Blau22 Blau JN. Migraine pathogenesis: the neural hypothesis reexamined. J Neurol Neurosurg Psychiatry. 1984;47(5):437-42.
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Analyze the hypothesis that migraine is a primary neurological disorder with secondary vascular manifestations. |
Sleep, besides being a trigger for migraine, may also be a way to resolve crisis. In addition, sleepiness is considered a symptom of migraine. |
It’s proposed that specific sensory areas of the cortex and hypothalamus may act as areas where a migraine attack is initiated. |
Sahota and Dexter66 Sahota RK, Dexter JD. Sleep and headache syndromes: a clinical review. Headache. 1990;30(2):80-4.
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Assess the association between sleep and headaches. |
Migraine seems to be associated with an increase in REM sleep and stages III and IV of non-REM sleep. This association is related to sleep quality rather than the circadian rhythm. A period of sleep may resolve the crisis. |
Given the close anatomical and neurochemical associations between headache and sleep, it’s feasible to consider the existence of a common substrate for these two phenomena. |
Inamorato, Minattihanntjch and Zukerman4242 Inamorato E, Minatti-Hanntjch SN, Zukerman E. The role of sleep in migraine attacks. Arq Neuropsiquiatr. 1993;51(4):429-32.
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Clarify the relationship between migraine and sleep. |
Patients report that sleep can affect them in one or several ways. When only one way was reported, relief was the most frequent. For those who report multiple ways of interaction, migraine attacks may be triggered by sleep deprivation or sleep excess. |
Patients identify that sleep affects them in a single or multiple ways, this suggests that there are multiple pathophysiological mechanisms contributing to the crisis. |
Kelman and Rains4343 Kelman L, Rains JC. Headache and sleep: examination of sleep patterns and complaints in a large clinical sample of migraineurs. Headache. 2005;45(7):904-10.
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Examine sleep complaints in relation to headache frequency and severity. |
Headache is triggered by sleep deprivation or excessive sleep. Sleep can also be a relieving factor. Migraineurs with few hours of sleep (<6h) have more frequent and intense headaches than migraineurs with more hours of sleep and are more likely to have morning episodes. |
The group that doesn’t get enough sleep exhibits a more severe and frequent pain pattern. Sleep complaints occur more frequently among patients with chronic headache. |
Calhoun and Ford 1313 Calhoun AH, Ford S. Behavioral sleep modification may revert transformed migraine to episodic migraine. Headache. 2007;47(8):1178-83.
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Evaluate the impact of BSM on chronic migraine in women. |
The group undergoing BSM report a reduction in headache frequency and intensity. Those who sleep less are more likely to transform migraine chronic to episodic |
Behavioral sleep intervention was associated with improvement in headache frequency and intensity, as well as making attacks sporadic. |
Gallup and Gallup4444 Gallup AC, Gallup GG JR. Yawning and thermoregulation. Physiol Behav. 2008;95(1):10-6.
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Evaluate the physiological substrate of yawning on thermoregulation. |
In rats, prolonged sleep deprivation has been shown to increase brain temperature, which causes yawning. |
Migraine has been associated with thermoregulatory dysfunction and atypical yawning. This mechanism could explain the relationship between sleep deprivation and the onset of a migraine attack. |
Rains77 Rains JC. Optimizing circadian cycles and behavioral insomnia treatment in migraine. Curr Pain Headache Rep. 2008;12(3):213-9.
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Discuss the nature and prevalence of sleep complaints in patients with migraine. |
In most cases, insomnia preceded migraine. Chronic insomnia is significantly related to headache. Sleep dysregulation can cause or reduce headache thresholds. |
Insomnia is the most common sleep disorder in patients with headache. Recent evidence suggests that migraine can be relieved with better sleep regulation, either by drug or behavioral therapy. |
Yeung, Chung and Won 4545 Yeung WF, Chung KF, Won CY. Relationship between insomnia and headache in community-based middle-aged Hong Kong Chinese women. J Headache Pain. 2010;11(3):187-95.
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Assess the frequency of headache, sleep difficulties, mood disturbances, and functional impairment in women through a self-administered questionnaire. |
Women with headache are significantly more likely to report symptoms of insomnia than those without headache. The prevalence of these symptoms is uniform among women with unspecified headache, TTH, and migraine. |
The association between insomnia and headache is more evident as the number of headache episodes increases. Middle-aged women with symptoms of anxiety, depression, and sleep disturbances are at increased risk for headache. |
Lovati et al.1515 Lovati C, D’Amico D, Raimondi E, Mariani C, Bertora P. Sleep and headache: a bidirectional relationship. Expert Review of Neurotherapeutics. 2010;10(1):105-17.
