Cognitive‐Behavioral Therapy for Insomnia to Reduce Chronic Migraine: A Sequential Bayesian Analysis

Smitherman, Todd A.; Kuka, Alexander J.; Calhoun, Anne H.; Walters, A. Brooke; Davis-Martin, Rachel; Ambrose, C; Rains, Jeanetta; Houle, Timothy T.

doi:10.1111/head.13313

Cited by 55 publications

(38 citation statements)

References 40 publications

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“…In a combined analysis of these 2 prior studies of behavioral interventions targeting insomnia in people with migraine using a Gaussian linear model to estimate the combined effect, monthly headache frequency of the treatment groups decreased by 6.2 days (95% CI −9.7 to −2.7) more than the control groups. The authors posit that there is a 97.5% chance that the CBTi treatment intervention is at least 2.7 days better than the control intervention at reducing headache days …”

Section: Discussionmentioning

confidence: 99%

Migraine Progression: A Systematic Review

et al. 2018

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Background Migraine is a common and often debilitating neurological disease. It can be divided into episodic and chronic subforms based on the number of monthly headache days. Because only a subset of individuals with episodic migraine (EM) progress to chronic migraine (CM) over any given time period, understanding the factors that predict the new onset of CM or “migraine progression” may provide insights into the mechanisms, pathophysiology, prevention, and treatment of CM. In this review, we identify and summarize studies that report risk factors associated with the new onset of CM or related chronic headache diagnoses, group these risk factors and report the strength of evidence for the identified risk factors. Objective To conduct a systematic review of studies that identify risk factors for the new onset of CM or related chronic headache diagnoses such as transformed migraine (TM) and chronic daily headache (CDH). Methods Herein we summarize the findings of studies of risk factors associated with the new onset of CM/TM, CDH, or related diagnoses from the English language literature published before March 2018. The PubMed database was searched for relevant studies. Longitudinal studies with follow‐up data and case‐control studies were included in this qualitative synthesis. We report methodology, analytic criteria, and results for each manuscript and for the parent study. Next, we review the strength of evidence for each of the identified risk factors using a modified version of AB Hill’s criteria for causation and rank evidence as fair, moderate, or strong. We categorized risk factors as nonmodifiable, modifiable and based on putative mechanisms. We further categorized risk factors into sociodemographics, lifestyle factors and habits, headache features, comorbid and concomitant diseases and conditions and pharmacologic treatment‐related. Finally, we review theories of the pathophysiology underlying the development of new onset chronic migraine or increasing attack frequency. Results The PubMed search yielded 1870 records after duplicates were removed. Nine additional records were identified through expert consultation and other methods (eg, citations found as references in manuscripts identified in the literature review and through communication with the authors of manuscripts included in the review). The 1879 manuscripts were screened against the inclusion and exclusion criteria and 109 were found to be potentially eligible. Of 109 full‐text articles, 17 studies were identified as meeting the prespecified criteria based on the consensus of all authors. Of the 17 full texts, 13 were longitudinal cohort studies and 4 were case‐controlled studies. We found strength of evidence ranging from fair to strong for the identified risk factors. The strongest data were found for increased headache day frequency, depression, and medication overuse/high‐frequency use. Risk factors for new onset CM and CDH in children and adolescents were similar to those identified in adults. Conclusions A range of risk factors for the n...

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Section: Discussionmentioning

confidence: 99%

Migraine Progression: A Systematic Review

et al. 2018

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“…Using a rigorous statistical approach and pooling evidence from the 2 controlled trials that each employed 1.5 hours of therapist contact (either one 90-minute 71 or three 30-minute treatment sessions 70 ), Smitherman and colleagues determined headache frequency was reduced at 6-8 week follow-up in the behavioral sleep treatment group 6.2 fewer headache days per month than the sham control group. 72 Interestingly, pharmacological treatment for insomnia did not replicate the behavioral treatment studies. A 6-week controlled trial of the hypnotic eszopiclone 3 mg yielded no change in chronic migraine compared to placebo.…”

