Preferential occurrence of attacks during night sleep and/or upon awakening negatively affects migraine clinical presentation

Abstract

SummaryIt is well known that migraine attacks can preferentially occur during night sleep and/or upon awakening, however the possible implications of this timing on migraine clinical presentation remain unclear. The aim of this study was to assess the possible consequences of sleep-related migraine (defined as ≥75% of migraine attacks occurring during night sleep and/or upon awakening) on the migraine clinical picture (i.e. migraine-related disability, attack severity, use of symptomatic drugs), subjective sleep quality, excessive daytime sleepiness and fatigue. Two hundred consecutive migraine without aura patients were enrolled; patients with comorbid disorders or chronic medication use were excluded. 39% of the migraineurs included in the study received a diagnosis of sleep-related migraine. The mean frequency of migraine attacks (days per month) did not significantly differ between the patients with and those without sleep-related migraine, whereas migraine-related disability (p<0.0001), mean attack severity (p<0.0001), and monthly intake of symptomatic drugs (p<0.0001) were significantly higher in patients with migraine preferentially occurring at night-time and/or upon awakening. Subjective sleep quality and excessive daytime sleepiness did not differ significantly between the two groups, whereas fatigue was significantly more present in the patients with sleep-related migraine (p=0.0001). These data seem to support the hypothesis that patients with sleep-related migraine represent a subset of individuals with a more severe and disabling clinical presentation of migraine and greater impairment of daily functioning, as suggested by the higher degree of fatigue. Migraineurs with night-time attacks Preferential occurrence of attacks during night sleep and/or upon awakening negatively affects migraine clinical presentation also showed a greater use of symptomatic drugs, possibly related to delayed use of symptomatic treatment. The identification of subtypes of patients with a higher disability risk profile could have crucial implications for individually tailored management of migraine patients. KEY WORDS: daytime sleepiness, fatigue, migraine-related disability, sleep-related migraine, subjective sleep quality. IntroductionMigraine is a primary headache disorder, characterized by recurrent attacks, lasting 4-72 hours, of pain, typically described as unilateral, pulsating, moderate or severe, aggravated by routine physical activity, and associated with nausea and/or photophobia and phonophobia (Headache Classification Subcommittee of the International Headache Society, 2004; Headache Classification Committee of the International Headache Society (IHS), 2013). Migraine is a highly disabling condition, ranked by the World Health Organization as the seventh highest cause of disability globally; it has a significant impact on the quality of life of affected subjects and is associated with a high socio-economic burden (Vos et al., 2012;Steiner et al., 2013). Migraine attacks can affect several aspects of a patient'...

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