Randomized Controlled Pilot Trial of Behavioral Insomnia Treatment for Chronic Migraine With Comorbid Insomnia

Smitherman, Todd A.; Walters, A. Brooke; Davis, Rachel; Ambrose, C; Roland, Malcolm; Houle, Timothy T.; Rains, Jeanetta

doi:10.1111/head.12760

Cited by 90 publications

(77 citation statements)

References 60 publications

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“…60 Similarly, in individuals with CM, behavioral treatment of comorbid insomnia yielded reductions in headache frequency. 53 These findings are interesting, albeit limited in number and scope, and underscore a need for additional, larger studies for confirmation.…”

Section: Discussionmentioning

confidence: 94%

“…52 Objective sleep data such as polysomnography are often not feasible for research due to cost and reactivity to test conditions or “first night effect.” Actigraphy was utilized recently in an outcome study of Cognitive behavioral therapy for insomnia (CBTi) in migraine. 53 Wearable accelerometers are inexpensive and increasingly widely available, and can represent sleep/wake cycles in normal sleepers with an accuracy that approximates actigraphy; however, they lack accuracy in determining sleep/wake cycles in clinical populations and correlate poorly with sleep stages documented in polysomnography. 54 Thus, the current standard of care in diagnosis of insomnia in the clinical setting is prospective sleep diaries and validated questionnaires.…”

Section: Discussionmentioning

confidence: 99%

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Sleep Disorders Among People With Migraine: Results From the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study

et al. 2018

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Objectives.— We examined the cross-sectional association of sleep apnea and indices of sleep quality with both episodic migraine (EM) and chronic migraine (CM). Background.— Sleep apnea and abnormal patterns of sleep, such as insomnia, were associated with migraine onset, severity, and progression in previous research. Methods.— The Chronic Migraine Epidemiology & Outcomes Study, a longitudinal study, used a series of web-based surveys to assess migraine symptoms, burden, and patterns of health care utilization. Quota sampling was used from September 2012 to November 2013 to generate a representative sample of the US population. Persons who screened positive for sleep apnea on the Berlin Questionnaire are said to be at “high risk” for sleep apnea. Respondents indicated if they believed that they had sleep apnea, if a physician had diagnosed it, and if and how they were treated. Other aspects of sleep quality were assessed using the Medical Outcomes Study (MOS) Sleep Measures. Results.— Of 12,810 eligible respondents with migraine and data on sleep, 11,699 with EM (91.3%) and 1111 with CM (8.7%) provided valid data for this analyses. According to the Berlin Questionnaire, 4739/12,810 (37.0%) were at “high risk” for sleep apnea, particularly persons with CM vs EM (575/1111 [51.8%] vs 4164/11,699 [35.6%]), men vs women (1431/3220 [44.4%] vs 3308/9590 [34.5%]), people with higher body mass index, and older people (all P < .001). Among respondents to the MOS Sleep Measures, persons with CM were more likely to report poor sleep quality than those with EM, including sleep disturbance (mean [SD] values: 53.2 [26.9] vs 37.9 [24.3]), snoring (38.0 [33.9] vs 31.0 [32.1]), shortness of breath (34.9 [29.8] vs 15.3 [20.6]), somnolence (44.1 [23.4] vs 32.2 [21.2]), and less likely to report sleep adequacy (34.0 [24.2] vs 39.2 [22.1]). Conclusions.— Compared with respondents with EM, a larger proportion of those with CM were at “high risk” for sleep apnea and reported poor sleep quality. This reflects an association between CM vs EM and sleep apnea and poor sleep quality; the potential relationships are discussed.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Sleep Disorders Among People With Migraine: Results From the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study

et al. 2018

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“…19 Treatment of insomnia in migraine patients with CBT for insomnia shows significant benefit in sleep efficiency (as measured by actigraphy) as well as reductions in headache frequency. 37 Sleep disturbances may be the manifestation of a common shared biology in at least a subset of patients with migraine, so should be screened and addressed.…”

Section: Sleep Disorders and Their Relationship To Migrainementioning

confidence: 99%

Sleep Disorders and Migraine: Review of Literature and Potential Pathophysiology Mechanisms

2018

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Migraine shares a complex and poorly understood relationship with sleep. Patients consistently report poor sleep prior to migraine attacks and during them, identifying poor sleep as a migraine trigger. However, anecdotally, sleep is reported to serve a therapeutic role in terminating headache. Are the associations between migraine and sleep simply the result of various bidirectional relationships? A growing body of evidence suggests there may be a common underlying etiology as well. Our objective was to review studies of sleep and migraine from the last 2 decades utilizing validated subjective and objective measures of sleep and to explore potential mechanisms underlying this complex relationship by incorporating recent advances in neuroscience. We specifically focus on insomnia, obstructive sleep apnea, parasomnias, sleep related movement disorders, and REM sleep related disorders and their relationship to migraine. Parts of brainstem-cortical networks involved in sleep physiology are unintentionally being identified as important factors in the common migraine pathway. Recent discoveries on anatomic localization (the hypothalamus as a key and early mediator in the pathophysiology of migraine), common mediating signaling molecules (such as serotonin and dopamine), and the discovery of a new CNS waste removal system, the glymphatic system, all point to a common pathophysiology manifesting in migraine and sleep problems.

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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%

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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Randomized Controlled Pilot Trial of Behavioral Insomnia Treatment for Chronic Migraine With Comorbid Insomnia

Cited by 90 publications

References 60 publications

Sleep Disorders Among People With Migraine: Results From the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study

Sleep Disorders Among People With Migraine: Results From the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study

Sleep Disorders and Migraine: Review of Literature and Potential Pathophysiology Mechanisms

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

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