Migraine Linked to Poor Sleep and Sleep Apnea

PainRelief.com: What are the main findings?

Response: We found that sleep apnea and poor sleep quality were more common among people with migraine than the general population and, as is true in the general population, rates of sleep apnea increased with older age, higher BMI, and among men.  We also found that rates of both sleep apnea and poor sleep were higher among those with chronic migraine compared with episodic migraine.

Results of the Berlin Questionnaire, which measures obstructive sleep apnea, showed that 37% of the CaMEO sample was at “high risk” for sleep apnea.  “High risk” was most common among people with chronic migraine vs. episodic migraine (51.8% vs. 35.6%) and men versus women (44.4% vs. 34.5%).  Rates increased significantly with higher body mass index and older age (p<0.001).  Other important sleep indices were measured by the Medical Outcomes Study Sleep Measures.  We found that people with CM were more likely to have poor sleep quality than those with EM on a range of indices including sleep disturbances, snoring, shortness of breath during sleep, daytime somnolence, and lack of sleep adequacy or in essence, getting enough sleep to feel well rested.  Among respondents to the Medical Outcomes Study 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]).

PainRelief.com: What should readers take away from your report?

Response: These results suggest that assessing sleep quality and screening for sleep apnea is valuable in the clinical care of people with migraine, especially among people with CM, men, older age, and higher BMI.  Screening for sleep apnea as part of migraine management, especially among people with CM, men, older age, and higher BMI may help identify this important comorbidity.  Positive screens should be followed with appropriate clinical referrals for more in-depth testing, treatment (which may include CPAP) and education.  All individuals with migraine, particularly those with sleep disturbances such as insomnia, could benefit from being educated about behavioral sleep regulation and healthy sleep hygiene and its likely value in the management of migraine.  

PainRelief.com: What recommendations do you have for future research as a result of this work?

Response: Future studies may employ sleep studies instead of a self-reported questionnaire to confirm our findings.  Participants with a healthcare professional-diagnosed sleep apnea diagnosis could use wearable devices to precisely and prospectively collect respiratory and sleep-related data.  We could also study whether improving sleep quality or treating sleep apnea improved outcomes for people with migraine such as reducing the frequency or intensity of migraine attacks and associated symptoms and improving general health and quality of life.

PainRelief.com: Is there anything else you would like to add?

Response: The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study is sponsored by Allergan plc (Dublin, Ireland).


Buse, D. C., Rains, J. C., Pavlovic, J. M., Fanning, K. M., Reed, M. L., Manack Adams, A. and Lipton, R. B. (2019), Sleep Disorders Among People With Migraine: Results From the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study. Headache: The Journal of Head and Face Pain, 59: 32-45. doi:10.1111/head.13435


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