Sleep disorder-related headaches

Causality Investigation between Gut Microbiome and Sleep-Related Traits: A Bidirectional Two-Sample Mendelian Randomization Study

Recent research has highlighted associations between sleep and microbial taxa and pathways. However, the causal effect of these associations remains unknown. To investigate this, we performed a bidirectional two-sample Mendelian randomization (MR) analysis using summary statistics of genome-wide association studies (GWAS) from 412 gut microbiome traits (N = 7738) and GWAS studies from seven sleep-associated traits (N = 345,552 to 386,577). We employed multiple MR methods to assess causality, with Inverse Variance Weighted (IVW) as the primary method, alongside a Bonferroni correction ((p < 2.4 × 10-4) to determine significant causal associations. We further applied Cochran's Q statistical analysis, MR-Egger intercept, and Mendelian randomization pleiotropy residual sum and outlier (MR-PRESSO) for heterogeneity and pleiotropy assessment. IVW estimates revealed 79 potential causal effects of microbial taxa and pathways on sleep-related traits and 45 inverse causal relationships, with over half related to pathways, emphasizing their significance. The results revealed two significant causal associations: genetically determined relative abundance of pentose phosphate decreased sleep duration (p = 9.00 × 10-5), and genetically determined increase in fatty acid level increased the ease of getting up in the morning (p = 8.06 × 10-5). Sensitivity analyses, including heterogeneity and pleiotropy tests, as well as a leave-one-out analysis of single nucleotide polymorphisms, confirmed the robustness of these relationships. This study explores the potential causal relationships between sleep and microbial taxa and pathways, offering novel insights into their complex interplay.

The clinical characteristic of catathrenia: a new look at an old issue-a systematic review of existing literature

STUDY OBJECTIVES

The International Classification of Sleep Disorders categorized catathrenia as a respiratory disorder, but there are doubts whether episodes appear during rapid eye movement (REM) sleep or the non-rapid eye movement (NREM), their duration, and symptoms. The main objectives were to identify the most common features and relations of catathrenia.

METHODS

PubMed, Embase, and Web of Science were searched according to the PRISMA 2020 guidelines. The Joanna Briggs Institute and the ROBINS-I tools were chosen to assess the risk of bias.

RESULTS

A total of 288 records were identified, 31 articles were included. The majority of the studies had a moderate risk of bias. 49.57% of episodes occurred during the NREM sleep, while 46% took place during REM. In 60.34% females, catathrenia was more common in the NREM, while in 59.26% of males was in REM sleep (p < 0.05). Females and obese individuals were found to have shorter episodes (p < 0.05). Age was inversely correlated with minimal episodes duration (r =  - 0.34). The continuous positive airway pressure (CPAP) therapy was inversely correlated with the maximal episode duration (r =  - 0.48).

CONCLUSIONS

Catathrenia occurs with similar frequency in both genders. The most frequent symptoms embraced groaning, awareness of disturbing bedpartners, and daytime somnolence-not confirmed by the Epworth Sleepiness Scale. The episodes occur more frequently in NREM than in REM sleep. Catathrenia may be considered as a sex-specific condition. The effects of CPAP treatment leading to shortening episodes duration, which may indicate the respiratory origin of catathrenia.

[The clinical significance of insomnia in chronic headache]

OBJECTIVE

To study the features of the manifestation of insomnia and its impact on the condition and quality of life in patients with chronic tension-type headache.

MATERIAL AND METHODS

The study included 65 patients with chronic tension-type headache and insomnia. Patients filled out questionnaires on headache severity, sleep quality, emotional status and quality of life. Seventeen patients underwent polysomnography.

RESULTS

Patients with more severe insomnia had significantly more severe anxiety (p<0.001) and depression (p=0.025). Such patients assessed their quality of life worse according to the SF-12 questionnaire (p<0.002) and the Subjective Well-Being Scale (p<0.001), a higher level of central sensitization was observed in patients with more severe insomnia (p<0.001).

CONCLUSION

The negative impact of insomnia on the condition of patients is not so much an increase in pain as such, but rather its influence on the quality of the emotional state and life in general, as well as an increase in the interdependence and mutual influence of other clinical and psychophysiological manifestations of the disease. Therefore, the clinical significance of insomnia is the deterioration of a person's ability to tolerate pain, which is the main prerequisite for a decrease in quality of life.

Supporting the Young Adulthood Transitions in Women With Migraine

Migraine is a painful neurological disorder that disproportionately affects women and has a significant impact on quality of life. This article summarizes the critical role of women's health nurses in supporting young adult women with migraine during major life transitions. Nurses can advocate for workplace or school disability accommodations for women with migraine. Nurses can also support young adult women with migraine by providing education about available treatment that becomes available after an individual's 18th birthday. Women's health nurses can also provide counseling on healthy lifestyle habits to sustain through life transitions, such as guidance on safe alcohol consumption and wellness approaches to migraine management. Through these interventions, women's health nurses can help women with migraine to succeed personally, professionally, and academically while effectively managing migraine symptoms.

Multimodal treatment, including extracorporeal shock wave therapy, for refractory chronic tension-type headache: a case report

BACKGROUND

Few reports have described multidisciplinary treatment, including extracorporeal shock wave therapy, for patients with refractory chronic tension-type headache. In this study, we conducted multidisciplinary treatment for a patient with chronic tension-type headache who suffered from chronic headache refractory to treatment.