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Review the anatomy and physiology of sleep disorders associated with perceived headache. |
Sleep quality is related to the presence of allodynia associated with migraine. |
Sleep disorders may favor central sensitization of the trigeminal nucleus causing allodynia, which in turn may undermine sleep. |
Lateef et al.1616 Lateef T, Swanson S, Cui L, Nelson K, Nakamura E, Merikangas K. Headaches and sleep problems among adults in the United States: Findings from the National Comorbidity Survey–Replication Study. Cephalalgia. 2010;31(6):648-53.
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Assess whether migraine differs from non-migraine headache in terms of insomnia and the severity of sleep disturbances. |
Adults with headache report greater difficulty in: initiating sleep, staying asleep, and waking up early in the morning. In addition, they have more fatigue during the day. |
Adults with headache have a greater risk of developing sleep disturbance regardless of the type of headache. |
Houle et al.4646 Houle TT, Butschek RA, Turner DP, Smitherman TA, Rains JC. Stress and sleep duration predict headache severity in chronic headache sufferers. Pain. 2012;153(12):2432-40.
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Evaluate the relationships between stress, sleep duration, and headache in patients with chronic headaches (migraine or TTH). |
Two consecutive days of high stress or not enough sleep were strongly predictive of headache, whereas two days of low stress or adequate sleep were protective. |
Headache risk increases proportionally with high stress and low sleep: these are strongly correlated and impact one another. |
Tran and Spierings88 Tran D P, Spierings EL. Headache and insomnia: their relation reviewed. Cranio. 2013;31(3):165-70.
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Summarize the current scientific literature concerning the nature of the headache-insomnia relationship. |
Headache is more associated with insomnia than vice versa. The association between insomnia and headache is more common in severe insomnia. |
Insomnia is a risk factor for headache. Patients with TTH and migraine should be routinely evaluated for insomnia. |
Engstrom et al.4747 Engstrom M, Hagen K, Bjork M, Gravdahl GB, Sand T. Sleep-related and non-sleep-related migraine: interictal sleep quality, arousals and pain thresholds. J Headache Pain. 2013;14(1):68.
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Compare subjective and objective sleep quality through diaries and PSG with headache in migraine. |
PSG of patients with migraine, in the inter-crisis period, shows signs of sleep deprivation although there are no objective differences in the amount of sleep. |
Migraine patients show relative sleep deprivation and need more hours of sleep than controls. |
Engstrom et al.4848 Engstrom M, Hagen K, Bjork MH, Stovner LJ, Gravdahl GB, Stjern M. Sleep quality, arousal and pain thresholds in migraineurs: a blinded controlled polysomnographic study. J Headache Pain. 2013;14(1):12.
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Compare subjective and objective sleep quality through diaries and PSG in patients with SM and NSM. |
SM patients present migraineurs crisis during sleep or upon awakening; whereas NSM patients present crisis throughout the day. Only NSM patients show evidence of sleep deprivation in PSG. |
Signs of sleep deprivation characteristic of migraine patients in the inter-crisis period are evident only for patients whose crises occur randomly during the day. |
Engstrom et al.4949 Engstrom M, Hagen K, Bjork MH, Stovner LJ, Sand T. Sleep quality and arousal in migraine and tension-type headache: the headache-sleep study. Acta Neurol Scand. 2014;129(198):47-54.
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Compare subjective and objective sleep quality through diaries and PSG in SM, NSM and TTH patients. |
Although the number of hours of sleep is adequate, the TTH and NSM groups have PSG with evidence of sleep deprivation. |
NSM and TTH patients show greater similarity to each other as they require more hours of sleep than SM and controls. SM patients show more sleep disturbances than controls. |
Walters, Hamer and Smitherman5050 Walters AB, Hamer JD, Smitherman TA. Sleep disturbance and affective comorbidity among episodic migraineurs. Headache. 2014;54(1):116-24.
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Quantify the relationships between sleep disturbances and headache-related variables in patients with episodic migraine. |
Patients with episodic migraine report poorer sleep quality. |
Poor sleep quality is associated with episodes of migraine and this relationship cannot be attributed exclusively to comorbidities such as depression and anxiety. |
Stark and Stark99 Stark CD, Stark RJ. Sleep and chronic daily headache. Curr Pain Headache Rep. 2015;19(1):468.
