A recent meta-analysis published in the journal Neurology has shown that persons with migraines have significantly impaired sleep quality and their sleep cycle is also altered compared to healthy individuals.

The meta-analysis included 32 trials up to December 2020 involving 10,243 adults and children. The self-reported Pittsburgh Sleep Quality Index (PSQI) was used to evaluate subjective sleep quality (such as time taken to fall asleep, use of sleep aids and total duration of sleep) in 21 trials of adults with either episodic or chronic migraine, with or without aura. The PSQI scores ranged from 0 to 21, with higher scores indicating poor sleep quality. Four of these trials had also subjected the participants to the Migraine Disability Assessment Test (MIDAS). The sleep cycle (sleep architecture) was assessed by polysomnography in both adults and children.

Overall, adults with migraines had higher PSQI scores compared to those who did not have migraines. Those with chronic migraines had worse subjective sleep quality versus persons with episodic migraines. Polysomnography revealed that both adults and children with migraines had less rapid eye movement (REM) sleep as a percentage of their total sleep time than the control groups. REM sleep follows non-REM sleep. It involves the most brain activity and vivid dreams and is important for learning and memory function.

Children with migraines took less time to fall asleep, but their total sleep time was reduced and they had  more wake time compared to healthy controls. No differences in any other sleep parameters were observed between the two groups.

Is poor sleep quality an outcome of migraine or vice versa is another chicken and egg situation and we still have no answers yet. While this study does not establish a cause-and-effect association, the findings do draw attention to how sleep patterns change in patients with migraine and how they affect the intensity of headaches. Sleep hygiene therefore should be a part of prescription of migraine patients.

Here are some tips from Dr KK’s Research Fund to improve sleep hygiene

• Go to bed when you are ready to sleep.
• Avoid caffeinated products close to bedtime.
• Light from cell phones, computers, TV, tablets etc. disturbs sleep; remove these from the bedroom.
• Try meditation, deep breathing, or progressive muscle relaxation to calm the mind and relax the muscles, if you are anxious and unable to sleep.
• Exercise (such as walking, jogging, or swimming) regularly
• Get up at the same time every day.
• Keep track of your sleep patterns for a week or two.

References

1. Stanyer EC, et al. Subjective Sleep Quality and Sleep Architecture in Patients With Migraine: A Meta-analysis. Neurology. 2021 Sep 22; doi: 10.1212/WNL.0000000000012701.
2. AAN News, September 22, 2021.