Bidirectional Relationship Between Headache and Sleep Disorders

Introduction: Migraine with and without aura, cluster headache, hypnic headache, and paroxysmal hemicranias are each reported as intrinsically related to sleep. Chronic daily headaches included migraine, tensionand medication overuse headache may cause sleep disturbance. Otherwise, both headache and sleep disorder may be manifestations of a same systemic dysfunction.Method and Material: We conducted a search in PubMed for English-language papers published between 2005and 2019. The following search terms were used: ‘tension-type headache’, ‘migraine’, ‘sleep disorders’, ‘sleep deprivation’, ‘sleep quality’, ‘depression’, ‘anxiety’, ‘hypersomnia’ and ‘insomnia’.Reference lists of included articles were searched for additional articles, and articles introducing general concepts were included.Results: A large population-based cohort study reported a higher risk (adjusted hazard ratio 3.52, 95% CI 3.28–3.79) of developing a subsequent migraine in subjects with non-apnea sleep disorders. Further, patients with headaches are at significantly higher risk of developing sleep problems (OR 2.5, 95% CI 2.0–3.1) than headache-free subjects, regardless of specific headache type. In this study, adults with headache reported more difficulty in initiating sleep (OR 2.0, 95% CI 1.6–2.5), difficulty staying asleep (OR 2.5, 95% CI 2.1–3.0), early morning awakening (OR 2.0, 95% CI 1.7–2.5), and more daytime fatigue (OR 2.6, 95% CI 2.2–3.2).Discussion: This bidirectional relationship can be related to the fact that sleep and headaches share common brain structures, such as the thalamus, hypothalamus, and brainstem nuclei, including the locus coeruleus and raphe nuclei.Conclusion: A better understanding of the potential relationships between these variables potentially associated with sleep quality in patients with TTH and migraine could assist clinicians in determining better therapeutic programs.

Keywords:

Headache , Sleep , Sleep disorders