysis, 521 participants who were newly diagnosed with migraine and 2084 controls using a 1:4 incidence density sampling approach. Consuming coffee (≥ 3 cups: RR = 1.666; 95% CI = 1.175-2.362, < 3 cups: RR = 1.439; 95% CI = 1.053-1.966), being obese (BMI ≥ 25: RR = 1.341, 95% CI = 1.003-1.793), and engaging in vigorous physical activity (RR = 1.010; 95% CI = 1.000-1.019) increased the risk of developing a migraine. Nurses with an annual salary greater than $3500 were less likely to develop migraines (RR = 0.786, 95% CI = 0.631-0.979). The results imply that lifestyle factors, such as the amount of coffee consumption, BMI level, and degree of physical activity could be considered when formulating treatment plans for women who have newly developed migraines.

Effectiveness of galcanezumab on sleep quality, migraine outcome, and multidimensional patient-reported outcome measures: a real-world experience in Turkish patients with episodic and chronic migraine

Introduction

This real-world study aimed to investigate the impact of galcanezumab on sleep quality, migraine outcome and multidimensional patient-reported outcomes measures (PROMs) in patients with episodic migraine (EM) and chronic migraine (CM).

Methods

Fifty-four patients with episodic migraine (n = 24) or chronic migraine (n = 30) received a 3-month series of galcanezumab injections and were evaluated for sleep quality, measured using the Pittsburgh Sleep Quality Index (PSQI), as well as migraine outcomes such as monthly headache days (MHDs), monthly migraine days (MMDs), and headache severity. Patient-reported outcome measures (PROMs) such as the Migraine Disability Assessment Scale (MIDAS), Headache Impact Test-6 (HIT-6), SF-36 Health-related Quality of Life (HRQoL), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI) were additionally included in the assessment.

Results

The percentage of patients with poor sleep quality (total PSQI scores ≥ 5) was 72.7% at baseline, decreasing to 57.5% and 56.2% at the 1st and 2nd months, respectively. By the 3rd month of galcanezumab injections, significant improvement was observed in the sleep disturbances domain in the overall study population (p = 0.016), and in subgroups of patients with low anxiety levels (p = 0.016) and none/minimal depression (p = 0.035) at baseline. Patients with sleep disorder at baseline exhibited marked improvements in total PSQI scores (p = 0.027) and in the subjective sleep quality (p = 0.034) and daytime dysfunction (p = 0.013) domains, by the 3rd month. Over the 1st, 2nd, and 3rd months, there were significant improvements in MHDs (p < 0.001), MMDs (p < 0.001), HIT-6 scores (p < 0.001 for each), BAI scores (p < 0.001 for each), BDI scores (p ranged from 0.048 to <0.001), and HRQoL scores (p ranged from 0.012 to <0.001).

Conclusion

Galcanezumab demonstrates notable benefits in improving sleep quality, along with a comorbidity-based and domain-specific effect on sleep parameters, which involved sleep disturbances domain in patients without depression or anxiety at baseline but the total PSQI scores, subjective sleep quality and daytime dysfunction in those with sleep disorder at baseline. The treatment also facilitates rapid-onset enhancements in migraine outcomes as well as various PROMs.

Association between Migraine and Quality of Life, Mental Health, Sleeping Disorders, and Health Care Utilization Among Older African American Adults

PURPOSE

This study examines the associations between migraine headaches, well-being, and health care use among a sample of underserved older African American adults. Controlling for relevant variables, the association between migraine headaches and (1) health care utilization, (2) health-related quality of life (HRQoL), and (3) physical and mental health outcomes was examined.

METHODS

Our sample included 760 older African American adults from South Los Angeles recruited through convenience and snowball sampling. In addition to demographic variables, our survey included validated instruments, such as the SF-12 QoL, Short-Form McGill Pain Questionnaire, and the Geriatric Depression Scale. Data analysis included 12 independent multivariate models using multiple linear regression, log transferred linear regression, binary and multinomial logistic regression, and generalized linear regression with Poisson distribution.

RESULTS

Having migraine was associated with three categories of outcomes: (1) higher level of health care utilization measured by (i) emergency department admissions and (ii) number of medication use; (2) lower level of HRQoL and health status measured by (i) lower self-rated health (ii) physical QoL, and (iii) mental QoL; and (3) worse physical and mental health outcomes measured by (i) higher number of depressive symptoms, (ii) higher level of pain, (iii) sleep disorder, and (iv) being disabled.

CONCLUSIONS

Migraine headache significantly was associated with quality of life, health care utilization, and many health outcomes of underserved African American middle-aged and older adults. Diagnoses and treatments of migraine among underserved older African American adults require multi-faceted and culturally sensitive interventional studies.

