Migraines and Sleep

If you’re one of the 35 million Americans suffering from migraines, you’re probably aware of how these debilitating headaches can wreak havoc on your nightly slumber. Most folks with migraine report experiencing sleep disturbances, such as insomnia and trouble falling or staying asleep. There’s also evidence that both sleeplessness and too much sleep can trigger migraines in sensitive individuals.

Now, a study published recently in Neurology reported that people with migraines may get less quality REM sleep – a stage critical for thinking, making, and retaining memories. Here’s what investigators found.

The Migraine-Sleep Connection

While there are many things we still don’t know about migraines (or sleep, for that matter), there’s one thing we do know: the two processes share a complex, bidirectional relationship where migraine attacks can be both caused and relieved by sleep. This relationship is precisely what researchers at King’s College London in the United Kingdom wanted to understand.

“Do migraines cause poor sleep quality or does poor sleep quality cause migraines?” asked Jan Hoffmann, MD, Ph.D., author of the study, and member of the American Academy of Neurology. For the study, Hoffmann and colleagues poured over data from 32 sleep and migraine studies. To be included in the analysis, the studies had to include non-pregnant individuals diagnosed with migraines who answered a questionnaire to self-rate their sleep quality or who underwent polysomnography (a type of sleep study that records certain sleep data).

Plenty of research already suggests that people with migraines tend to have lower sleep quality, more daytime sleepiness, and more sleep-related disorders, like insomnia, snoring, and sleep apnea. For example, a 2009 study published in Cephalgia (the medical journal of the International Headache Society) found that sleep quality is indeed decreased in migraineurs, and that this reduction is a consequence of the migraine attack itself, not other factors like depression or anxiety.

Still, up until this new analysis, investigators had not been able to pin down whether pediatric and adult migraine patients really could have subjective differences in sleep quality in comparison with healthy controls. Nor was it clear whether objective structural differences could explain the prevalence of sleep disturbances within this group.

“We wanted to analyze recent research to get a clearer picture of how migraines affect people’s sleep patterns and the severity of their headaches.” Hoffman said. “That way, clinicians can better support people with migraines and deliver more effective sleep treatments.”

After analyzing data from over 10,000 participants from almost three dozen studies, researchers found that adults with migraines — particularly adults with chronic migraine — consistently scored worse on the Pittsburgh Sleep Quality Index (PSQI), a survey that asks about sleep quality, use of medication, daytime sleepiness, sleep duration, and more. Children with migraines also had significantly more awake time and less total sleep time. And both had a lower percentage of rapid eye movement, or REM, during sleep.

The Importance of REM Sleep

Migraines and Sleep

 

There are four distinct stages of sleep; the first three stages are conveniently named NREM (non-rapid eye movement) 1 to 3, followed by the fourth and final stage: rapid eye movement or REM sleep, sometimes also known as active or paradoxical sleep.

Each stage has a unique function in keeping the brain healthy and your cognitive performance sharp. But REM sleep, in particular, is the stage where your brain’s activity most closely resembles its activity during wake hours and has been associated with memory and emotion processing and consolidation.

REM is considered one of the most important stages of sleep because it stimulates areas of the brain critical for thinking, learning, and remembering. In fact, animal studies show that rats are more likely to display hyperalgesia, extreme sensitivity to pain, the next day after being subjected to REM sleep deprivation. Some studies have also found that REM sleep-deprived rats have significantly shorter life spans and could be more susceptible to oxidative stress.

What the Results Mean for Migraine Sufferers

While there’s still a lot to learn about the mechanisms involved in migraines and sleep disturbances, this study is a first step towards untangling this complicated relationship and finding better and more comprehensive interventions for managing these common, yet debilitating conditions.

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