Sleep disturbances and excessive daytime sleepiness in migraine: A comparison between comorbidities and disability

Microstructural changes of basal ganglia in migraine with restless legs syndrome: findings from a neuroimaging study

In this study, it is planned to investigate the integrity of the basal ganglia structures in migraineurs with restless legs syndrome (RLS) to explore this relationship. In this study, 58 patients who were diagnosed migraine and 51 healthy controls (HCs) were included. Patients diagnosed with migraine were divided into two groups: Group I (migraine without RLS) and Group II (migraine with RLS). The integrity of basal ganglia was evaluated with region of interest diffusion tensor imaging method which allows us to assess microstructural changes of the tissue. The mean age of the patients was 35.98 ± 7.92 years, and the mean age of the HCs was 33.84 ± 11.06. 84.5% (n = 49) of the patients were female and 15.5% (n = 9) were male. 82.4% (n = 42) of the HCs were female, 17.6% (n = 9) were male. The number of  the patients without RLS was 41 (Group I), and the number of the patients with RLS was 17 (Group II). When basal ganglia structures were compared between groups of the patients with and without RLS, the fractional anisotropy (FA) value of the left putamen differed (Group I: 0.30 ± 0.06 vs. Group II: 0.25 ± 0.7, p = 0.01). The significant relationship was found attack frequency and presence of RLS with left putamen FA values according to multiple regression analysis. It was determined in this study that the changes in the microstructure of putamen, one of the basal ganglia structures, may be associated with the presence of RLS in migraineurs.

Subjective Sleep Quality and Sleep Architecture in Patients With Migraine: A Meta-analysis

Background and Objectives

Sleep disturbance is often associated with migraine. However, there is a paucity of research investigating objective and subjective measures of sleep in patients with migraine. This meta-analysis aims to determine whether there are differences in subjective sleep quality measured using the Pittsburgh Sleep Quality Index (PSQI) and objective sleep architecture measured using polysomnography (PSG) between adult and pediatric patients and healthy controls.

Methods

This review was preregistered on PROSPERO (CRD42020209325). A systematic search of 5 databases (Embase, MEDLINE, Global Health, APA PsycINFO, and APA PsycArticles, last searched on December 17, 2020) was conducted to find case–control studies that measured PSG or PSQI in patients with migraine. Pregnant participants and those with other headache disorders were excluded. Effect sizes (Hedges g) were entered into a random effects model meta-analysis. Study quality was evaluated with the Newcastle Ottawa Scale and publication bias with the Egger regression test.

Results

Thirty-two studies were eligible, of which 21 measured PSQI or Migraine Disability Assessment Test in adults, 6 measured PSG in adults, and 5 measured PSG in children. The overall mean study quality score was 5/9; this did not moderate any of the results and there was no risk of publication bias. Overall, adults with migraine had higher PSQI scores than healthy controls (g = 0.75, p < 0.001, 95% confidence interval [CI] 0.54–0.96). This effect was larger in those with a chronic rather than episodic condition (g = 1.03, p < 0.001, 95% CI 0.37–1.01; g = 0.63, p < 0.001, 95% CI 0.38–0.88, respectively). For polysomnographic studies, adults and children with migraine displayed a lower percentage of rapid eye movement sleep (g = −0.22, p = 0.017, 95% CI −0.41 to −0.04; g = −0.71, p = 0.025, 95% CI −1.34 to −0.10, respectively) than controls. Pediatric patients displayed less total sleep time (g = −1.37, p = 0.039, 95% CI −2.66 to −0.10), more wake (g = 0.52, p < 0.001, 95% CI 0.08–0.79), and shorter sleep onset latency (g = −0.37, p < 0.001, 95% CI −0.54 to −0.21) than controls.

Discussion

People with migraine have significantly poorer subjective sleep quality and altered sleep architecture compared to healthy individuals. Further longitudinal empirical studies are required to enhance our understanding of this relationship.

Botulinum toxin type A wear-off phenomenon in chronic migraine patients: how long does the maximum efficiency last?

