Migraine is highly prevalent in the pediatric population, with findings from population-based studies indicating rates of 7.7%–9.1% among children and adolescents. 1 Sleep disorders are also frequently observed in these groups and represent a common comorbidity in pediatric patients with migraine. Reports of increasing sleep impairment and migraine prevalence in pediatric populations in recent years highlight the need to elucidate the nature of the relationship between these conditions.
“The cerebral structures, networks, and neurochemical systems that are involved in the genesis of migraine align closely with those responsible for the regulation of sleep,” suggesting a shared pathophysiology between migraine and sleep disorders, according to a review published in Pediatric Neurology.1 For example, the hypothalamus, cortex, and brainstem have been identified as critical structures in both sleep physiology and migraine pathophysiology, while shared neurochemical systems include melatonin, adenosine, orexin, and calcitonin gene-related peptide.
Numerous studies have demonstrated a bidirectional relationship between sleep disorders and migraine throughout childhood and adolescence. Disturbed sleep in infancy was shown to predict the development of headache during childhood, with a 2015 meta-analysis noting that infants with a history of colic were over 5 times more likely to develop migraine compared to those with no colic history (odds ratio [OR], 5.6; 95% CI, 3.3—9.5; P =.004).2 Additionally, sleep impairment has been cited as one of the most common triggers in pediatric migraine.1
Other findings have shown associations between various non-rapid eye movement (NREM) parasomnias and migraine in children. A survey of parents of 100 pediatric migraineurs revealed substantially higher rates of several disorders compared to controls: night terrors (77% vs 11%), sleep walking (55% vs 16%), and nocturnal enuresis (41% vs 16%).1 In a 2019 retrospective study of 185 children with migraine, polysomnography revealed high prevalence rates of obstructive sleep apnea (40%), insomnia (27%, and periodic limb movement disorder (15%).3
A 2012 case-control study found that the prevalence of restless legs syndrome (RLS) was 22% in children and adolescents with migraine compared to 5% among those who did not have migraine (P <.001).4
Nonpharmacologic sleep-based interventions have demonstrated efficacy in treating pediatric migraine. In an earlier study of pediatric migraineurs with poor sleep hygiene, those who received sleep hygiene instruction showed significant reductions in the mean duration and frequency of migraine compared to controls.5