CASE PRESENTATION

The patient was a 45-year-old Japanese male suffering from 20 years of headache. As his headache had worsened recently, he visited a local clinic. With the diagnosis of suspected tension-type headache, its treatment was unsuccessful and he was referred to our hospital. The neurology department confirmed the tension-type headache and prescribed another medication, but he showed no improvement. Then, the patient was referred to the rehabilitation medicine department for consultation. At the initial visit, we identified multiple myofascial trigger points in his bilateral posterior neck and upper back regions. At the initial visit, he was prescribed 10 mL of 1% lidocaine injected into the muscles in these areas. In addition, he received 2000 extracorporeal shock wave therapy into bilateral trapezius muscles, and was instructed to take oral Kakkonto extract granules, benfotiamine, pyridoxine hydrochloride, and cyanocobalamin. Cervical muscle and shoulder girdle stretches and exercises were also recommended. At follow-up treatment visits, we used extracorporeal shock wave therapy to bilateral trapezius muscles, which led to immediate pain relief. After 11 weeks, he was not taking any medication and his headache was subjectively improved and his medical treatment ended.

CONCLUSION

A patient with chronic tension-type headache refractory to regular treatment was successfully treated with a multimodal approach including extracorporeal shock wave therapy in addition to standard treatment. For patients with tension-type headache accompanied by myofascial trigger points, it may be recommended to promptly consider aggressive multimodal treatment that includes extracorporeal shock wave therapy.

The physical impact of migraines on female chiropractic patients: A qualitative study

Background

Migraines are highly prevalent among the female population and have a significant burden on one's quality of life and physical functioning.

Aim

The study explored the physical impact and contributory factors of migraines on women and their experience of chiropractic treatment for migraine pain management.

Setting

The study was conducted in the eThekwini region of KwaZulu-Natal, South Africa.

Methods

The study used a qualitative descriptive design and adopted purposive sampling. The data were collected through 12 semi-structured interviews, between March and September 2021, and analysed using thematic analysis.

Results

The first theme that emerged focused on the physical effects of migraines. The second theme related to the factors that contributed to migraines. The third theme that emerged focused on chiropractic treatment for migraines.

Conclusion

The majority of the participants experienced chronic migraines and migraines without aura. The participants felt incapacitated and experienced debilitating physical effects with their migraines. The study highlighted that chiropractic treatment was favourable among the female population in improving the quality of life and reducing the severity, disability, duration of suffering and frequency of migraines. It was revealed that chiropractic was the preferred non-pharmacological approach for migraine treatment, as it proved to be a beneficial and effective treatment for migraine pain management.

Contribution

The findings contribute to a greater awareness of chiropractic as an effective evidence-based treatment approach for migraine pain management, which may be beneficial to migraineurs and healthcare practitioners.

Migraine, Allergy, and Histamine: Is There a Link?

The relationship between migraines and allergies is controversial. Though they are epidemiologically linked, the underlying pathophysiological connection between them remains unclear. Migraines and allergic disorders have various underlying genetic and biological causes. As per the literature, these conditions are epidemiologically linked, and some common pathophysiological pathways have been hypothesized. The histaminergic system may be the clue to understanding the correlation among these diseases. As a neurotransmitter in the central nervous system with a vasodilatory effect, histamine has a well-documented influence on the allergic response and could be involved in the pathophysiology of migraines. Histamine may influence hypothalamic activity, which may play a major role in migraines or may simply influence their severity. In both cases, antihistamine drugs could prove useful. This review examines whether the histaminergic system, particularly H3 and H4 receptors, may provide a mechanistic link between the pathophysiology of migraines and allergic disorders, two common and debilitating conditions. Identifying their connection could help identify novel therapeutic strategies.

Relationship of sleep quality, chronotype, and obstructive sleep apnea with migraine in the elderly population

PURPOSE

Disturbances of sleep have frequently been reported in individuals with migraine. On top of this, an elderly patient with migraine also suffers from sleep disturbances due to changes in physiologic and mental health associated with aging. This study aimed to compare several sleep factors, namely sleep quality, chronotype, and obstructive sleep apnea (OSA) risk, between elderly people with and without migraine.

METHODS

This was a multicenter cross-sectional study conducted in 10 neurologic clinics located in Tehran, Iran, over 2 years. The sample size was calculated as 189, including 63 migraine and 126 non-migraine patients.

RESULTS

A significant difference was observed in the mean score of the global Pittsburgh Sleep Quality Index (PSQI) between migraine and non-migraine groups (p-value = 0.002), and in the individual components of the PSQI. However, there were no significant differences in the frequency of different types of chronotype (p-value = 0.125, T = 1.541) or OSA risk between the two groups (p-value = 0.568, T = -0.573). The binary logistic regression model showed that the relationship between global PSQI and migraine was significant (p = 0.002).

CONCLUSION

Sleep quality is a problem for elderly migraine sufferers. Meanwhile, certain factors such as chronotype and OSA have no significant relationship with migraine among community-dwelling seniors. Further studies are required to enhance our understanding of this observation.

Normal glymphatic system function in patients with new daily persistent headache using diffusion tensor image analysis along the perivascular space

OBJECTIVES

To investigate the glymphatic function in patients with new daily persistent headache (NDPH) using the diffusion tensor image analysis along the perivascular space (DTI-ALPS) method.

BACKGROUND

NDPH, a rare and treatment-refractory primary headache disorder, is poorly understood. There is limited evidence to suggest that headaches are associated with glymphatic dysfunction. Thus far, no studies have evaluated glymphatic function in patients with NDPH.

