Onset of nocturnal attacks of chronic cluster headache in relation to sleep stages

Abstract

Nocturnal attacks are symptomatic of numerous primary headache syndromes. It has proven possible to verify, with polygraphic sleep recordings, a strict correlation between the onset of headache attacks and the rapid eye movements (REM) stage for migraineurs, patients with chronic paroxysmal hemicrania and cluster headache (CH). The purpose of this study was to investigate the correlation between attack onset of chronic CH and sleep stages, the REM stage in particular. Nine patients from our headache outpatient service with a diagnosis of CH were examined in this study. All medication was discontinued at least one week prior to sleep polygraphias, which were conducted in a sleep laboratory on two consecutive nights. Any attacks were treated with oxygen inhalation during the drug-free period. EEG, EMG, and EOG were continuously monitored during the sleep polygraphias. Eight patients had 25 CH attacks during 12 of the 17 nights recorded. Only three of these patients had arousals with attacks in the REM stage and these amounted to five of the 25 recorded attacks. Eleven attacks were in stage 2, four in stage 1 and two in stage 3. These results correlate with recent findings according to which headache attacks were often related to REM in episodic CH, but rarely in the chronic type. Whether or not different pathogenic mechanisms are involved in the episodic and the chronic type of CH is a matter for further discussion.

Cluster headaches and sleep disorders

“…Bono et al [3] and Ferrari et al [13] demonstrated reduced cluster headache attack frequency over several days for patients treated by sleep withdrawal. Pfaffenrath et al [14] confirmed a REM sleep phase linkage with cluster headache attacks without distinguishing the precise type of cluster headache (episodic or chronic). Kudrow [15] reported the results of sleep studies involving patients with episodic and chronic cluster headache, which he performed in an attempt to verify his hypothesis that carotid body activity was impaired secondary to hypothalamic vasomotor regulatory dysfunction.…”

“…Other researchers also saw a similar association between sleep apnea and oxygen desaturation and REM-stage dependency in patients with episodic cluster headaches. The results from the study by Pfaffenrath et al [14] differed regarding patients with chronic cluster headache, suggesting a close relationship to REM sleep. This suggests that there may be a difference between the two types of cluster headache with respect to the onset of nocturnal attacks, their relationship to sleep apnea, or disturbances in circadian rhythms.…”

Sleep and headaches

“…This marked increase in the incidence of sleep apnea among cluster headache patients had been reported in earlier research [25,26], and treatment of sleep apnea had been observed to improve cluster headache control [25]. Cluster headache attacks observed on polysomnography were linked to REM sleep [14], at least in cases of episodic cluster, although perhaps not for patients having the chronic form of cluster headache [27].…”

Sleep and Chronic Daily Headache

“…Cluster headache can be triggered by REM sleep [25]. Patients with chronic paroxysmal hemicrania exhibit decreased total sleep time and rapid eye movement sleep [26].…”