Temporomandibular disorders in migraine and tension-type headache patients: a systematic review with meta-analysis

The simultaneous occurrence of primary headaches and temporomandibular disorders can pose a challenge in determining the best clinical management of patients. Therefore, we aimed to summarize evidence regarding the risk and prevalence of temporomandibular disorders (TMDs) in migraine and tension-type headaches (TTH) patients. Cross-sectional studies published in English comparing the presence of TMDs in adults with TTH or migraine to subjects without headaches were included, International Classification of Orofacial Pain, Diagnostic Criteria for Temporomandibular Disorders or Research Diagnostic Criteria for Temporomandibular Disorders, and large epidemiological studies (sensitive diagnostic criteria (SDC)). The methodological quality was assessed by Modified Newcastle-Ottawa Quality Assessment Scale. Odds ratio (OR) and random effects were calculated. 1405 articles were identified in PubMed, Embase and Central databases, and 13 cross-sectional studies were finally included. Overall Risk of TMDs was statistically significantly higher than control groups in both Migraine (SDC: 11 studies; OR: 3.79 (2.43, 5.90); I2 = 99%), with higher values in chronic migraine (OR: 24.27; (95% Confidence interval (CI): 5.84, 100.82); I2 = 0%) and TTH populations (SDC: 8 studies; OR: 4.45 (2.63, 7.53); I2 = 86%). Headache subjects presented a higher risk of muscular TMDs (5 studies; OR: 2.01 (1.62, 2.50); I2 = 0%), Combined TMDs (5 studies; OR: 2.74 (1.40, 5.36); I2 = 63%), or Painful TMDs (8 studies; OR: 5.31 (2.96, 9.54); I2 = 96%). Headache patients didn't show the risk of arthrogenous TMDs (4 studies; OR: 0.96 (0.54, 1.71); I2 = 33%) or nonpainful TMDs (2 studies; OR: 1.10 (0.28, 4.26); I2 = 84%). The high heterogeneity in the results was reduced following subgroup analysis. Migraine and TTH appear to increase the risk of painful, myogenous or combined arthrogenous and myogenous TMDs.

Sleep disorders and orofacial pain: insights for dental practice

In dental sleep medicine several sleep disorders commonly coexist with pain, contributing to complex clinical presentations which might affect the provision of appropriate and timely treatment. There are associations between sleep disorders and pain in general, as well as with specific orofacial pain conditions. As many as five of six patients with orofacial pain can present with sleep problems. The comorbidity of orofacial pain and sleep disorders overlays a complex web of altered neurobiological mechanisms that predispose to the chronification of orofacial pain. This review discusses the relationship between orofacial pain and sleep disorders and highlights their interactions and the neurobiological mechanisms underlying those relationships.

Effects of prophylactic drug therapies and anti-calcitonin peptide-related monoclonal antibodies on subjective sleep quality: An Italian multicenter study

OBJECTIVE/BACKGROUND

sleep alterations strongly influence migraine severity. Prophylactic therapies have a major impact on migraine frequency and associated symptoms. The study purpose was to compare the impact of oral drug therapies or gene-related anti-calcitonin monoclonal antibodies (anti-CGRP mAbs) on sleep alterations. We also evaluated which drug therapies are more effective on sleep quality and the different impact on migraine frequency and life quality.

PATIENTS/METHODS

this is a multicenter, prospective study conducted in three specialized headache centers (Marche Polytechnic University, Ancona; University of Palermo, Palermo; Fondazione Policlinico Campus Bio-Medico, Rome). At baseline, we assigned migraine patients to preventive therapy with first-line drugs or anti-CGRP mAbs. The Pittsburgh Sleep Quality Index (PSQI) and Migraine Disability Assessment (MIDAS) scales were administered. After three months, we re-evaluated the patients with the same scales.

RESULTS

214 patients were enrolled. Any prophylaxis was significantly associated with a reduction in PSQI score (mean difference 1.841; 95%CI:1.413-2.269; p < 0.0001), most significantly in the anti-CGRP mAb group (mean difference 1.49; 95%CI:2.617-0.366; p = 0.010). Anti-CGRP mAbs resulted in significant improvement in migraine severity and MIDAS scores. Among oral therapies, calcium antagonists and antidepressants were the most effective in reducing PSQI score between T0 and T1 (p = 0.042; p = 0.049; p < 0.0001, respectively).

CONCLUSIONS

anti-CGRP mAbs revitalized the management of migraine with stable and well-documented efficacy. Our data also suggest that anti-CGRP mAbs result in a positive effect on sleep quality, with a significant improvement in PSQI scores. Knowing the relevant impact of sleep disruption on migraine severity, these data could help for the management of migraine patients.

Photophobia is associated with lower sleep quality in individuals with migraine: results from the American Registry for Migraine Research (ARMR)

BACKGROUND

Patients with migraine often have poor sleep quality between and during migraine attacks. Furthermore, extensive research has identified photophobia as the most common and most bothersome symptom in individuals with migraine, second only to headache. Seeking the comfort of darkness is a common strategy for managing pain during an attack and preventing its recurrence between episodes. Given the well-established effects of daily light exposure on circadian activity rhythms and sleep quality, this study aimed to investigate the relationship between photophobia symptoms and sleep quality in a cohort of patients with migraine.