METHODS

In this cross-sectional study conducted in the Headache Center of Beijing Tiantan Hospital, patients with NDPH and healthy controls were enrolled. All participants underwent brain magnetic resonance imaging examinations. Clinical characteristics and neuropsychological evaluation were examined in patients with NDPH. ALPS indexes for both hemispheres were measured to determine the glymphatic system function in patients with NDPH and healthy controls.

RESULTS

In total, 27 patients with NDPH (14 males, 13 females; age [mean ± standard deviation (SD)]: 36.6 ± 20.6) and 33 healthy controls (15 males, 18 females; age [mean ± SD]: 36.0 ± 10.8) were included in the analysis. No significant differences between groups were observed in the left ALPS index (1.583 ± 0.182 vs. 1.586 ± 0.175, mean difference = 0.003, 95% confidence interval [CI] of difference = -0.089 to 0.096, p = 0.942), or right ALPS index (1.578 ± 0.230 vs. 1.559 ± 0.206, mean difference = -0.027, 95% CI of difference = -0.132 to 0.094, p = 0.738). Additionally, ALPS indexes were not correlated with clinical characteristics or neuropsychiatric scores.

CONCLUSION

No glymphatic dysfunction was detected in patients with NDPH by means of the ALPS method. Additional studies with larger samples are needed to confirm these preliminary findings and improve the understanding of glymphatic function in NDPH.

Neurological manifestations in patients and disease carriers in an Italian family with osteosclerosis

BACKGROUND

Hereditary cranial hyperostosis is a rare disease never described in Italy, so the neurological manifestations in patients and carriers of the disease have been little studied.

METHODS

We describe the neurological and neuroimaging features of patients and carriers of the gene from a large Italian family with sclerosteosis.

RESULTS

In this family, genetic testing detected the homozygous p.Gln24X (c.70C > T) mutation of the SOST gene in the proband and a heterozygous mutation in 9 siblings. In homozygous adults, severe craniofacial hyperostosis was manifested by cranial neuropathy in childhood, chronic headache secondary to intracranial hypertension, and an obstructive sleep apnea syndrome in adults. In one of the adult patients, there was a compressible subcutaneous swelling in the occipital region caused by transosseous intracranial-extracranial occipital venous drainage, a compensation mechanism of obstructed venous drainage secondary to cranial hyperostosis. Mild cranial hyperostosis causing frequent headache and snoring was evident in the nine heterozygous subjects.

CONCLUSIONS

Multiple cranial neuropathies and headache in children, while severe chronic headache and sleep disturbances in adults, are the neurological manifestations of the first Italian family with osteosclerosis. It is reasonable to extend neurological and neuroimaging evaluation to gene carriers as well.

Sleep Disturbances in Adolescents With Idiopathic Intracranial Hypertension

BACKGROUND

We aimed to assess the presence of sleep disturbances in adolescents with idiopathic intracranial hypertension (IIH) and to determine whether demographic, anthropometric, and clinical factors are associated with disrupted sleep.

METHODS

Sleep disturbances and patterns were evaluated in a cohort of adolescents (aged 12 to 18 years) with ongoing IIH and compared with a healthy age- and sex-matched control group. All participants responded to three self-rating questionnaires: the School Sleep Habits Survey (SSHS), the Pediatric Sleep Questionnaire (PSQ), and the Depression, Anxiety, and Stress Scale. The study group's demographic, clinical, laboratory, and radiological data were documented, and their association with sleep patterns was examined.

RESULTS

Thirty-three adolescents with ongoing IIH and 71 healthy controls were included. There was a significantly higher prevalence of sleep disturbances in the IIH group compared with the controls (SSHS, P < 0.001 and PSQ, P < 0.001), as well as of their independent subscales: sleep-related breathing disorders (P = 0.006), daytime sleepiness (P = 0.04), sleep/wake disruptions (P < 0.001), and sleep-related depressive tendencies (P < 0.001). According to subgroup analyses, these differences were also present between the normal-weight adolescents but not between the overweight IIH and control adolescents. No differences were found in the demographic, anthropometric, and IIH disease-related clinical measures between individuals with IIH with disrupted and normal sleep patterns.

CONCLUSIONS

Sleep disturbances are common among adolescents with ongoing IIH, irrespective of their weight and disease-related characteristics. Screening adolescents with IIH for sleep disturbances is recommended as part of their multidisciplinary management.

Dialysis headache: prevalence and clinical presentation in hemodialysis and kidney transplant patients

