Migraine, a recurrent, moderate to severe headache that can be throbbing or vibrating, felt on one side of your head, and accompanied by nausea and weakness, shares a complex and not entirely clear relationship with sleep disorders. sleep, according to doctors specialized in Neurology.
Sleep disorders comprise a series of very varied disorders, many of them little known, and range from difficulties falling asleep or staying asleep, or falling asleep at inappropriate times, to sleeping too much or experiencing abnormal behaviors while sleeping.
The sleep-migraine relationship is “in both directions” so it is essential to take it into account in the diagnosis and treatment of both sleep disorders and migraine, as explained in the 2024 edition of CEFABOX, annual update meeting. in chronic migraine and other headaches, organized by the biopharmaceutical company AbbVie.
Complex relationship in two directions.
This “complex and bidirectional relationship” is not very clear from the point of view of pathophysiology (relationship between alterations in the functions of the human body and the appearance of certain diseases), explains Dr. Nuria González, specialist in Neurology at the Clinical Hospital. San Carlos de Madrid (Spain).
Dr. González points out that “in consultation, patients with migraine report that lack or excess of sleep can play a role in triggering their attacks” and that “sleep disorders are one of the causes of their migraine becoming chronic.” .
“On the one hand, insomnia or lack of sleep, even if only occasionally, can trigger a migraine attack; and on the other hand, this can also occur when the patient has slept in excess of the number of hours he usually sleeps,” as he explains.
Likewise, migraine, especially in its chronic forms, can worsen the quality of sleep due to the pain it generates, with attacks frequently appearing in the early morning in patients who have excessive use of symptomatic medication, according to Dr. González.
A positive aspect of this bidirectional relationship, according to González, is that “sleep can have a restorative effect on pain,” which is why many patients sleep to get relief when they have a crisis, as he highlights.
For this reason, this specialist considers “it is very important to treat sleep in patients with migraine and correctly diagnose the sleep disorders they present in order to offer them the best treatment,” she highlights.
Currently, “the headache consultation includes questions about sleep and its quality, and preventive treatments are frequently used that can help not only improve the frequency of pain, but can also promote insomnia, such as drugs with a sedative profile.” ”, he points out.
“In the most complex cases, the patient is referred to the Sleep Unit, where complementary tests are performed to complete the diagnosis of their underlying sleep pathology and find the best therapeutic strategy,” according to González.
Main sleep disturbances
Sleep disorders include: insomnia, hypersomnia (abnormal sleeping situations), narcolepsy (extreme daytime sleepiness), snoring, apneas (stopping breathing), parasomnias (talking during sleep or confusion upon waking), restless legs syndrome, or RLS (uncontrollable urge to move the legs), night terrors (intense fear and agitation during sleep), nightmares and sleepwalking.
“Insomnia, RLS and bruxism (grinding, grinding or clenching the teeth while asleep) are the most common sleep disturbances in patients with migraine,” Dr. González explains to EFE.
“Treating migraine attacks alone may be insufficient for many patients, who could benefit from recently developed preventive treatments focused on reducing the frequency, duration and intensity of attacks, and which have represented a great leap in the quality of life of patients”, according to the specialists gathered at CEFABOX 2024.
“Special attention should be paid to the pain-free period before the person feels that a migraine is coming, which is the so-called premonitory or prodromal phase and begins about a day before the migraine attack,” according to Dr. Samuel Díaz-Insa. , coordinator of the Headache Unit at the La Fe University and Polytechnic Hospital in Valencia (Spain).
During the premonitory phase, “the patient may experience symptoms that warn him that a migraine is coming, such as sensitivity to light, fatigue, food cravings and nausea, feeling more or less sleepy or even feeling more restless,” he explains. Dr. Díaz-Insa.
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