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Evaluate the relationship between chronic headache and sleep disorders, especially OSA. |
In addition to OSA, migraine may also be related to parasomnias, restless legs syndrome, daytime sleepiness, poor sleep quality, and insomnia. |
There is a clear association between OSA and snoring with morning headache. OSA and chronic migraine share obesity and patent foramen ovale as possible comorbidities. |
Borkum5151 Borkum JM. Migraine triggers and oxidative stress: a narrative review and synthesis. Headache. 2016;56(1):12-35
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Present the available literature on the capacity of migraine triggers to generate oxidative stress in the brain. |
The TRPA1 receptor, present in C-type fibers, can be activated by oxidative stress, promoting CGRP release and triggering neurogenic inflammation.
Except for pericranial pain, the other common triggers of migraine, including sleep deprivation, are capable of generating oxidative stress.
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Sleep deprivation is associated with depletion of reduced glutathione in the brain, so it’s capable of generating oxidative stress, triggering neurogenic inflammation and headache. |
Woldeamanuel and Cowan 5252 Woldeamanuel YW, Cowan RP. The impact of regular lifestyle behavior in migraine: a prevalence case–referent study. J Neurol. 2016;263(4):669-76.
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Evaluate the occurrence of episodic and chronic migraine in patients who maintain and those who do not maintain a regular lifestyle. |
Patients with chronic migraine had a less regular lifestyle than patients with episodic migraine. |
A regular lifestyle characterized by exercise, standardized meal times, adequate hours of sleep, and hydration status prevent chronic migraine. |
Kim et al.5353 Kim J, Cho SJ, Kim WJ, Yang KI, Yun CH, Chu MK. Insufficient sleep is prevalent among migraineurs: a population-based study. J Headache Pain. 2017;18(1):50.
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Evaluate the occurrence of insufficient sleep in three groups of subjects: without pain, with non-migraine pain, and with migraine. |
Insufficient sleep is most frequent in the respective order: migraineurs, patients with non-migraine pain, and lastly, patients without pain. |
The average sleep time reported was equal in all three groups, so it’s assumed that migraineurs need more hours of sleep to feel rested. |
Rosenberg, Butler and Seng1414 Rosenberg L, Butler N, Seng EK. Health behaviors in episodic migraine: why behavior change matters. Curr Pain Headache Rep. 2018;22(10):65.
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Analyze lifestyle habits in people with episodic migraine. |
Recent studies suggest that individuals with episodic migraine have poor quality sleep that influences the frequency and severity of pain. |
Episodic migraine appears to be more associated with sleep quality than with sleep duration. |
Song et al.5454 Song TJ, Yun CH, Cho SJ, Kim WJ, Yang KI, Chu MK. Short sleep duration and poor sleep quality among migraineurs: A population-based study. Cephalalgia. 2018;38(5): 855-64.
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Correlate the frequency and intensity of migraine episodes with the duration and quality of sleep. |
Headache intensity is similar in migraineurs who sleep < 6 h or > 6 h. However, in migraineurs who sleep < 6 h, there is a higher frequency of episodes. |
Short self-reported sleep duration (< 6 h) is associated with an increase in headache frequency. |
Bertisch et al.5555 Bertisch SM, Li W, Buettner C, Mostofsky E, Rueschman M, Kaplan ER et al. Nightly sleep duration, fragmentation, and quality and daily risk of migraine. Neurology. 2020;94(5):489-96.
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Temporally correlate sleep quality with migraine attacks. |
Low sleep efficiency is related to a higher risk of headache on the second day after the evaluated night. |
Low sleep efficiency appears to increase the risk of migraine onset from 48 hours following the period of compromised |
Navarro-Pérez et al.5656 Navarro-Pérez M P, Suller-Marti A, Bellosta-Diago E, Roche-Bueno JC, Santos-Lasaosa S. Impact of 24-hour on-call shifts on headache in medical residents: a cohort study. Headache. 2020;60(7):1427-31.
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Evaluate the effect of 24-hour oncall shifts on disability caused by headache. |
Among doctors with migraine, disability increased from little or none to moderate disability after six months, along with worsening depressive and anxious symptoms. |
It’s not possible to conclude whether the increase in headache disability is due to sleep deprivation or to worsening depressive and anxious symptoms. |