Introduction Headache is a common symptom among hemodialysis patients, with a prevalence around 70%. Dialysis headache is defined according to International Classification of Headache Disorders (ICHD-3) as a headache without specific characteristics, occurring during and caused by hemodialysis that spontaneously disappears within 72 hours after the dialysis session. There is no consensus on trigger factors or physiopathology. Objective To evaluate prevalence, clinical characteristics, and associated factors with dialysis headache. Methods Observational study with quantitative analysis. Study patients were divided into two groups: (HD) 25 hemodialysis patients and (Tx) 25 early post kidney transplant patients. A structured questionnaire was applied to all patients, including Hospital Anxiety and Depression Scale (HADS) and Epworth Sleepiness Scale. Laboratory data, blood pressure and body weight were analyzed before and after one dialysis session. Results: In group HD, eight patients (32%) had diagnosis of dialysis headache, with pulsating headache (n=6, 75%), photophobia (n=6, 75%), phonophobia (n=4, 50%), and nauseas or vomiting (n=6, 75%), with a mean pain score of 7.75 ± 1.58. Headache group had higher scores of anxieties (7.00 ± 3.93 vs. 3.82 ± 3.23, p=0.03) and sleepiness (9.13 ± 3.94 vs. 4.76 ± 3.85, p=0.01), lower levels of serum calcium (p=0.01), and higher systolic (p=0.02) and diastolic (p=0.02) blood pressure pre dialysis. In group Tx, five patients (20%) reported dialysis headache, with pulsating headache (n=4, 80%), nauseas or vomiting (n=4, 80%), with a mean pain score of 8.0 ± 1.41. Headache group had a higher score of sleepiness (9.20 ± 4.32 vs. 4.80 ± 4.51, p=0.029) and were younger (38.93 ± 14.43 vs. 54.02 ± 8.31, p=0.03). Conclusion Headache is frequent among hemodialysis patients and had similar symptoms of migraine. In this series dialysis headache was associated with higher scores of anxieties and sleepiness, higher blood pressure and lower calcium pre dialysis.

Chiari Malformation Type 1 in Adults

The term Chiari malformation refers to a heterogeneous group of anatomical abnormalities at the craniovertebral junction. Chiari malformation type 1 (CM1) refers to the abnormal protrusion of cerebellar tonsils through the foramen magnum and is by far the commonest type. Its prevalence is estimated approximately 1%; it is more common in women and is associated with syringomyelia in 25-70% of cases. The prevalent pathophysiological theory proposes a morphological mismatch between a small posterior cranial fossa and a normally developed hindbrain that results in ectopia of the tonsils.In most people, CM1 is asymptomatic and diagnosed incidentally. In symptomatic cases, headache is the cardinal symptom. The typical headache is induced by Valsalva-like maneuvers. Many of the other symptoms are nonspecific, and in the absence of syringomyelia, the natural history is benign. Syringomyelia manifests with spinal cord dysfunction of varying severity. The approach to patients with CM1 should be multidisciplinary, and the first step in the management is phenotyping the symptoms, because they may be due to other pathologies, like a primary headache syndrome. Magnetic resonance imaging, which shows cerebellar tonsillar decent 5 mm or more below the foramen magnum, is the gold standard investigative modality. The diagnostic workup may include dynamic imaging of the craniocervical junction and intracranial pressure monitoring.The management of CM1 is variable and sometimes controversial. Surgery is usually reserved for patients with disabling headaches or neurological deficits from the syrinx. Surgical decompression of the craniocervical junction is the most widely used procedure. Several surgical techniques have been proposed, but there is no consensus on the best treatment strategy, mainly due to lack of high-quality evidence. The management of the condition during pregnancy, restriction to lifestyle related to athletic activities, and the coexistence of hypermobility require special considerations.

The Development of Psychiatric Illness and Chemoprophylaxis of Botulinum Toxin in Migraine: A Narrative Review

A migraine is not just a headache. It is an extremely prevalent neurological condition marked by periodic episodes of unilateral headache, with more than 10 million cases yearly. Migraine often begins at the age of puberty. It substantially impacts the brain and, consequently, psychiatric behavior linked with frequent migraine attacks that may be moderate to severe in intensity. A crucial aspect of migraine variability is comorbidity with other neurological diseases, vascular diseases, and mental illnesses. Psychiatric disorders related to migraine include anxiety disorders, panic disorder, bipolar disorder, depression, etc. It is also estimated that people suffering from migraine are about five times more likely to develop depression than others without migraine. The stimulus for migraine is stress, lack of sleep, skipped meal or fasting, visual stimulation due to high intensity of light, auditory stimulus due to noise, and olfactory stimulus due to a pungent smell. A majority of patients suffer from migraine attacks triggered by noise, some due to visual stimulation, and a few due to perfumes or other odors that trigger their migraine. Diagnosis of this is primarily dependent on history taking and clinical evaluation. Migraine can be classified depending on whether an aura is present or absent. It can further be divided based on the frequency of headaches into episodic migraine or chronic migraine, which may be determined by the duration of the headache. The development of migraine is influenced by both genetics and the environment. It has a detrimental effect on children's quality of life. A comprehensive analysis of psychiatric illnesses in migraine contributes to early diagnosis and proper treatment of the disease. Also, having a healthy lifestyle (including exercise, a balanced diet, and enough sleep) seems to prevent and improve the condition. Headache in migraine is resistant to medical treatment but responds well to botulinum toxin. This review primarily focuses on the psychiatric issues like depression and anxiety that often accompany migraine. The article also highlights the effects of botulinum toxin on migraine.

Obstructive sleep apnea and headache: an integrative review of the last 18 years

Introduction Obstructive sleep apnea (OSA) is a prevalent and underdiagnosed clinical condition, characterized by the presence of repetitive airway collapse during sleep, resulting in oxyhemoglobin desaturation and sleep fragmentation. Among the most frequent reports of patients with OSA, is morning headache or chronic daily headache, which in 2004 received its own classification in the International Classification of Headache Disorders (ICHD-2) as sleep apnea headache. Objective The present review aims to evaluate the available scientific literature on the association between OSA and headache after classification, totaling a period of 18 years. Results In 8 included studies, 1,637 patients were analyzed, observing a bilateral and frequent association between the two pathologies. Conclusion However, there is still no consensus on the mechanism behind this relationship, and the results of studies are divergent.

