Headache Syndromes and Sleep




© Springer Science+Business Media, LLC 2015
Sudhansu Chokroverty and Michel Billiard (eds.)Sleep Medicine10.1007/978-1-4939-2089-1_37


37. Headache Syndromes and Sleep



Munish Goyal , Niranjan Singh  and Pradeep Sahota 


(1)
Department of Neurology, University of Missouri Hospitals & Clinics, 5 Hospital Drive, DC047.00 CE507, 65212 Columbia, MO, USA

 



 

Munish Goyal (Corresponding author)



 

Niranjan Singh



 

Pradeep Sahota



Keywords
HeadacheSleepMigraineSleep apneaNarcolepsyHypnic headache



Introduction


The intimate and complex relationship between sleep and headache has been a concern for many clinicians for ages. In a patient suffering from sleep disorder and headache syndrome, it is difficult and challenging to ascertain whether the sleep disorder leads to headache or the headache syndrome leads to the sleep disorder. It is known that both these disorders are common and occur concurrently, complicating each other.


History


Throughout history there are references about sleep and headaches . For example, Romberg in 1853, writing about migraine, stated that, “the attack is generally closed by a profound and refreshing sleep” [1]; Leiving in 1873 described sleep as a factor terminating headache [2]; Bing in 1945 wrote about headaches occurring on arousal from sleep [3]; Gans described reduction in migraine attacks following selective sleep deprivation, especially deep sleep [4]; Dexter reported an association between morning arousals with headache and increased amount of slow-wave sleep and rapid eye movement (REM) sleep [5]. In 1990, Sahota and Dexter wrote a landmark review article describing the relationship between headache and sleep [4]. Sahota and Dodick then emphasized the relationship between sleep and headache in the second edition of the international classification of sleep disorders (ICSD), diagnostic and coding manual, in 2005 [5]. Subsequent reports further review this relationship, but the above represent some of the key contributions.


Relationship Between Headache and Sleep


The enigmatic relationship of headache and sleep is bidirectional—sleep affects headache and headache in turn affects sleep. Headaches have been described to occur during sleep [6], following sleep [3, 7, 8], and in relation to different sleep stages [6, 7, 9, 10]. In a review article, Sahota and Dexter [4] proposed a classification about the relationship between sleep and headache. Headache can be broadly classified as primary and secondary headaches. The primary headache is a headache which is not caused by any other medical condition or disorder. The secondary headache is defined as a headache due to other medical disorders. In this chapter, we will focus on primary and secondary headaches related only to sleep disorders.


Primary Headache



Cluster Headache (CH)


Nicolas Tulp has been credited for describing CH in 1641 [11]. CH is classified under the spectrum of disorders called trigeminal autonomic cephalalgias (TACs). CH is characterized by the core features of unilateral, severe excruciating head pain occurring in clusters (1–8 episodes per day), lasting from 15 to 180 min, with accompanying features of autonomic dysfunction (e.g., conjunctival injection, lacrimation, ptosis, miosis, nasal congestion, and rhinorrhea) [5]. Russel et al. found a preponderance of attacks beginning during sleep and the majority of daytime attacks began when patients were physically relaxed [12]. CH attacks have been shown to occur during REM sleep or within 9 min of REM termination [6, 13]. It has been reported in several studies that the patients with CH have a higher prevalence of obstructive sleep apnea (OSA) [1317]. Nocturnal hypoxia related to OSA could be a trigger for the CH [14]. A role of hypothalamus in this correlation has also been proposed, as noted by the improvement in sleep architecture in patients treated with deep brain stimulator for chronic CH [18].


Tension-Type Headache (TTH)


Insufficient sleep, oversleeping, and sleep disorders have been implicated as precipitating and aggravating factors for TTH [2729]. Results from the third Nord-Trøndelag Health Survey indicated that subjects with chronic headache were 17 times more likely to have severe sleep disturbances and the association was somewhat stronger for chronic migraine than for chronic TTH [19].

In a cross-sectional study from Norway, the authors reported that the presence and severity of sleep apnea seem not to influence presence and attack frequency of TTH in the general population [20].


Hypnic Headache (HH)


Raskin in 1988 described a case series of six elderly patients having headaches exclusively in sleep [21] . The criteria for diagnosis of HH were proposed in 1997 by Goadsby et al. [22]. The headache should occur at least 15 times per month for at least 1 month, awaken the patient from sleep, lasting for 5–60 min, the pain being generalized or bilateral and not associated with autonomic features. They proposed that HH should be added to the international headache society classifications under miscellaneous headaches [22]. Later in year 2004, the HH was classified under International Classification of Headache Disorders-II (ICHD II), in the category of “other primary headache.” The diagnostic criteria state that the headache is dull, occurs after age of 50 years, develops only during sleep, and awakens the patient .


