Sleep and Headache
Introduction
It is well established that headache and sleep share neurophysiological and anatomical substrates and that specific headache diagnoses and sleep disorders are strictly correlated. This close correlation is linked to common anatomical structures and neurochemical processes that are involved in the pathophysiology of sleep and headaches.1
From the headache perspective, a sleep disturbance (too much, too little, inappropriate timing, or inappropriate sleep behavior) can be a trigger for headache but sleep is also used to terminate the attack; on the contrary, headache might be a symptom of sleep disturbance and side effect of sleep- or wake-modulating treatments.2, 3 Furthermore, both conditions highly increase the risk for each other.
More specifically, convincing clinical evidence supports the existence of mutual interactions between sleep and headache, mediated by time (headache occurs during sleep, after sleep, and in relationship with sleep stages) or quantitative (excess, lack, bad quality, or short duration of sleep may trigger headache) relationships and by a reciprocal connection: noxious stimuli and painful disorders interfere with sleep, and sleep disturbances affect pain perception.
Both sleep disturbances and headache disorders are widespread health problems during childhood: migraine and tension headaches alone occur in approximately 12% of the pediatric population, and 25% of children have experienced at least 1 type of sleep problem.4, 5
Specific evaluation in headache centers generally leads to the diagnosis of a primary headache syndrome (migraine or tension-type headache [TTH]).
Migraine is a common form of primary headache that often begins during the early school-age years. The prevalence of migraine in children is estimated at 10%, with higher rates occurring among older teenagers.6, 7, 8, 9 Migraine in children younger than 7 years of age has not received much attention,10 with only a limited number of published studies describing the clinical and therapeutic features in this younger age group.11, 12, 13, 14, 15, 16, 17, 18
Headache or migraine in children is often associated with other physical and emotional complaints with the most commonly reported neurological and psychiatric disorders being represented by sleep disorders, depression, anxiety, and epilepsy.1 We have already demonstrated that sleep disorders are the most frequent comorbid disorders in children with migraine, followed by anxiety disorders and depression.19
In young children not able to report correctly the symptoms, owing to immature language and cognitive abilities, migraine descriptors can be missed or sleep disturbances may not be recognized as causative factors for migraine.20
Section snippets
Correlation Between Early Sleep Problems and Headache
Due to the aforementioned relations, it is possible that common genetic, pathophysiological and behavioral factors or both exist that predispose some patients to both primary headaches and sleep disturbances, but these factors have not yet been clearly identified.21
The possible common neurobiological substrate might act from the beginning of life, supporting the comorbidity between these 2 disorders. Subjects with migraine report a higher prevalence of family history for sleep disturbances and
Sleep Disorders and Headaches
The most common sleep difficulties found in children who suffer from headache are represented by insufficient sleep, cosleeping with parents, difficulties falling asleep, anxiety related to sleep, restless sleep, night waking, nightmares, fatigue during the day,22, 27 and parasomnias.28, 29, 30, 31 Surveys in large pediatric populations have confirmed the strong association between headache and different sleep disorders such as parasomnias, insomnia, sleep-breathing disorders, and daytime
Chronobiology and Headache
There is scientific evidence of a relationship between different headache syndromes and a variety of cyclic phenomena. Headache has been described as being related to biological cycles: a circadian periodicity of migraine attacks, with an overrepresentation during the waking hours, a menstrual periodicity, and a weak seasonal periodicity86 have been reported.
Several findings suggest a role for chronobiological factors in migraine, probably related to a hypothalamic involvement.21, 87
An indirect
BiDirectional Treatment in Headache and Sleep
In children and adolescents, most studies have addressed the association between primary headaches and sleep disruptions using cross-sectional designs, which limit conclusions about the direction of the effects.8, 27, 96, 97, 98 Longitudinal study designs are better suited to examine how headaches affect sleep and how sleep affects headaches. Bruni et al96 randomly assigned migraineurs, aged 5-14 years, to 2 groups: 1 group received recommendations about sleep hygiene, and the other group did
Conclusion
To better understand the pathophysiology and the high comorbidity between the migraine or headache and disturbed sleep we must acknowledge the existence of common structural and neurotransmitters pathways. The trigeminal nucleus caudalis in the pons and midbrain and the hypothalamus are involved in the emergence and spreading of the head pain. The hypothalamus with its connection to the pineal gland, the noradrenergic locus coeruleus, the antinociceptive system represented by the
References (111)
- et al.
Specific headache factors predict sleep disturbances among youth with migraine
Pediatr Neurol
(2014) - et al.
Migraine and tension headache in children under 6 years of age
Eur J Pain
(2004) - et al.
Relationships between headache and sleep in a non-clinical population of children and adolescents
Sleep Med
(2008) - et al.
Sleep-related headaches
Neurol Clin
(2012) - et al.
Prevalence of headache and its association with sleep disorders in children
Pediatr Neurol
(2007) - et al.
Prevalence of headache and its association with sleep disorders in children
Pediatr Neurol
(2007) - et al.
Sleep quality versus sleep quantity: relationships between sleep and measures of health, wellbeing and sleepiness in college students
J Psychosom Res
(1997) - et al.