Melatonin as a treatment for migraine sufferers: a systematic review

Background

Migraine is a primary headache with a prevalence of 12–20% in the world. Approximately 38% sufferers were indicated for prophylactic therapy, but only a small proportion (3–13%) received prophylactic therapy. The role of melatonin in migraine is to protect the brain against toxins through anti-free radical activity, inhibition of the release of inflammatory factors and neurotransmitters.

Results

This review uses the PRISMA protocol and uses source from Pubmed. A total of 142 articles were found according to the search strategy. 5 articles were collected with a randomized-controlled trial design that matched the inclusion criteria. Of the 5 articles, there were only 2 articles that proved significant where melatonin gave better results compared to placebo in migraine sufferers, especially in the frequency of attacks, duration, and reduction in the use of other analgesics. Based on the dose and duration of melatonin administration, although most use a dose of 3 mg melatonin with a duration of 2–3 months, this still needs to be investigated further because the available data are not sufficient. In addition, the use of melatonin before going to bed at night is said to be better because it is associated with the majority of side effects that occur, namely sleepiness.

Conclusion

Studies on melatonin and migraine with a randomized-controlled trial design are still limited so there is not enough evidence to support the administration of melatonin as a treatment for migraine sufferers, including the safety and side effects, especially for a long period of time.

Stellate ganglion block rectifies excessive daytime sleepiness: a case report

Excessive daytime sleepiness (EDS) is classified as a neurofunctional disorder that manifests as uncontrolled sleeping propensity in the daytime. Currently, consistent and effective therapeutic approaches for EDS are lacking. Stellate ganglion block (SGB) has a clear effect in various complicated pain syndromes, vascular insufficiency, hyperhidrosis, and posttraumatic stress syndrome. We report an EDS case that involved a patient who recovered after several sessions of SGB.

The effect of tension variability for sleep quality in headache patients: A Holter monitoring study

BACKGROUND

Hypertension is one of the common causes of headaches. Disruption in the circadian rhythm of blood pressure (BP) also leads to some chronic diseases. Sleep disturbances have a relationship with neurologic and cardiac diseases. Our aim was to compare the sleep quality of patients with headaches showing dipper and nondipper BP patterns.

METHODS

This retrospective study included 57 patients who applied to a neurology clinic due to headaches and were referred to the cardiology department for Holter monitoring. Chronic diseases, drugs used, smoking and exercise habits, and physical examination findings were recorded. The 24-hour Holter monitoring results were classified as dipper and nondipper. The Pittsburgh Sleep Quality Index scores were determined for each patient. The Pittsburgh Sleep Quality Index scores of patients with dipper and nondipper patterns were compared.

RESULTS

The sleep quality of patients with dipper Holter patterns was better than that of patients with nondipper patterns (P < .001), and patients without chronic diseases had significantly better sleep quality compared with those with chronic diseases (P = .029). In the presence of chronic disease, the number of patients with a nondipper Holter pattern was higher (P = .024). There were no significant differences in Holter results or sleep quality between smokers and nonsmokers (P > .05).

CONCLUSION

Diagnoses of sleep disorders and BP abnormalities in the outpatient clinic are valuable in increasing the quality of life of patients and in preventing chronic diseases, especially cardiac diseases that may develop in the future.

Glymphatic System Dysfunction: A Novel Mediator of Sleep Disorders and Headaches

Sleep contributes to the maintenance of overall health and well-being. There are a growing number of patients who have headache disorders that are significantly affected by poor sleep. This is a paradoxical relationship, whereby sleep deprivation or excess sleep leads to a worsening of headaches, yet sleep onset also alleviates ongoing headache pain. Currently, the mechanism of action remains controversial and poorly understood. The glymphatic system is a newly discovered perivascular network that encompasses the whole brain and is responsible for removing toxic proteins and waste metabolites from the brain as well as replenishing nutrition and energy. Recent studies have suggested that glymphatic dysfunction is a common underlying etiology of sleep disorders and headache pain. This study reviews the current literature on the relationship between the glymphatic system, sleep, and headaches, discusses their roles, and proposes acupuncture as a non-invasive way to focus on the glymphatic function to improve sleep quality and alleviate headache pain.

Health-related quality of life and associated factors in Chinese menstrual migraine patients: a cross-sectional study

BACKGROUND

Menstrual migraine is a particular form of migraine with a significant impact on the quality of life for women afflicted. Presently, no study has reported the quality of life in menstrual migraine patients. This work aims to assess the health-related quality of life and identify its associated factors among Chinese menstrual migraine patients.

METHODS

The cross-sectional study group consisted of 109 patients with menstrual migraine, and the control group consisted of 397 female patients with non-menstrual migraine. In total, 506 patients completed questionnaires for demographic and clinical information, the Self-rating Idea of Suicide Scale, the Hamilton Depression Scale, the Hamilton Anxiety Scale, the Headache Impact Test-6, the Perceived Social Support Scale, the Pittsburgh Sleep Quality Index. Health-related quality of life was measured using the 36-Item Short Form Survey.

RESULTS

Compared with non-menstrual migraine patients, five dimensions of health-related quality of life were all found to be significantly impaired in menstrual migraine patients. Headache frequency (ß = - 0.218, P = 0.014), the impact of headache on daily life (ß = - 0.270, P = 0.002), depression symptoms (ß = - 0.345, P < 0.001) were significantly associated with physical component summary, depression symptoms (ß = - 0.379, P < 0.001), social support (ß = 0.270, P < 0.001), suicidal ideation (ß = - 0.344, P < 0.001) were closely related to mental component summary.