METHODS

A cross-sectional observational study was conducted using existing data extracted from the American Registry for Migraine Research (ARMR). Participants with a migraine diagnosis who had completed the baseline questionnaires (Photosensitivity Assessment Questionnaire (PAQ), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-2 (PHQ-2)), and selected questions of the ARMR Sleep questionnaire were included. Models were created to describe the relationship of photophobia and photophilia with various sleep facets, including sleep quality (SQ), sleep disturbance (SDis), sleep onset latency (SOL), sleep-related impairments (SRI), and insomnia. Each model was controlled for age, sex, headache frequency, anxiety, and depression.

RESULTS

A total of 852 patients meeting the inclusion criteria were included in the analysis (mean age (SD) = 49.8 (13.9), 86.6% (n = 738) female). Those with photophobia exhibited significantly poorer sleep quality compared to patients without photophobia (p < 0.001). Photophobia scores were associated with SQ (p < 0.001), SDis (p < 0.001), SOL (p = 0.011), SRI (p = 0.020), and insomnia (p = 0.005) after controlling for age, sex, headache frequency, depression, and anxiety, signifying that higher levels of photophobia were associated with worse sleep-related outcomes. Conversely, photophilia scores were associated with better sleep-related outcomes for SQ (p < 0.007), SOL (p = 0.010), and insomnia (p = 0.014).

CONCLUSION

Results suggest that photophobia is a significant predictor of poor sleep quality and sleep disturbances in migraine. These results underscore the necessity for comprehensive and systematic investigations into the intricate interplay between photophobia and sleep to enhance our understanding and develop tailored solutions for individuals with migraine.

Influences of Genetic and Environmental Factors on Chronic Migraine: A Narrative Review

PURPOSE OF REVIEW

In this narrative review, we aim to summarize recent insights into the complex interplay between environmental and genetic factors affecting the etiology, development, and progression of chronic migraine (CM).

RECENT FINDINGS

Environmental factors such as stress, sleep dysfunction, fasting, hormonal changes, weather patterns, dietary compounds, and sensory stimuli are critical triggers that can contribute to the evolution of episodic migraine into CM. These triggers are particularly influential in genetically predisposed individuals. Concurrently, genome-wide association studies (GWAS) have revealed over 100 genetic loci linked to migraine, emphasizing a significant genetic basis for migraine susceptibility. In CM, environmental and genetic factors are of equal importance and contribute to the pathophysiology of the condition. Understanding the bidirectional interactions between these elements is crucial for advancing therapeutic approaches and preventive strategies. This balanced perspective encourages continued research into the complex gene-environment nexus to improve our understanding and management of CM.

Characterizing Cannabis Use and Perceived Benefit in a Tertiary Headache Center Patient Sample

Background and Objectives

Research suggests a potential role for cannabinoids in the etiology and treatment of migraine. However, there is a paucity of research on usage patterns and perceived benefits of cannabis use in clinical headache patient populations.

Methods

Patients from a tertiary headache center completed a 1-time online survey regarding cannabis use patterns and perceived benefits of cannabis-based products in treating migraine symptoms, clinical features, and risk factors (e.g., depression, sleep disturbance). Descriptive analyses were performed.

Results

Data were collected from 1373 patients (response rate 25.4% [1,373/5,400]), with 55.7% reporting cannabis-based product use in the past 3 years and 32.5% indicating current use. The most frequently cited reasons for cannabis-based product use were treating headache (65.8%) and sleep concerns (50.8%). Inhaled products (i.e., smoked/vaped) and edibles were the most commonly reported delivery methods, with THC/CBD (∆9 tetrahydrocannabinol/cannabidiol) blends as the most-cited product composition. A majority of participants reported cannabis-related improvements in migraine headache characteristics (i.e., intensity: 78.1%; duration: 73.4%; frequency: 62.4%), nausea (56.3%), and risk factors (sleep disturbance: 81.2%; anxiety: 71.4%; depression: 57.0%). Over half (58.0%) of the respondents reported only using cannabis products when experiencing a headache, while 42.0% used cannabis most days/daily for prevention. Nearly half (48.9%) of the respondents reported that cannabis use contributed to a reduction in medication amount for headache treatment, and 14.5% reported an elimination of other medications. A minority (20.9%) of participants reported experiencing side effects when using cannabis products for headache, most commonly fatigue/lethargy. For those participants who reported no use of cannabis-based products in the previous 3 years, approximately half indicated not knowing what cannabis product to take or the appropriate dosage.