Subjective sleep disturbances in adolescents with chronic pain: relationship to daily functioning and quality of life
J Pain
(2005) - et al.
Characterization of symptoms of sleep disorders in children with headache
Pediatr Neurol
(2006) - et al.
Serotoninergic hypothesis of sleepwalking
Med Hypotheses
(2005)
Prevalence and association of headaches, temporomandibular joint disorders, and occlusal interferences
J Prosthet Dent
Polysomnographic findings in children with headaches
Pediatr Neurol
International Restless Legs Syndrome Study Group (IRLSSG). The official World Association of Sleep Medicine (WASM) standards for recording and scoring periodic leg movements in sleep (PLMS) and wakefulness (PLMW) developed in collaboration with a task force from the International Restless Legs Syndrome Study Group (IRLSSG)
Sleep Med
Possible joint origin of restless leg syndrome RLS and migraine
Med Hypotheses
Physiology and pharmacology of melatonin in relation to biological rhythms
Pharmacol Rep
Headache and comorbidity in children and adolescents
J Headache Pain
Headache and sleep: Shared pathophysiological mechanisms
Cephalalgia
Headache, drugs and sleep
Cephalalgia
Prevalence of headache and migraine in schoolchildren
Br Med J
Sleep problems
Curr Probl Pediatr Adolesc Health Care
Clinical and demographic characteristics of migraine in urban children
Headache
Epidemiology of migraine among students from randomly selected secondary schools in Lodz
Headache
Primary headaches in children under the age of 7 years
Curr Pain Headache Rep
Prevalence of headache at preschool age in an unselected child population
Cephalalgia
Headaches in children younger than 7 years of age
Arch Neurol
Recurrent and chronic headaches in children below 6 years of age
J Headache Pain
Primary headaches in preschool age children: clinical study and follow-up in 163 patients
Cephalalgia
Changing headache from preschool age to puberty. A controlled study
Cephalalgia
Symptoms of migraine in the paediatric population by age group
Cephalalgia
Primary headache disorders in children under 7 years of age
Scott Med J
Sleep duration from ages 1 to 10 years: variability and stability in comparison with growth
Pediatrics
Headache and psychiatric comorbidity: clinical aspects and outcome in an 8-year follow-up study
Cephalalgia
The relationship between sleep and headache in children: implications for treatment
Cephalalgia
Comorbidities of sleep disorders in childhood and adolescence: focus on migraine
Nat Sci Sleep
Prevalence of sleep disorders in childhood and adolescence with headache: A case-control study
Cephalalgia
Idiopathic headache in children under six years of age: a follow-up study
Headache
Infantile migraine presenting as colic
J Child Neurol
Is infantile colic a migraine-related phenomenon?
Clin Pediatr Phila
Association between childhood migraine and history of infantile colic
J Am Med Assoc
Migraine headaches and sleep disturbances in children
Headache
Childhood migraine and somnambulism
Neurology
Somnambulism, migraine and propranolol
Headache
Migraine et somnambulisme. Une enquete portant sur 122 migraineux
Rev Neurol
The relationship between stage III + IV + REM sleep and arousals with migraine
Headache
The prevalence of triggers in paediatric migraine: a questionnaire study in 102 children and adolescents
J Headache Pain
Headache and sleep: examination of sleep patterns and complaints in a large clinical sample of migraineurs
Headache
Migraine in childhood and its prognosis
Cephalalgia
Sleep-related breathing disorders and headache
Neurol Sci
Sleep disordered breathing in patients with cluster headache
Neurology
Quality of sleep, fatigue and daytime sleepiness in migraine—A controlled study
Cephalalgia
Cited by (36)
Sleep Deficiency and Pediatric Chronic Pain
2021, Nursing Clinics of North AmericaCitation Excerpt :An estimated 26% to 69% of children suffer from headaches (eg, migraines, tension, cluster).1,4,32 Several studies show short sleep duration, poor sleep quality, insomnia, and sleep bruxism (eg, teeth grinding) in children and adolescents with headaches.32–34 Prolonged headache duration and greater pain intensity and frequency have been shown to predict sleep anxiety, bedtime resistance, and sleep bruxism.35–38
Comorbidities in children and adolescents
2021, Pediatric HeadacheMigraine and Sleep in Children: A Bidirectional Relationship
2020, Pediatric NeurologyCitation Excerpt :Optogenetic inhibition of these cells inhibits arousal in response to hypercapnia, but not to other stimuli.75 There is a bidirectional relationship between migraine and sleep disorders in childhood.76 Sleep disorders are the most common comorbidity with migraine in children.77
Clinical presentation, diagnosis and polysomnographic findings in children with migraine referred to sleep clinics
2019, Sleep MedicineCitation Excerpt :A recent study showed that sleep disturbances in migraine were significantly associated with higher levels of functional disability, anxiety, and depression compared to other types of headaches in children [12]. It was speculated that the common anatomical structures and neurochemical processes, such as the serotonergic system involved in the pathophysiology of sleep and headache, could explain this link [13,14]. Several studies in children with migraine have shown an association with comorbid sleep disorders.
Sleep in Pediatric Patients
2019, Handbook of Sleep Disorders in Medical Conditions