CONCLUSION

Menstrual migraine patients had a significantly poorer health-related quality of life in many domains than non-menstrual migraine patients. Headache frequency, the impact of headache on daily life, depression symptoms, social support, and suicidal ideation were significantly associated with health-related quality of life in menstrual migraine patients.

TRIAL REGISTRATION

ChiCTR1800014343. This study was registered prospectively on 7 January 2018 at Chinese Clinical Trial registry. http://www.chictr.org.cn/showproj.aspx?proj=24526.

Migraine signaling pathways: amino acid metabolites that regulate migraine and predispose migraineurs to headache

Migraine is a common, debilitating disorder for which attacks typically result in a throbbing, pulsating headache. Although much is known about migraine, its complexity renders understanding the complete etiology currently out of reach. However, two important facts are clear, the brain and the metabolism of the migraineur differ from that of the non-migraineur. This review centers on the altered amino acid metabolism in migraineurs and how it helps define the pathology of migraine.

Headache as a Neurologic Manifestation of Systemic Disease

Purpose of Review

Recent Findings

Summary

Prednisolone induces sleep disorders via inhibition of melatonin secretion by the circadian rhythm in zebrafish

Prednisolone (PN) is a glucocorticoid (GC) analog that is clinically used to treat allergic inflammation and autoimmune diseases. However, the long-term use of GC-like drugs results in many side effects, among which sleep disorders caused by PN have attracted much attention. Many studies have showed that GCs indirectly cause sleep disorders by disrupting the circadian rhythm of the peripheral biological clock. However, the detailed mechanism of this effect in zebrafish remains unclear. In the present study, we aimed to study the pharmacology and toxicology of PN by analyzing the sleep phenotype and internal circadian oscillation of zebrafish. Exposure of zebrafish to PN resulted in decreased melatonin secretion and shortened sleep time. Additionally, analysis of the internal circadian rhythm of the zebrafish revealed that the expression of per and cry was significantly upregulated, resulting in a significant delay in the phase of the zebrafish behavioral rhythm. A dual-luciferase reporter assay further revealed that PN repressed per2 and cry1aa expression via the GC receptor (GR), which inhibited aanat2 expression. This caused a decrease in melatonin secretion and led to sleep disorders. The findings of this study highlight the mechanisms underlying the effects of GCs on sleep.

Nightmares in Migraine: A Focused Review

Nightmares usually occur during the sleep phase of rapid eye movement (REM) and are associated with some physical symptoms, including sweating, shortness of breath, and lower limb movements. Emotions of fear, anger, shame, and sadness may also accompany nightmares. These symptoms can occur during dreaming, upon awakening, or later when the dream experience is recollected. Nightmares may sporadically occur for everyone, but nightmare disorders are associated with features of impaired mental and physical health and require professional medical treatment. The occurrence of nightmares with several disorders has been reported in the literature, but in migraines it has only been investigated in a small number of studies. Considering the existing relationship between sleep disorders and migraine, the occurrence of nightmares in migraine can negatively affect this association and elevate the risk of depression and anxiety. This, in turn, further reduces the quality of life of affected individuals. Hence, expanding the knowledge on the link between nightmares and migraine, promoting an acceptable quantity and quality of sleep through pharmacological and nonpharmacological interventions in the management of nightmares in migraine, and further scientific investigation of the biopsychosocial mechanisms underlying the link, will be highly valuable for optimal care. This focused review, therefore, gives a brief overview of the current understanding of nightmares in migraine to highlight the open questions and value of further research. The ultimate goal is to contribute to timely recognition and sufficient action to offer beneficial outcomes for affected patients.

Comorbidities of primary headache disorders: a literature review with meta-analysis

Background

Primary headache disorders are common and burdensome conditions. They are associated to several comorbidities, such as cardiovascular or psychiatric ones, which, in turn, contribute to the global burden of headache. The aim of this study is to provide a comprehensive description of the pooled prevalence of comorbidities of primary headache disorders using a meta-analytical approach based on studies published between 2000 and 2020.

Methods

Scopus was searched for primary research (clinical and population studies) in which medical comorbidities were described in adults with primary headache disorders. Comorbidities were extracted using a taxonomy derived from the Global Burden of Disease (GBD) study. We compared prevalence of comorbidities among headache sufferers against general population using GBD-2019 estimates, and compared comorbidities’ proportions in clinical vs. population studies, and by age and gender.

Results

A total of 139 studies reporting information on 4.19 million subjects with primary headaches were included: in total 2.75 million comorbidities were reported (median per subject 0.64, interquartile range 0.32–1.07). The most frequently addressed comorbidities were: depressive disorders, addressed in 51 studies (pooled proportion 23 %, 95 % CI 20–26 %); hypertension, addressed in 48 studies (pooled proportion 24 %, 95 % CI 22–26 %); anxiety disorders addressed in 40 studies (pooled proportion 25 %, 95 % CI 22–28 %). For conditions such as anxiety, depression and back pain, prevalence among headache sufferers was higher than in GBD-2109 estimates. Associations with average age and female prevalence within studies showed that hypertension was more frequent in studies with higher age and less females, whereas fibromyalgia, restless leg syndrome, and depressive disorders were more frequent in studies with younger age and more female.