Discussion

This is the largest study to date to document cannabis product usage patterns and perceived benefits for migraine management in a clinical headache patient sample. A majority of patients surveyed reported using cannabis products for migraine management and cited perceived improvements in migraine characteristics, clinical features, and associated risk factors. The findings warrant experimental trials to confirm the perceived benefits of cannabis products for migraine prevention and treatment.

Models of Trigeminal Activation: Is There an Animal Model of Migraine?

Migraine, recognized as a severe headache disorder, is widely prevalent, significantly impacting the quality of life for those affected. This article aims to provide a comprehensive review of the application of animal model technologies in unraveling the pathomechanism of migraine and developing more effective therapies. It introduces a variety of animal experimental models used in migraine research, emphasizing their versatility and importance in simulating various aspects of the condition. It details the benefits arising from the utilization of these models, emphasizing their role in elucidating pain mechanisms, clarifying trigeminal activation, as well as replicating migraine symptoms and histological changes. In addition, the article consciously acknowledges the inherent limitations and challenges associated with the application of animal experimental models. Recognizing these constraints is a fundamental step toward fine-tuning and optimizing the models for a more accurate reflection of and translatability to the human environment. Overall, a detailed and comprehensive understanding of migraine animal models is crucial for navigating the complexity of the disease. These findings not only provide a deeper insight into the multifaceted nature of migraine but also serve as a foundation for developing effective therapeutic strategies that specifically address the unique challenges arising from migraine pathology.

The glymphatic system in migraine and other headaches

Glymphatic system is an emerging pathway of removing metabolic waste products and toxic solutes from the brain tissue. It is made of a network of perivascular spaces, filled in cerebrospinal and interstitial fluid, encompassing penetrating and pial vessels and communicating with the subarachnoid space. It is separated from vessels by the blood brain barrier and from brain tissue by the endfeet of the astrocytes rich in aquaporin 4, a membrane protein which controls the water flow along the perivascular space. Animal models and magnetic resonance (MR) studies allowed to characterize the glymphatic system function and determine how its impairment could lead to numerous neurological disorders (e.g. Alzheimer's disease, stroke, sleep disturbances, migraine, idiopathic normal pressure hydrocephalus). This review aims to summarize the role of the glymphatic system in the pathophysiology of migraine in order to provide new ways of approaching to this disease and to its therapy.

The crucial role of locus coeruleus noradrenergic neurons in the interaction between acute sleep disturbance and headache

BACKGROUND

Both epidemiological and clinical studies have indicated that headache and sleep disturbances share a complex relationship. Although headache and sleep share common neurophysiological and anatomical foundations, the mechanism underlying their interaction remains poorly understood. The structures of the diencephalon and brainstem, particularly the locus coeruleus (LC), are the primary sites where the sleep and headache pathways intersect. To better understand the intricate nature of the relationship between headache and sleep, our study focused on investigating the role and function of noradrenergic neurons in the LC during acute headache and acute sleep disturbance.

METHOD

To explore the relationship between acute headache and acute sleep disturbance, we primarily employed nitroglycerin (NTG)-induced migraine-like headache and acute sleep deprivation (ASD) models. Initially, we conducted experiments to confirm that ASD enhances headache and that acute headache can lead to acute sleep disturbance. Subsequently, we examined the separate roles of the LC in sleep and headache. We observed the effects of drug-induced activation and inhibition and chemogenetic manipulation of LC noradrenergic neurons on ASD-induced headache facilitation and acute headache-related sleep disturbance. This approach enabled us to demonstrate the bidirectional function of LC noradrenergic neurons.

RESULTS

Our findings indicate that ASD facilitated the development of NTG-induced migraine-like headache, while acute headache affected sleep quality. Furthermore, activating the LC reduced the headache threshold and increased sleep latency, whereas inhibiting the LC had the opposite effect. Additional investigations demonstrated that activating LC noradrenergic neurons further intensified pain facilitation from ASD, while inhibiting these neurons reduced this pain facilitation. Moreover, activating LC noradrenergic neurons exacerbated the impact of acute headache on sleep quality, while inhibiting them alleviated this influence.

CONCLUSION

The LC serves as a significant anatomical and functional region in the interaction between acute sleep disturbance and acute headache. The involvement of LC noradrenergic neurons is pivotal in facilitating headache triggered by ASD and influencing the effects of headache on sleep quality.

Mediterranean diet adherence and sleep pattern: a systematic review of observational studies

BACKGROUND AND AIMS

Despite a huge body of evidence on the linkage between dietary intakes and pattern of sleeping, the findings are controversial. The current study aimed to summarize earlier findings on the association between adherence to Mediterranean diet (MD) and pattern of sleeping.

METHODS

This study performed based on PRISMA guideline. Systematically search was applied in PubMed, Scopus and Google Scholar to find out relevant publications appeared up to February 2023. No restrictions on language and time of publication were applied. Duplicate citations were removed. We included observational studies which assessed MD as the main exposure and kind of sleep disorders as the main outcome.

