Sleeping behavior and migraine. An evaluation by daily self-reports

Abstract

Regarding the coherence of sleeping behavior and the occurrence of migraine attacks, we conducted a study based on migraine and sleeping diaries. Besides the daily recording of times of falling asleep and waking up, duration of sleep, sleep disruption and quality of sleep, clinical migraine parameters like occurrence of migraine attacks, headache intensity and duration and the daily mood rating were registered over periods of at least 6 weeks. In the analyses, we defined two classes of events: (1) nights not followed by a migraine attack; (2) nights followed by migraine. We examined a retrospective sample (23 patients with altogether 580 attacks) and a prospective sample (16 patients with altogether 96 attacks). In both samples, we found that the duration of sleep was significantly reduced in nights followed by migraine (6.8 vs. 8.1 h and 6.4 vs. 7.2 h respectively) due to earlier awakening, with unchanged time of falling asleep. Up to two thirds of the observed migraine attacks were reported to be present directly after awakening. Quality of sleep was markedly reduced in nights followed by a migraine attack (i.e. sleep disruptions, feeling exhausted/no feeling of restedness when wakening up). We found only weak and insignificant correlations between the foregoing daily mood rating and the quantitative parameters of sleeping behavior on nights followed by migraine; somewhat more pronounced correlations were observable between the mood rating and the qualitative sleep parameters. Overall, we conclude that the observed changes in sleeping behavior are largely part of the migraine attack, with the possibility that REM sleep functions as a migraine trigger. In clinical application, we strongly recommend the use of daily self-observations of patients' sleep-related behaviors in the migraine diary, identifying migraine-prone sleeping habits and evaluating their potency for triggering migraine attacks.