Breathing Sleep Disturbances and Migraine: A Dangerous Synergy or a Favorable Antagonism?

Abstract

Sleep and headache are two realities known to be linked in a bidirectional way [01]. Clinical research correlates specific headache diagnoses and sleep disorders with chronobiologic patterns and sleep processes, implicating that common anatomic structures and neurochemical processes are involved in the regulation of both sleep and headache. Sleep and pain perception share several structures, such as the thalamus, the hypothalamus, and a number of mesencephalic, pontine and bulbar nuclei, some of which are also involved in breathing regulation. The respiratory parameters during sleep at night may play a important role in modifying susceptibility to various pathological conditions, including headache. Morning headache was found to be more frequent among Obstructive Sleep Apnea Syndrome (OSAS) patients with a direct relationship with the severity of the sleep breathing disorder: apnoea hypopnoea index (AHI) has been found higher in OSAS patients with morning headache compared with those without morning headaches and also mean oxygen saturation value (SpO2) during total sleep time has been found significantly lower in OSAS patients with morning headache [02]. Furthermore, it has been observed that morning headache may be largely resolved with nasal continuous positive airway pressure. The relevance of respiratory disturbances during sleep in subjects with primary headaches has not been clearly evaluated. Additionally, in a previous study we found that subjects with headache, and particularly those with headache-related cutaneous allodynia, had alterations in sleep behaviour [03]. Consequently, a possible link between sleep behavior disturbances, respiratory disorders during sleep and primary headaches may be hypothesized.