Conclusions

Some of the most relevant comorbidities of primary headache disorders – back pain, anxiety and depression, diabetes, ischemic heart disease and stroke – are among the most burdensome conditions, together with headache themselves, according to the GBD study. A joint treatment of headaches and of these comorbidities may positively impact on headache sufferers’ health status and contribute to reduce the impact of a group of highly burdensome diseases.

Supplementary Information

The online version contains supplementary material available at 10.1186/s10194-021-01281-z.

Migraine Is More Than Just Headache: Is the Link to Chronic Fatigue and Mood Disorders Simply Due to Shared Biological Systems?

Migraine is a symptomatically heterogeneous condition, of which headache is just one manifestation. Migraine is a disorder of altered sensory thresholding, with hypersensitivity among sufferers to sensory input. Advances in functional neuroimaging have highlighted that several brain areas are involved even prior to pain onset. Clinically, patients can experience symptoms hours to days prior to migraine pain, which can warn of impending headache. These symptoms can include mood and cognitive change, fatigue, and neck discomfort. Some epidemiological studies have suggested that migraine is associated in a bidirectional fashion with other disorders, such as mood disorders and chronic fatigue, as well as with other pain conditions such as fibromyalgia. This review will focus on the literature surrounding alterations in fatigue, mood, and cognition in particular, in association with migraine, and the suggested links to disorders such as chronic fatigue syndrome and depression. We hypothesize that migraine should be considered a neural disorder of brain function, in which alterations in aminergic networks integrating the limbic system with the sensory and homeostatic systems occur early and persist after headache resolution and perhaps interictally. The associations with some of these other disorders may allude to the inherent sensory sensitivity of the migraine brain and shared neurobiology and neurotransmitter systems rather than true co-morbidity.

Migraine and Sleep-An Unexplained Association?

Migraine and sleep disorders are common chronic diseases in the general population, with significant negative social and economic impacts. The association between both of these phenomena has been observed by clinicians for years and is confirmed by many epidemiological studies. Despite this, the nature of this relationship is still not fully understood. In recent years, there has been rapid progress in understanding the common anatomical structures of and pathogenetic mechanism between sleep and migraine. Based on a literature review, the authors present the current view on this topic as well as ongoing research in this field, with reference to the key points of the biochemical and neurophysiological processes responsible for both these disorders. In the future, a better understanding of these mechanisms will significantly expand the range of treatment options.

Use of Nutraceutical Ingredient Combinations in the Management of Tension-Type Headaches with or without Sleep Disorders

Headache is the most common pain complaint in the pediatric population, with tension type headache (TTH) having a prevalence of 10–15% in children. Up to 70% of pediatric patients with chronic headache also experience sleep disruption, with a likely bidirectional relationship between headache and poor sleep. Treatment options include specific pharmacological approaches as well as non-pharmacological alternatives; nutraceuticals have the advantage of a relative lack of side effects. Exogenous melatonin has been shown to be useful and safe in improving sleep-wake cycles and quality of sleep in children, helping to regulate the circadian rhythm, with a secondary positive impact on headache. Supplementation with other nutraceutical ingredients, such as tryptophan, magnesium, and B vitamins, can have significant additional effects in children with primary headache, with or without sleep disorders. Tryptophan may reduce night awakenings and improve the efficiency of sleep. Primary headache has been related to low amounts of magnesium in serum, and integration with magnesium appears to be effective in reducing headache attacks without adverse effects. There are different observational reports and uncontrolled studies suggesting a possible synergistic effect for these nutraceuticals, but there is now a need for high-quality randomized controlled trials in order to confirm these positive preliminary findings.

Premonitory symptoms in migraine from China: A multi-clinic study of 4821 patients

OBJECTIVE

To observe the prevalence and characteristics of premonitory symptoms in Chinese migraineurs and explore their associations with migraine-related factors.

METHOD

Migraineurs who visited a tertiary headache clinic and one of nine neurology clinics between May 2014 and November 2019 were studied.

RESULT

Among the 4821 patients meeting the migraine criteria (International Classification of Headache Disorders, 3rd edition), 1038 (21.5%) patients experienced at least one premonitory symptom. The most common premonitory symptoms were neck stiffness, dizziness, yawning and drowsiness. The logistic regression analysis demonstrated that aura, photophobia, aggravation by routine physical activity, triggers, family history, depression, coffee consumption and physical exercise were associated with an increased probability of experiencing premonitory symptoms (p ≤ 0.001). The premonitory symptoms of migraine with and without aura differ in prevalence and most common symptoms. The cluster analysis revealed pairwise clustering of the following premonitory symptoms: Photophobia/phonophobia, concentration change/dysesthesia, loquacity/overactivity, yawning/drowsiness, fatigue/dizziness, and mood change/irritability. The correlation analysis of triggers and premonitory symptoms revealed that temperature change, environment change, sleep disorder, activity and stress were related to multiple premonitory symptoms, and that food, light, menstruation, alcohol and odor were related to special premonitory symptoms (p ≤ 0.001).

CONCLUSION

The prevalence of premonitory symptoms among migraineurs in China is 21.5%. Some factors influence the probability of experiencing premonitory symptoms. Paired premonitory symptoms in the clustering analysis may share similar origins. Certain triggers associated with multiple premonitory symptoms may induce brain dysfunction; however, other triggers that overlap with corresponding special premonitory symptoms may be premonitory symptoms or a form of premonitory symptom.