BACKGROUND

Botulinum toxin Type A (BoNTA) is a successful treatment for chronic migraine prophylaxis.

OBJECTIVE

We aimed to evaluate the monthly change of effectiveness of BoNTA treatment.

METHODS

A total of 80 patients (70 females and 10 males) with chronic migraine were included. In our study protocol, we applied to 155 U across 31 fixed-sites and if the patient had pain, 40 U dose injections were applied across 8 specific head/neck muscle areas. Headache days and analgesic intake were noted before the BoNTA injection and during the interviews at the first, second, and third months after the BoNTA injection.

RESULTS

The mean age was 37.59 ± 7.60 and 87.5% of the patients were female. The mean number of headache days/month before BoNTA was 18.95±2.69, decreasing to 10.55±3.15 days/month in the first month (p<0.001), 9.31±2.43 days/month in the second month (p<0.001), and increased to 11.97±3.27 days/month in the third month (p<0.001). The mean analgesic intake before BoNTA was 11.48±4.68 tablets/month, while it decreased to 6.53±2.72 tablets/month in the first month (p<0.001) and 5.40±2.46 tablets/month in the second month (p<0.001). In the third month, it was 5.85±2.59 tablets/month (p<0.001). There was a significant increase in pain medication use from the second to the third month (p<0.001).

CONCLUSION

In our study, there was a significant reduction in analgesic intake and headache days in the first and second months after BoNTA injection, and an increase was observed in the third month.

Subjective cognitive impairment in patients with transformed migraine and the associated psychological and sleep disturbances

PURPOSE

Migraines are associated with multiple comorbidities like depression, anxiety, poor sleep quality, and subjective cognitive impairment (SCI). This study aimed to evaluate the association of SCI with depression, anxiety, and modalities of sleep in those who have transformed migraines (TM).

SUBJECTS AND METHODS

The study was conducted on 120 participants with TM and 41 control group participants. The subjective cognitive decline questionnaire classified the participants as SCI and non-SCI. The Headache Impact Test-6, Migraine Disability Assessment, Montreal Cognitive Assessment, Mini-Mental State Examination, Patient Health Questionnaire-9, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Full Polysomnography, and Beck's Anxiety and the Depression Inventories were used and analyzed between patients with SCI and non-SCI.

RESULTS

Patients with TM who had SCI represented 34% with severe headache effects, disability, pain severity, increased depression, and increased anxiety. They showed shorter sleep duration during weekdays, lower sleep quality, less sleep time, lower efficiency, and less REM sleep along with greater sleep latency, periodic limb movements, a higher arousal index, snore index, and percent of NREM3. There was a positive correlation between certain polysomnography parameters like percent NREM3, sleep period, sleep index, sleep latency, sleep arousal index, and periodic limb movements, and an inverse correlation with the percent of REM sleep, total sleep time, and sleep efficiency.

CONCLUSION

Subjective cognitive complaints are common in patients with transformed migraine affecting about 34% of cases. TM patients with SCI had more sleep and psychological disturbances.

TRIAL REGISTRATION

Clinicaltrials.gov is NCT04413110.

Migraine and sleep disorders: a systematic review

Migraine and sleep disorders are common and often burdensome chronic conditions with a high prevalence in the general population, and with considerable socio-economic impact and costs.The existence of a relationship between migraine and sleep disorders has been recognized from centuries by clinicians and epidemiological studies. Nevertheless, the exact nature of this association, the underlying mechanisms and interactions are complex and not completely understood. Recent biochemical and functional imaging studies identified central nervous system structures and neurotransmitters involved in the pathophysiology of migraine and also important for the regulation of normal sleep architecture, suggesting a possible causative role, in the pathogenesis of both disorders, of a dysregulation in these common nervous system pathways.This systematic review summarizes the existing data on migraine and sleep disorders with the aim to evaluate the existence of a causal relationship and to assess the presence of influencing factors. The identification of specific sleep disorders associated with migraine should induce clinicians to systematically assess their presence in migraine patients and to adopt combined treatment strategies.