Although anecdotal evidence suggests that patients who suffer from migraines often report an increased rate of sleep disturbances, including trouble falling and staying asleep, studies conclusively addressing this issue are lacking. With the hypothesis that migraine can directly impact sleep in mind, Angeliki Vgontzas, MD, and colleagues sought to determine how long or well migraineurs slept the night of an attack for a study that was published in Sleep.
Led by Suzanne Bertisch, MD, MPH, the researchers conducted a 6-week prospective cohort study, collecting data daily from patients through twice-daily logged electronic diaries and an actigraph, a device worn on the wrist that estimates duration and continuity of sleep. The actigraph was used to track sleep duration, time awake after sleep onset (WASO), and percentage of time asleep while in bed. Participants continued their daily lives while recording migraine attacks in their diaries and wearing the actigraph. “We also used data on sleep collected from the morning diaries (duration, quality),” explains Dr. Vgontzas. “We then compared sleep on the nights a headache was reported with nights on headache-free days.” The team also controlled for factors such as daily use of caffeine, alcohol, physical activity, and sleep medications that could impact sleep.
Dr. Vgontzas and colleagues tracked more than 4,400 days, including more than 1,000 reported migraine days. Participants reported an average of 5 migraine days per month. The average nightly objective sleep duration was 7.3 hours, efficiency was 89.5%, and WASO was 44.8 minutes. No significant difference in objective sleep duration (7.3 minutes longer) was observed on nights following a migraine day.
“We recommend clinical evaluation and treatment of sleep disturbances in patients with episodic migraine who have sleep complaints in the clinical setting,” emphasizes Dr. Vgontzas. “Physicians should not assume that treatment of their migraine attacks will necessarily improve their sleep complaints.” The study team believes further research is needed to understand the biological mechanisms at play in both migraine and sleep disturbance. Dr. Vgontzas hypothesizes that there may be a subset of those with migraine whose sleep disturbance is biologically related to their migraine. Structures in the hypothalamus and brainstem could be involved, as could the glymphatic system (a newly identified waste clearance system in the brain primarily active in sleep), as well as common neurotransmitters like dopamine and serotonin.