Migraine


Migraine and sleep disorders can be present in an individual when it is difficult to ascertain if migraine caused the sleep disorder or the sleep disorder is the cause for the migraine . Migraine can emerge during nocturnal sleep or following a brief period of daytime sleep; attacks can be preceded by a lack of sleep; sleep has also been shown to relieve migraine, especially in children [23]. Patients with migraine without aura have a much higher prevalence of sleep abnormalities as compared to controls which may be due to multiple contributory factors [24]. It has been reported that preferential emergence of attacks during night sleep or upon awakening progressively increases with aging [25].


Migraine and Restless Legs Syndrome (RLS)


The frequency of RLS in migraine patients in pediatric age group was significantly higher than in controls (22 vs. 5 % ( p< 0.001) [26]. A strong association between migraine and RLS is reported in the women with migraine with and without aura [27]. Rhode et al., in a case-control study of patients with migraine, found a significantly higher lifetime prevalence of RLS than the control group [28]. Similar correlation has been reported by d’Onofrio et al. [29] and by Chen et al. [30]. The underlying pathophysiology has been linked to the dysfunction of dopaminergic metabolism in migraine [28, 31].


Migraine and Parasomnias


A higher incidence of several parasomnias, e.g., bruxism, sleepwalking, sleep talking, and night terrors, has been found in children with migraine [32].


Migraine and Narcolepsy


There has been controversial correlation between migraine and narcolepsy. In two different studies, Dahmen et al. reported two to fourfold increase in the migraine prevalence in patients with narcolepsy [33, 34]. These results were challenged by a multicenter case-control study which concluded that there is no association between migraine and narcolepsy but that patients with narcolepsy show more unspecific headache, probably due to sleep disturbances [35].


Migraine and Insomnia


Sevillano-García et al. reported insomnia in 37.42 % of their patients [36]. In a survey by Lateef et al., adults with migraine reported more frequent difficulty initiating sleep, difficulty staying asleep, early-morning awakening, and daytime fatigue when compared to the individuals without headache [37]. In another survey in Hong Kong Chinese women with different headache diagnoses, the prevalence of insomnia symptoms was reported as problem waking up too early in 29.4 %, difficulty staying asleep in 28.0 %, and difficulty falling asleep in 24.4 % [38].


Migraine and Excessive Daytime Sleepiness (EDS)


EDS has been reported in patients with migraine . The exact mechanism is unknown. Peres et al. reported EDS in patients with migraine. Epworth sleepiness scale(ESS) score ≥ 10 was in 37 % of patients and ESS of ≥ 15 in 10 % of patients [39]. In a case-control study, EDS was more frequent in migraineurs than in controls (14 vs. 5 %) [40].

In summary, there is a broad spectrum of relationships between migraine and sleep. While the above observations are important, a full range of this relationship still needs to be defined. Further research can possibly explain common pathphysiological pathways between these two entities.


Secondary Headaches



Sleep Apnea Headache


According to the ICHD II, sleep apnea headache [10.1.3] has been classified under secondary headaches—headache attributed to disorder of homeostasis . The diagnostic criteria include—a recurrent headache with at least one of the following—headache occurring on more than 15 days per month; headaches being bilateral with pressing quality and not accompanied by nausea, photophobia, or phonophobia; and each headache resolved within 30 min. The headache should be present upon awakening and it ceases within 72 h, and does not recur, after effective treatment of sleep apnea [5]. Aldrich et al. reported a frequency of morning headaches in 18 % of patients with OSA versus 21–38 % in the patients with other sleep disorders versus 6 % in control group. They concluded that the symptom of morning headache is nonspecific in patients with sleep disorders [41]. Morning headaches have been reported to have a 90-day prevalence of around 60 % in habitual snorers as well as in their bed partners [42].

In a recent population-based cross-sectional study from Norway, sleep apnea headache is reported in 11.8 % of the participants with OSA. In a Turkish study, the morning headaches resolved in 90 % of the patients using positive airway pressure [43]. In a large telephone questionnaire study ( n = 18,980) from the general populations of the UK, Germany, Italy, Portugal, and Spain, prevalence of chronic morning headache was found to be 7.6 %. The headache was most common in patients with depression, insomnia, and sleep-related breathing disorders. The authors concluded that the chronic morning headaches are not specific to sleep-related breathing disorder [44].


Exploding Head Syndrome (EHS)


Described by Armstrong-Jones [45] in 1920, it is a unique and rare syndrome of sudden, loud, painless, explosive sound in the head without actual headache, which can frighten and awaken the subject from sleep. In a study with polysomnographic evaluation in nine patients with EHS, Sachs and Svanborg concluded that EHS occurs during a nocturnal awakening when the subject is relaxed but temporarily awake [46]. In ICSD II, EHS is listed as one of the parasomnias [47]. The treatment options include clomipramine [46, 48] and topiramate [49].


Recent Advances in Treatment of Headache


Given the relationship between sleep and headache , treatment of headache can have implications for sleep. Treatment of headache can be divided into acute and preventive treatment. Acute treatments are required for all patients at some point of time while some patients may need preventive therapy depending upon headache duration, frequency, severity, and response to acute treatment. Migraine being the most common type of headache in practice has gained the most attention.

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Mar 18, 2017 | Posted by in PSYCHIATRY | Comments Off on Headache Syndromes and Sleep

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