New Mobile Device to Measure Verticality Perception: Results in Young Subjects with Headaches

The subjective visual vertical (SVV) test has been frequently used to measure vestibular contribution to the perception of verticality. Recently, mobile devices have been used to efficiently perform this measurement. The aim of this study was to analyze the perception of verticality in subjects with migraines and headaches. A cross-sectional study was conducted that included 28 patients with migraine, 74 with tension-type headache (TTH), and 93 healthy subjects. The SVV test was used through a new virtual reality system. The mean absolute error (MAE) of degrees deviation was also measured to qualify subjects as positive when it was greater than 2.5°. No differences in the prevalence of misperception in verticality was found among healthy subjects (31.18%), migraineurs (21.43%), or those with TTH (33.78%) (p = 0.480). The MAE was not significantly different between the three groups (migraine = 1.36°, TTH = 1.61°, and healthy = 1.68°) (F = 1.097, p = 0.336, and η2 = 0.011). The perception of verticality could not be explained by any variable usually related to headaches. No significant differences exist in the vestibular contribution to the perception of verticality between patients with headaches and healthy subjects. New tests measuring visual and somatosensory contribution should be used to analyze the link between the perception of verticality and headaches.

Sleep Alterations in Female College Students with Migraines

Background: Many factors are thought to potentially trigger migraines, among which sleep disturbances are one of the most frequently reported. Both sleep disorders and migraines affect more women than men. This study aims to analyze sleep alterations in young adult women with migraines and how they are related to the presence, frequency, intensity, and disability of migraines in this population. Methods: Fifty-one female university students with physician-diagnosed migraines and 55 healthy female university students completed surveys assessing demographic information and frequency, intensity, and disability of migraines and sleep quality variables. Results: No differences in sleep quality were found between migraine subjects and healthy women (p = 0.815), but women with migraines presented higher daytime somnolence (p = 0.010), greater sleep disruptions (p = 0.002), and decreased sleep adequacy (p = 0.019). The presence of a migraine was significantly related to daytime somnolence (p = 0.003) and sleep disruptions (p = 0.021). Migraine-related disability was associated with sleep disruptions (p = 0.002), snoring (p = 0.016), and a decreased quantity of sleep (p = 0.040). Migraine frequency was related to sleep disturbance (p = 0.003) and snoring (p < 0.001). The intensity of migraines was associated with sleep disruptions (p = 0.004). Conclusions: Our results suggest a relationship between migraines and sleep alterations.

[Migraine burden and clinical inertia: what can we do?]

AIM

To study the compliance of neurologists and headache specialists to chronic headache and chronic migraine (CM) diagnosis and treatment guidelines.

MATERIAL AND METHODS

The survey included 634 neurologists from all regions of the Russian Federation. Mean age of respondents was 40.7±8.5 years, mean years of experience 14.2±7.8 years.

RESULTS

Most doctors work in outpatient or hospital settings (49% and 24%, respectively), 7% were headache specialists. Tension-type headache (TTH) was diagnosed in 30% and CM in 17% of patients while 44% of patients were presumed to have a mixed headache disorder (TTH+CM). Only 10% of physicians do not use instrumental diagnostic methods in chronic headache. This study has shown sufficient attention to comorbid conditions and frequent prescription of headache preventative treatment. Botox prescription data is equivocal: 35% of physicians recommend such treatment, 27% do not, while other doctors prescribe it for off-label indications.

CONCLUSION

To overcome clinical inertia, further education in chronic headaches and their optimal treatment is warranted.

Role of Melatonin in the Regulation of Pain

Melatonin is a pleiotropic hormone synthesized and secreted mainly by the pineal gland in vertebrates. Melatonin is an endogenous regulator of circadian and seasonal rhythms. Melatonin is involved in many physiological and pathophysiological processes demonstrating antioxidant, antineoplastic, anti-inflammatory, and immunomodulatory properties. Accumulating evidence has revealed that melatonin plays an important role in pain modulation through multiple mechanisms. In this review, we examine recent evidence for melatonin on pain regulation in various animal models and patients with pain syndromes, and the potential cellular mechanisms.

The relationship between obstructive sleep apnea and Parkinson's disease: a systematic review and meta-analysis

BACKGROUND

Obstructive sleep apnea (OSA) is a common sleep disorder in Parkinson's disease (PD). However, the relationship between OSA and PD is still inconsistent. Our study was aimed to evaluate the relationship between PD and OSA.

METHODS

Studies on OSA and PD were searched using PubMed, Embase, Web of Science, Cochrane library, and Chinese National Knowledge Infrastructure databases. Review Manager 5.3 software was used to calculate the pooled estimate effect. The inverse variance model was used to pool the mean difference (MD) or hazard ratios (HRs); the Mantel-Haenszel method was used to pool the odds ratio (OR). Heterogeneity among the studies was assessed using I² statistic and Q test.

RESULTS

A total of 12 studies with 93,332 cases were deemed eligible and included in our meta-analysis. Overall, the occurrence of PD was more frequent in patients with OSA (HR 1.59, 95% CI, 1.36-1.85). The subgroup analysis demonstrated the risk similarly by sex. Male and female had HR of incident PD with OSA of 1.56 (95% CI, 1.30-1.87) and 1.60 (95% CI, 1.21-2.11), respectively. The incidence of OSA did not increase in PD patients (OR 0.89, 95% CI, 0.53-1.49). The MD of apnea-hypopnea index (AHI) in PD patients was also not statistically significant (P = 0.5).

CONCLUSIONS

The results indicate that OSA is one of independent risk factors of PD. However, OSA does not seem to be abnormally frequent in PD.