Sleep and Headache

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The interaction between sleep and headache or migraine is powerful and an elevated comorbidity between these 2 disorders has been reported in either adults or children. This comobidity is linked to common neurophysiological and neuroanatomical substrates that are genetically based strongly. The first reports on this relationship were related to the prevalence of parasomnias and sleep-disordered breathing in headache but recent research has expanded the comorbidity to several other sleep disorders, such as restless legs syndrome, periodic limb movements during sleep, and narcolepsy. The assessment of children with headache should always include an accurate anamnesis for the presence of sleep problems either in the child or in the relatives; no correct approach for treating children and adolescents is possible without an integrated method of evaluation and management.

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

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