RESULTS

A total of 20 observational studies included. Out of these studies, two were cohort studies and 18 had a cross-sectional design. A total of 21,714 participants included. Usual dietary intakes were assessed using a validated Food Frequency Questionnaire, and a diet history questionnaire. Some studies did not report methods of measuring habitual dietary intakes. Adherence to MD was evaluated by KIDMED questionnaire, PREMED, alternate Mediterranean (aMed) questionnaire, MEDAS questionnaire, MedDietScore, MEDI-LITE score, modified Mediterranean Diet Score (mMDS), Mediterranean food pattern (MFP) and modified Mediterranean diet score (mMED). Pattern of sleeping was examined as sleep quality, sleep duration, sleep latency, sleep efficacy, sleepiness, sleep disturbance, taking a nap and some other sleep disorders.

CONCLUSION

In conclusion, findings of published studies highlighted the importance of consumption of MD for better sleep quality.

Relationship between shift work, night work, and headache and migraine risk: A meta-analysis of observational studies

BACKGROUND

To date, there is insufficient research on whether shift work and night work increase the risk of experiencing headaches and migraines.

OBJECTIVES

This study aimed to evaluate the potential association between shift work, night shift work, and headache/migraine.

METHODS

We conducted a thorough search of the PubMed, Embase, and Web of Science databases up until October 2023 to identify relevant studies. Our inclusion criteria focused on observational studies that investigated the association between shift work exposure and headache/migraine outcomes. We extracted adjusted risk estimates from each study and calculated pooled odds ratios using either fixed or random-effects models. Our methodology followed the Meta-Analysis Group guidelines for observational studies in epidemiology. To ensure accuracy and consistency, two investigators independently reviewed the retrieved records and extracted data based on the predefined inclusion criteria.

RESULTS

This meta-analysis included a total of seven studies involving 422,869 participants. The pooled analysis revealed a significant association between shift work and an increased risk of headaches (HR = 1.32, 95% CI: 1.15-1.52, P < 0.001). Specifically, individuals working night shifts had a 44% higher risk of developing headaches (HR = 1.44, 95% CI: 1.09-1.90, P = 0.011). Furthermore, shift work was also found to be associated with a higher incidence of migraines (HR = 1.63, 95% CI: 1.27-2.08, P < 0.001). Interestingly, night shift work was associated with a decreased incidence of migraines (HR = 0.74, 95% CI: 0.57-0.96, P = 0.024).

CONCLUSION

Our study found a noteworthy association between shift work/night work and the occurrence of headaches and migraines. However, it is important to note that our study does not establish a causal relationship. Future research should investigate potential common vulnerability factors, such as genetics or health behaviors. This knowledge can help inform the implementation of preventive measures and interventions to mitigate the health risks associated with shift work.

Sleep Spindle Alterations in Children With Migraine

BACKGROUND

The modulation of thalamocortical activity is the most important site of several levels of interference between sleep spindles and migraine. Thalamocortical circuits are responsible for the electrophysiological phenomenon of sleep spindles. Spindle alterations may be used as a beneficial marker in the diagnosis and follow-up of children with migraine. We aimed to formulate the hypothesis that there is a shared mechanism that underlies migraine and sleep spindle activity.

METHODS

We analyzed the amplitude, frequency, duration, density, and activity of sleep spindles in non-rapid eye movement stage 2 sleep in patients with migraine without aura when compared with healthy control subjects.

RESULTS

The amplitudes of average, slow, and fast sleep spindles were higher in children with migraine without aura (P = 0.020, 0.013, and 0.033, respectively). The frequency of fast spindles was lower in children with migraines without aura when compared with the control group (P = 0.03). Although not statistically significant, the fast sleep spindle duration in the migraine group was shorter (P = 0.055). Multivariate analysis revealed an increased risk of migraine associated with increased mean spindle amplitude and decreased fast spindle frequency and duration.

CONCLUSIONS

Our data suggest that spindle alterations may correlate with the vulnerability to develop migraine and may be used as a model for future research about the association between the thalamocortical networks and migraine.

Association Between Electronic Diary-Rated Sleep, Mood, Energy, and Stress With Incident Headache in a Community-Based Sample

BACKGROUND AND OBJECTIVES

The aim of this study was to examine the diurnal links between average and changes in average levels of prospectively rated mood, sleep, energy, and stress as predictors of incident headache in a community-based sample.

METHODS

This observational study included structured clinical diagnostic assessment of both headache syndromes and mental disorders and electronic diaries that were administered 4 times per day for 2 weeks yielding a total of 4,974 assessments. The chief outcomes were incident morning (am) and later-day (pm) headaches. Generalized linear mixed-effects models were used to evaluate the average and lagged values of predictors including subjectively rated mood, anxiety, energy, stress, and sleep quality and objectively measured sleep duration and efficiency on incident am and pm headaches.

