Chronic Migraine and Insomnia Have a Strong Bidirectional Relationship

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A comprehensive literature review supports the association between sleep disorders and chronic migraine, leading to poor quality of life, loss of workforce and economic burden.

There's been recent evidence indicating that those who suffer from migraines and poor sleep are likely to develop chronic migraines due to the lack of quality sleep. However, the mechanisms of chronic migraines that impact sleep behavior are not fully understood.

Complications associated with migraines can be severe by affecting an individual's ability to work, leading to work disability, loss of workforce and a deteriorated quality of life. Global estimates show that 1.4-2.2% of the population has a diagnosis of chronic migraine.

Additionally, the symptoms and comorbidities vary among individuals which can make diagnosis and treatment difficult. A team of investigators led by Hikmet Saçmacı, Department of Neurology, Yozgat Bozok University, School of Medicine, aimed to further understand the pathogenesis between chronic migraine and sleep by performing a comprehensive review of all related published articles.

The Historical Evidence of Sleep and Migraines

The team's objective was to analyze common sleep disturbances reported by individuals who have chronic migraines and then determine the effect that chronic migraines have on sleep quality. Chronic migraines were classified as experiencing a headache at least 15 days per month for at least 3 months. The headaches must have migraine-like symptoms for a minimum of 8 days throughout the month.

A total of 535 articles were identified from literature inception to March 2022 that were potentially relevant to the review. This included clinical trials, observational studies, and case series consisting of 20 or more cases.

Investigators searched PubMed for randomized controlled trials and open studies that evaluated chronic migraine and sleep quality, published in English from 1983-2022 by using keywords: chronic migraine, sleep, insomnia, sleep quality, polysomnography, and Pittsburgh Sleep Quality Index.

Analyzing Significant Sleep and Migraine Statistics

A total of 36 full-text clinical studies on the association were included in the review for analysis after exlusions were made. Eligibility was determined by the relationship of the title, abstract and statistically significant results.

The reviewed studies consisted of case-control, prevalence study, prospective cohort study, and sleep assessment after intervention with interventional-behavioral-digital or drug therapy and occurred in multiple geographic regions.

Findings the review demonstrated that poor sleep and chronic migraines are linked with other accompanying comorbidities and dysregulation of circadian rhythm. The risk factors associated with chronic migraines were well defined with triggering factors.

Emotional and physical stress, nutrition, and sleep disturbances all play an integral role in an individual's level of risk. Investigators found that poor sleep has a particularly strong affect on the chronicity process of migraines.

The team emphasized the importance of planning lifestyle and bahvioral changes combined with acute and prophylactic treatments to manage the symptoms and severity of migraine attacks as well as reduce the frequency and duration of them.

"Understanding specific comorbidities in migraine is important for several reasons. First, recognition of migraine comorbidities may help understand the genetic or biological mechanisms that support the development of new treatments and facilitate disease management, and may also improve prognosis," they wrote. "The identification of migraine comorbidities can also help in the development of new treatments for subgroups and the recognition of underlying biological diseases."

The study "Current Perspectives on the Impact of Chronic Migraine on Sleep Quality: A Literature Review" was published in Nature and Science of Sleep.