The headache-sleep study:: Sleep and pain thresholds in healthy controls and patients with migraine and tension type headache

Abstract

Background

Headache can be relieved or released during sleep, but there are few polysomnograpic (PSG) studies on headache patients. Our aim was to evaluate subjective and objective sleep, affective symptoms and pain thresholds (PT) in patients with tension type headache (TTH) and migraine and healthy controls.

Methods

All results are based on a blinded study comparing data in headache patients and controls regarding polysomnography, measurements of PT, data from headache and sleep diaries and questionnaires. We included 20 patients with TTH, 50 migraineurs and 34 healthy controls. Migraineurs who had their sleep recording more than two days from an attack were classified as interictal (n=33) while those registered 2 days or less from an attack were classified as either preictal (n=9) or postictal (n=8). Migraineurs with attack onset mainly during night or by awakenings was classified as sleep related migraine (SM) and compared to migraineurs without a preference for nightly attacks (non-sleep related migraine (NSM)). TTH patients were classified either as episodic TTH (ETTH) or chronic (CTTH) if headache days per month respectively were <15 or &nbsp; ≥15.

Results

All headache groups had more anxiety symptoms, more subjective sleep disturbances than controls, but sleep diaries revealed no sleep time differences. Migraineurs recorded in the preictal phase had shorter latency to sleep onset than migraineurs registered in the interictal phase. Both TTH and NSM patients had findings consistent with foregoing sleep deprivation i.e. more slow wave sleep in PSG, more frequent subjective daytime tiredness and a tendency to lower PT than healthy controls. SM patients had findings consistent with slightly reduced sleep quality in PSG, but not increased frequency of daytime tiredness or reduced PT.

Conclusions

Based on data in this thesis headache patients with attack onset during daytime may need more sleep than healthy controls. Subjects with SM had findings indicating slightly disturbed sleep. However, since no specific clinically relevant disturbing factor was detected, an increased sensitivity to slight subclinical sleep disturbances might be characteristic for patients with headache onset during sleep.