RESULTS

The sample included 477 participants (61% female), aged 7 through 84 years. After adjusting for demographic and clinical covariates and emotional states, incident am headache was associated with lower average (ß = -0.206*; confidence intervals: -0.397 to -0.017) and a decrease in average sleep quality on the prior day (ß = -0.172*; confidence interval: -0.305, -0.039). Average stress and changes in subjective energy levels on the prior day were associated with incident headaches but with different valence for am (decrease) (ß = -0.145* confidence interval: -0.286, -0.005) and pm (increase) (ß = 0.157*; confidence interval: 0.032, 0.281) headache. Mood and anxiety disorders were not significantly associated with incident headache after controlling for history of a diagnosis of migraine.

DISCUSSION

Both persistent and acute changes in arousal states manifest by subjective sleep quality and energy are salient precursors of incident headaches. Whereas poorer sleep quality and decreased energy on the prior day were associated with incident morning headache, an increase in energy and greater average stress were associated with headache onsets later in the day. Different patterns of predictors of morning and later-day incident headache highlight the role of circadian rhythms in the manifestations of headache. These findings may provide insight into the pathophysiologic processes underlying migraine and inform clinical intervention and prevention. Tracking these systems in real time with mobile technology provides a valuable ancillary tool to traditional clinical assessments.

Mendelian Randomization Applied to Neurology: Promises and Challenges

The Mendelian randomization (MR) paradigm allows for causal inferences to be drawn using genetic data. In recent years, the expansion of well-powered publicly available genetic association data related to phenotypes such as brain tissue gene expression, brain imaging, and neurologic diseases offers exciting opportunities for the application of MR in the field of neurology. In this review, we discuss the basic principles of MR, its myriad applications to research in neurology, and potential pitfalls of injudicious applications. Throughout, we provide examples where MR-informed findings have shed light on long-standing epidemiologic controversies, provided insights into the pathophysiology of neurologic conditions, prioritized drug targets, and informed drug repurposing opportunities. With the ever-expanding availability of genome-wide association data, we project MR to become a key driver of progress in the field of neurology. It is therefore paramount that academics and clinicians within the field are familiar with the approach.

Associations between the burdens of comorbid sleep problems, central sensitization, and headache-related disability in patients with migraine

Objective

Sleep disturbances are common in migraine patients and affect quality of life. Central sensitization (CS) is likely to play a role in the increased severity and chronicity of migraine. We hypothesized that the number of comorbid sleep problems would affect headache-related disability through the effects of central sensitization (CS).

Methods

We performed a cross-sectional study including 215 consecutive patients with migraine. Insomnia was defined as a Pittsburgh Sleep Quality Index (PSQI) global score greater than 5. Probable REM sleep behavior disorder (pRBD) was defined as an RBD screening score of 5 or greater. Excessive daytime sleepiness (EDS) was defined as an Epworth Sleepiness Scale score of 10 or higher. Suspected sleep apnea (SA) was defined as patients with snoring or sleep apnea witnessed 3 or more nights a week. CS was assessed by the Central Sensitization Inventory (CSI).

Results

Restless legs syndrome, insomnia, EDS, SA and pRBD were observed in 25.6%, 71.6%, 34.4%, 10.2%, and 21.4%, respectively, of the patients. At least one sleep problem was present in 87.0% of the patients. According to the results of the multinomial logistic regression analysis with no sleep problems as a reference, after we corrected for adjustment factors, the Migraine Disability Assessment (MIDAS) score significantly increased when three or more comorbid sleep problems were present. According to our mediation analysis, an increased number of sleep problems had a direct effect on the MIDAS score after we adjusted for other variables, and the CSI score was indirectly involved in this association.

Conclusion

The present study showed an association between migraine-related disability and the burden of multiple sleep problems, which was partially mediated by CS.

Insomnia and Migraine: A Missed Call?

Migraine is one of the most prevalent and disabling neurological conditions, presenting episodes of throbbing headache that limit activities of daily living. Several factors may influence migraine frequency, such as lifestyle or alcohol consumption. Among the most recognised ones, sleep plays a biunivocal role, since poor sleep quality may worsen migraine frequency, and a high migraine frequency may affect sleep quality. In this paper, the authors evaluate the relationship between migraine and insomnia by exploring a cohort of patients affected by episodic or chronic migraine. To do so, a phone interview was performed, asking patients about their migraine frequency and mean pain intensity, in addition to the questions of the Insomnia Severity Index. The last one explores several symptoms impairing sleep that focus on insomnia. Patients complaining of insomnia showed an increased migraine frequency, and a weak but significant correlation was found between headache days per month and insomnia scores. Such results were particularly evident in patients affected by chronic migraine. Such results suggest how insomnia, in the presented data, seems to be associated with migraine frequency but not with pain intensity.