Section: Assess Sleep Disturbance and Insomnia In Chronicmentioning

confidence: 99%

Sleep and Migraine: Assessment and Treatment of Comorbid Sleep Disorders

Rains

2018

Headache

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The relationship of sleep and migraine is unequivocal and familiarity with the nature and magnitude of these associations may inform clinical practice. Recent prospective, longitudinal, and time-series analysis has begun to unravel the magnitude and temporal patterns of sleep and migraine. Prospective evidence has shown that sleep variables can trigger acute migraine, precede and predict new onset headache by several years, and indeed, sleep disturbance and snoring are risk factors for chronification. The presence of a sleep disorder is associated with more frequent and severe migraine and portends a poorer headache prognosis. Interestingly, the disorders linked to migraine are quite varied, including insomnia, snoring and obstructive sleep apnea, restless legs, circadian rhythm disorders, narcolepsy, and others. Insomnia is by far the most common sleep disorder in headache patients. In fact, the majority of patients with chronic migraine presenting for treatment have insomnia. Despite a rapidly expanding literature, very few controlled treatment studies have been published to guide clinical practice. This paper focuses on clinical assessment and treatment of sleep disorders. An algorithm is presented for sleep disorders management in the migraine patient, which highlights major sleep disorders and psychiatric comorbidity. Diagnostic procedures are recommended that are conducive to clinical practice. Suggested tools include the sleep history, screening mnemonics, prediction equation, and sleep diary. New developments in treatment have produced abbreviated and cost-effective therapies for insomnia and obstructive sleep apnea that may reach a larger population. Revisions in the diagnostic manuals for sleep and headache disorders enhance recognition of sleep-related headache. Recommendations include behavioral sleep regulation, shown in recent controlled trials to decrease migraine frequency, management for sleep apnea headache, cognitive behavioral therapy (CBT) for insomnia abbreviated for the physician practice setting, sleep-related headache trigger, and others. There is no empirical evidence that sleep evaluation should delay or supersede usual headache care. Rather, sleep management is complimentary to standard headache practice.

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“…[3][4][5] Migraineurs frequently report poor sleep quality, which is associated with increased migraine frequency and severity. [13][14][15] The relationship may be bi-directional, however. A recent study reported that patients with insomnia had a higher prevalence of migraine than did patients without insomnia; interestingly, patients with migraine who had insomnia reported more headache-related disability (as measured by the Headache Impact Test [HIT-6]) than patients with migraine but without insomnia.…”

Section: Introductionmentioning

confidence: 99%

“…12 Of particular clinical note, behavioral interventions and cognitive behavioral therapy for insomnia may improve migraine, and in some patients may revert a chronic pattern of migraine to an episodic pattern. [13][14][15] The relationship may be bi-directional, however. Insomnia at baseline was associated with a 40% higher prevalence of the development of migraine at 11-year follow-up in a large Nordic study, 16 but an analysis of patients in the same cohort with headache, but not insomnia at baseline, demonstrated an increased risk of developing insomnia over the 11-year follow-up period.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Shift Work on Migraine: A Case Series and Narrative Review

et al. 2019

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Objective We present a case report of 2 migraine patients engaged in shift work, followed by a narrative review, to assess whether shift work influences headache‐related disability and chronification of migraine. Background Numerous modifiable factors can lead to chronification of migraine and to higher headache‐related disability. These include, among others, obesity, depression, overuse of acute medications, ineffective acute treatments, and stressful life events. Sleep disruptions and disorders are also felt to increase the risk of transitioning from episodic to chronic migraine. We hypothesize that shift work, which by definition leads to atypical or irregular sleep cycles, along with poor quality sleep, is a risk factor for chronification of migraine. Methods We present the case histories of 2 shift workers with migraine as per International Classification of Headache Disorders 3 criteria, seen at a large, busy academic headache center, followed by a narrative review of the literature. Results Previous literature regarding the relationship between shift work and migraine is sparse and conflicting, with more recent studies suggesting that shift work may be a risk factor for migraine‐related disability. In our case series, both patients initially reported severe migraine headache‐related disability and both patients had noted a worsening of their headaches after beginning night shift work. Both improved when switched back to day shifts, then worsened upon being put back on night shifts. Their headache patterns finally reverted from chronic to episodic migraine after eliminating night shifts completely and maintaining a good sleep routine. Conclusions In the 2 cases presented, shift work appeared to be associated with chronification of migraine and higher headache‐related disability despite optimal headache management and good patient adherence. A switch to only day shifts promoted transition to an episodic, less disabling pattern of migraine. It is clinically important to take a detailed sleep history in headache patients, and when appropriate, provide support for workplace accommodations. Further larger‐scale, rigorous studies are needed to more clearly delineate the relationship between shift work and migraine.

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Cognitive‐Behavioral Therapy for Insomnia to Reduce Chronic Migraine: A Sequential Bayesian Analysis

Cited by 55 publications

References 40 publications

Migraine Progression: A Systematic Review

Migraine Progression: A Systematic Review

Sleep and Migraine: Assessment and Treatment of Comorbid Sleep Disorders

The Impact of Shift Work on Migraine: A Case Series and Narrative Review

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