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Abstract
BackgroundBecause the prevalence and characteristics of primary headache have yet to be thoroughly studied in patients with hypersomnia disorders, including narcolepsy and idiopathic hypersomnia, we examined these parameters in the Japanese population.MethodsIn a multicentre cross-sectional survey, among 576 consecutive outpatients with sleep disorders, 68 narcolepsy patients and 35 idiopathic hypersomnia patients were included. Additionally, 61 healthy control subjects participated. Semi-structured headache questionnaires were administered to all participants.ResultsThe patients with narcolepsy (52.9%) and idiopathic hypersomnia (77.1%) more frequently experienced headache than the healthy controls (24.6%; p<0.0001). The prevalence rates were 23.5%, 41.2% and 4.9% for migraine (p<0.0001) and 16.2%, 23.5% and 14.8% (p = 0.58) for tension-type headache among the narcolepsy patients, the idiopathic hypersomnia patients and the control subjects, respectively. Those who experienced migraine more frequently experienced excessive daytime sleepiness, defined as an Epworth Sleepiness Scale score of ≥10, than those who did not experience headache among the patients with narcolepsy (93.8% vs. 65.6%, p = 0.040) and idiopathic hypersomnia (86.7% vs. 37.5%, p = 0.026). Dream-enacting behaviour (DEB), as evaluated by the rapid eye movement sleep disorders questionnaire, was more frequently observed in the narcolepsy patients than in the idiopathic hypersomnia patients and the control subjects. An increased DEB frequency was observed in the narcolepsy patients with migraines compared to those without headache.ConclusionsMigraines were frequently observed in patients with narcolepsy and idiopathic hypersomnia. DEB is a characteristic of narcolepsy patients. Further studies are required to assess the factors that contribute to migraines in narcolepsy and idiopathic hypersomnia patients.
Highlights
The close relationship between sleep and headache has been recognised for over a century [1]
The prevalence rates were 23.5%, 41.2% and 4.9% for migraine (p
dream-enacting behaviour (DEB) is a characteristic of narcolepsy patients
Summary
The close relationship between sleep and headache has been recognised for over a century [1]. An increased prevalence of headache disorders has been reported for patients with sleep disorders such as sleep apnoea syndrome and restless legs syndrome [3,4]. We found that dream-enacting behaviour (DEB) was frequently observed in migraine patients compared to healthy controls and that DEB was associated with impaired sleep and severe headache-related disability in migraine patients [6]. These observations suggest that the brainstem, which is responsible for the regulation of both rapid eye movement sleep and pain processing, may be involved in migraine. Because the prevalence and characteristics of primary headache have yet to be thoroughly studied in patients with hypersomnia disorders, including narcolepsy and idiopathic hypersomnia, we examined these parameters in the Japanese population
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