Prevalence of headaches and their relationship with obstructive sleep apnea (OSA) - Systematic review and meta-analysis

Obstructive sleep apnea (OSA) is one of the most common sleep disorders; however, there are inconsistent results about the connection and occurrence of primary and secondary headaches in OSA. Therefore, the primary objectives were to estimate the prevalence and potential relationship between all types of headaches and OSA. A systematic review was conducted according to PRISMA 2020 guidelines. Studies were searched in PubMed, Embase, and Web of science up to July 2023. The Joanna Briggs Institute tool assessed the risk of bias. 1845 articles were identified, and 23 studies describing 15,402 patients were included. Pooled prevalence of all headaches in OSA was 33% (95% CI: 0.25-0.41), 33% for morning headaches (95% CI: 0.24-0.45), 25% for sleep apnea headaches (95% CI: 0.18-0.34), 19% for tension-type headache (95% CI: 0.15-0.23), and 16% for migraine (95% CI: 0.09-0.26). Relative risk for the occurrence of headache in OSA patients compared to the non-OSA people was 1.43 (95% CI: 0.92-2.25). OSA females and males had morning headaches with similar frequency. The prevalence of headaches in OSA was moderate. OSA did not increase the risk of headache. There is a need to conduct further studies focused on bidirectional connections between sleep disorders and headaches.

Structural and functional changes of anterior cingulate cortex subregions in migraine without aura: relationships with pain sensation and pain emotion

Migraine without aura is a multidimensional neurological disorder characterized by sensory, emotional, and cognitive symptoms linked to structural and functional abnormalities in the anterior cingulate cortex. Anterior cingulate cortex subregions play differential roles in the clinical symptoms of migraine without aura; however, the specific patterns and mechanisms remain unclear. In this study, voxel-based morphometry and seed-based functional connectivity were used to investigate structural and functional alterations in the anterior cingulate cortex subdivisions in 50 patients with migraine without aura and 50 matched healthy controls. Compared with healthy controls, patients exhibited (1) decreased gray matter volume in the subgenual anterior cingulate cortex, (2) increased functional connectivity between the bilateral subgenual anterior cingulate cortex and right middle frontal gyrus, and between the posterior part of anterior cingulate cortex and right middle frontal gyrus, orbital part, and (3) decreased functional connectivity between the anterior cingulate cortex and left anterior cingulate and paracingulate gyri. Notably, left subgenual anterior cingulate cortex was correlated with the duration of each attack, whereas the right subgenual anterior cingulate cortex was associated with migraine-specific quality-of-life questionnaire (emotion) and self-rating anxiety scale scores. Our findings provide new evidence supporting the hypothesis of abnormal anterior cingulate cortex subcircuitry, revealing structural and functional abnormalities in its subregions and emphasizing the potential involvement of the left subgenual anterior cingulate cortex-related pain sensation subcircuit and right subgenual anterior cingulate cortex -related pain emotion subcircuit in migraine.

The long-term effect of work schedule, shift work disorder, insomnia and restless legs syndrome on headache among nurses: A prospective longitudinal cohort study

BACKGROUND

The preset study aimed to explore whether work schedules and sleep disorders predict the onset of headache.

METHODS

A longitudinal study was conducted with questionnaire data from 2014 (baseline) and 2017 (follow-up) on work schedule, number of night shifts, number of quick returns, insomnia, shift work disorder (SWD), restless legs syndrome (RLS) and validated headache diagnoses among 1560 Norwegian nurses. Associations were explored by multivariate regression analyses.

RESULTS

Work related factors at baseline did not predict onset of headache three years later. In the adjusted logistic regressions, insomnia at baseline predicted increased risk of new onset of migraine (odds ratio (OR) = 1.58; 95% confidence interval (CI) = 1.08-2.33), chronic headache (OR = 2.02; 95% CI = 1.04-4.66) and medication-overuse headache (OR = 3.79; 95% CI = 1.26-11.42) at follow-up. SWD at baseline predicted new onset of migraine (OR = 1.64; 95% CI = 1.07-2.50) and RLS at baseline predicted new onset of headache ≥1 day per month (OR = 1.55; 95% CI = 1.01-2.36) and migraine (OR = 1.55; 95% CI = 1.03-2.32) at follow-up. No factors predicted tension-type headache.

CONCLUSIONS

Overall, work related factors did not predict the onset of headache three years later, whereas insomnia, SWD and RLS at baseline all increased the risk of future headaches.

Mechanisms for the biological activity of Gastrodia elata Blume and its constituents: A comprehensive review on sedative-hypnotic, and antidepressant properties

BACKGROUND

Insomnia and depressive disorder are two common symptoms with a reciprocal causal relationship in clinical practice, which are usually manifested in comorbid form. Several medications have been widely used in the treatment of insomnia and depression, but most of these drugs show non-negligible side effects. Currently, many treatments are indicated for insomnia and depressive symptom, including Chinese herbal medicine such as Gastrodia elata Blume (G. elata), which has excellent sedative-hypnotic and antidepressant effects in clinical and animal studies.

