Sleep Disturbance and Migraine Onset

Post by Sarah Hill 

What's the science?

Getting a good night's sleep goes a long way towards helping a person stay healthy, and for those that suffer from migraine, maybe even more so. According to previous research, the same neurotransmitter system responsible for mediating sleep and wake states may also initiate the onset of a migraine, characterized by severe headache with adverse sensory, autonomic, and cognitive effects. Thus, sleep disturbance may directly trigger migraine in some patients. Despite this mechanistic evidence, the link between sleep disturbance and migraine has been poorly investigated in a real-world setting. This week in Neurology, Bertisch and colleagues show that disturbances in sleep efficiency and fragmentation, but not duration or quality, temporally precede a migraine.   

How did they do it?

The authors conducted a prospective cohort study to test the hypothesis that sleep disturbance is temporally associated with migraine onset. For this study, they recruited 98 adult participants with episodic migraine. Participants were asked to wear wrist actigraphs continuously for 6 weeks to monitor sleep activity, as well as record sleep measures each morning in a sleep diary. Subjects also reported the presence of migraine each morning and evening, including the time of onset, duration, symptom intensity, and medications used, as well as other factors, such as daily caffeine and alcohol use and stress levels. In addition to sleep duration, the following sleep parameters were assessed: 1) WASO - minutes awake after sleep onset 2) sleep efficiency - the proportion of total sleep duration/duration of rest period 3) sleep quality (self-reported rating). After the 6-week study period, the relationship between sleep disturbance and migraine onset was examined throughout the day immediately following each sleep period (day 0) and the subsequent day (day 1).      

What did they find?

Unexpectedly, the authors found no association between sleep duration or quality and migraine occurrence on either day. Instead, diary-assessed low sleep efficiency (defined as ≤90%) was associated with a 39% increase in the odds of migraine occurrence on day 1. Paradoxically, high sleep fragmentation (defined as actigraphy-based WASO ≥53 minutes and efficiency ≤88%) was associated with a 36% reduction in the odds of headache during the day immediately following the sleep period (day 0). Taken together, these results suggest that low sleep fragmentation precedes migraine on day 0, while low sleep efficiency precedes migraine on day 1.   

What's the impact?

The findings presented here indicate that changes in sleep efficiency and fragmentation, but not duration or quality, precede migraine onset. This is one of the few studies to investigate a link between sleep quality and migraine using a prospective cohort study design, and the largest to collect objective sleep data in adults with episodic migraine.

Bertisch et al. Nightly sleep duration, fragmentation, and quality and daily risk of migraine. Neurology (2019). Access the original scientific publication here.