PURPOSE

To summarize the mechanisms of insomnia and depression and the structure-activity mechanism for G. elata to alleviate these symptoms, particularly by hypothalamic-pituitary-adrenal (HPA) axis and intestinal flora, aiming to discover new approaches for the treatment of insomnia and depression.

METHODS

The following electronic databases were searched from the beginning to November 2023: PubMed, Web of Science, Google Scholar, Wanfang Database, and CNKI. The following keywords of G. elata were used truncated with other relevant topic terms, such as depression, insomnia, antidepressant, sedative-hypnotic, neuroprotection, application, safety, and toxicity.

RESULTS

Natural compounds derived from G. elata could alleviate insomnia and depressive disorder, which is involved in monoamine neurotransmitters, inflammatory response, oxidative stress, and gut microbes, etc. Several clinical trials showed that G. elata-derived natural compounds that treat depression and insomnia have significant and safe therapeutic effects, but further well-designed clinical and toxicological studies are needed.

CONCLUSION

G. elata exerts a critical role in treating depression and insomnia due to its multi-targeting properties and fewer side effects. However, more clinical and toxicological studies should be performed to further explore the sedative-hypnotic and antidepressant mechanisms of G. elata and provide more evidence and recommendations for its clinical application. Our review provides an overview of G. elata treating insomnia with depression for future research direction.

Relationship between sleep problems and headaches among adolescents: Pelotas 2004 Birth cohort

Objective

To investigate the cross-sectional association between sleep problems (the exposure) and headaches (the outcome) among 15-year-olds from the Pelotas 2004 Birth Cohort, a population-based study in the south of Brazil.

Method

The occurrence of headaches was obtained through the question: "Do you usually suffer headaches?" and the ICHD-3 criteria were used to classify as: tension-type headache, headache with characteristics of migraine with or without aura, or other. Regarding sleep, the weekly frequency in the last month of insomnia and bad dreams/nightmares, and self-reported sleep quality were investigated. Unadjusted and adjusted prevalence ratios (PR) with 95% confidence intervals were calculated using Poisson regression with robust variance.

Results

A total of 1916 adolescents were analyzed. The prevalence of headaches was 51.6% (69.0% in females and 34.8% in males): 31.8% (39.7% vs. 24.1%) reported tension-type headache; 14.7% (21.9% vs. 7.8%), headaches with characteristics of migraines without aura; 3.6%, headaches with characteristics of migraines with aura; and 1.5% (5.1% vs. 2.3%), other types. Adolescents with insomnia ≥3 times/week presented higher probability of headaches (PR = 1.54; 95%CI 1.23-1.93), compared with those with no problems falling asleep or maintaining sleep. Among those who classified their sleep as poor/very poor, the probability of headaches was 33% higher (PR = 1.33; 95%CI 1.13-1.57) than among those who classified their sleep as very good.

Conclusions

Headaches were highly prevalent among the adolescents and were related to sleep problems even after allowing for several confounders.

Effects of a Single Session of OnabotulinumtoxinA Therapy on Sleep Quality and Psychological Measures: Preliminary Findings in a Population of Chronic Migraineurs

Chronic migraine is a burdensome condition, and onabotulinumtoxinA is revealed to be an effective therapy. Migraine shows a bidirectional relationship with sleep, but the effects of preventive therapies on sleep quality are poorly studied. This study aims to evaluate the effects of a single session of onabotulinumtoxinA on patients' sleep quality and correlates the results with measures of comorbid anxiety/depression. Patients completed self-administrable questionnaires about sleep quality (Pittsburgh Sleep Quality Index-PSQI) and psychological symptoms (Beck Depression Inventory, 2nd edition-BDI-II-and Hospital Anxiety and Depression Scale-HADS-subscales "a" and "d" for anxiety and depression, respectively), and reported migraine frequency at baseline and after 12 weeks. The 42 included patients showed a significant reduction in migraine days (from 20.6 ± 6.0 to 13.6 ± 6.2, p < 0.001), while no changes were observed in sleep quality (PSQI score from 11.0 ± 5.0 to 9.8 ± 4.6, p = 0.277) or psychological measures (BDI-II from 16.7 ± 10.2 to 15.7 ± 10.3, p = 0.678; HADS-a from 10.3 ± 4.8 to 9.3 ± 5.5, p = 0.492; and HADS-d from 7.2 ± 3.9 to 7.1 ± 5.0, p = 0.901). On the other hand, a strong correlation among PSQI, BDI-II, HADS-a, and HADS-d scores (p < 0.001, rho > 0.7) was found. Despite its efficacy in migraine prevention, a single session of onabotulinumtoxinA was not able to affect patients' sleep quality or their psychological symptoms.