Top

The Journal of Headache and Pain

Published in:

Open Access 01-12-2023 | Migraine | Research

Investigating the relationship between sleep and migraine in a global sample: a Bayesian cross-sectional approach

Authors: Emily C. Stanyer, Jack Brookes, Jia Rong Pang, Alexandre Urani, Philip R. Holland, Jan Hoffmann

Published in: The Journal of Headache and Pain | Issue 1/2023

Abstract

Background

There is a bidirectional link between sleep and migraine, however causality is difficult to determine. This study aimed to investigate this relationship using data collected from a smartphone application.

Methods

Self-reported data from 11,166 global users (aged 18–81 years, mean: 41.21, standard deviation: 11.49) were collected from the Migraine Buddy application (Healint Pte. Ltd.). Measures included: start and end times of sleep and migraine attacks, and pain intensity. Bayesian regression models were used to predict occurrence of a migraine attack the next day based on users’ deviations from average sleep, number of sleep interruptions, and hours slept the night before in those reporting ≥ 8 and < 25 migraine attacks on average per month. Conversely, we modelled whether attack occurrence and pain intensity predicted hours slept that night.

Results

There were 724 users (129 males, 412 females, 183 unknown, mean age = 41.88 years, SD = 11.63), with a mean monthly attack frequency of 9.94. More sleep interruptions (95% Highest Density Interval (95%HDI [0.11 – 0.21]) and deviation from a user’s mean sleep (95%HDI [0.04 – 0.08]) were significant predictors of a next day attack. Total hours slept was not a significant predictor (95%HDI [-0.04 – 0.04]). Pain intensity, but not attack occurrence was a positive predictor of hours slept.

Conclusions

Sleep fragmentation and deviation from typical sleep are the main drivers of the relationship between sleep and migraine. Having a migraine attack does not predict sleep duration, yet the pain associated with it does. This study highlights sleep as crucial in migraine management.

Available only for authorised users

Holland PR (2014) Headache and sleep: shared pathophysiological mechanisms. Cephalalgia 34:725–744. https://doi.org/10.1177/0333102414541687CrossRefPubMed

Dodick DW, Eross EJ, Parish JM (2003) Clinical, anatomical, and physiologic relationship between sleep and headache. Headache J Head Face Pain 43:282–292. https://doi.org/10.1046/j.1526-4610.2003.03055.xCrossRef

Moldofsky H (2001) Sleep and pain. Sleep Med Rev 5:385–396. https://doi.org/10.1053/smrv.2001.0179CrossRefPubMed

Gago-Veiga AB, Vivancos J, Sobrado M (2019) The premonitory phase: a crucial stage in migraine. Neurol Engl Ed. https://doi.org/10.1016/j.nrleng.2017.09.006

Kelman L (2007) The triggers or precipitants of the acute migraine attack. Cephalalgia 27:394–402. https://doi.org/10.1111/j.1468-2982.2007.01303.xCrossRefPubMed

Bigal ME, Lipton RB (2009) What predicts the change from episodic to chronic migraine? Curr Opin Neurol 22:269–276. https://doi.org/10.1097/WCO.0b013e32832b2387CrossRefPubMed

Kelman L, Rains JC (2005) Headache and sleep: examination of sleep patterns and complaints in a large clinical sample of Migraineurs. Headache J Head Face Pain 45:904–910. https://doi.org/10.1111/j.1526-4610.2005.05159.xCrossRef

Nesbitt AD, Leschziner GD, Peatfield RC (2014) Headache, drugs and sleep. Cephalalgia 34:756–766. https://doi.org/10.1177/0333102414542662CrossRefPubMed

Hamelsky SW, Lipton RB (2006) Psychiatric comorbidity of migraine. Headache J Head Face Pain 46:1327–1333. https://doi.org/10.1111/j.1526-4610.2006.00576.xCrossRef

10.

Stanyer EC, Creeney H, Nesbitt AD et al (2021) Subjective sleep quality and sleep architecture in patients with migraine: a meta-analysis. Neurology. https://doi.org/10.1212/WNL.0000000000012701CrossRefPubMedPubMedCentral

11.

Vos T, Abajobir AA, Abate KH et al (2017) Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the global burden of disease study 2016. The Lancet 390:1211–1259. https://doi.org/10.1016/S0140-6736(17)32154-2CrossRef

12.

Kawata AK, Shah N, Poon J-L et al (2021) Understanding the migraine treatment landscape prior to the introduction of calcitonin gene-related peptide inhibitors: results from the Assessment of TolerabiliTy and Effectiveness in MigrAINe Patients using Preventive Treatment (ATTAIN) study. Headache J Head Face Pain 61:438–454. https://doi.org/10.1111/head.14053CrossRef

13.

Al-Hassany L, Boucherie DM, Creeney H et al (2023) Future targets for migraine treatment beyond CGRP. J Headache Pain 24:76. https://doi.org/10.1186/s10194-023-01567-4CrossRefPubMedPubMedCentral

14.

Edwards RR, Almeida DM, Klick B et al (2008) Duration of sleep contributes to next-day pain report in the general population. Pain® 137:202–207. https://doi.org/10.1016/j.pain.2008.01.025CrossRefPubMed

15.

Houle TT, Butschek RA, Turner DP et al (2012) Stress and sleep duration predict headache severity in chronic headache sufferers. Pain® 153:2432–2440. https://doi.org/10.1016/j.pain.2012.08.014CrossRefPubMedPubMedCentral

16.

Smith MT, Edwards RR, McCann UD, Haythornthwaite JA (2007) The effects of sleep deprivation on pain inhibition and spontaneous pain in women. Sleep 30:494–505. https://doi.org/10.1093/sleep/30.4.494CrossRefPubMed

17.

Bertisch SM, Li W, Buettner C et al (2019) Nightly sleep duration, fragmentation, and quality and daily risk of migraine. Neurology. https://doi.org/10.1212/WNL.0000000000008740.10.1212/WNL.0000000000008740CrossRefPubMed

18.

Ahn AH, Goadsby PJ (2013) Migraine and sleep: new connections. Cerebrum Dana Forum Brain Sci 2013:15

19.

Leso V, Gervetti P, Mauro S et al (2020) Shift work and migraine: a systematic review. J Occup Health 62:e12116. https://doi.org/10.1002/1348-9585.12116CrossRefPubMedPubMedCentral

20.

Hoffmann J, Schirra T, Lo H et al (2015) The influence of weather on migraine – are migraine attacks predictable? Ann Clin Transl Neurol 2:22–28. https://doi.org/10.1002/acn3.139CrossRefPubMed

21.

Zhao I, Bogossian F, Turner C (2012) The effects of shift work and interaction between shift work and overweight/obesity on low back pain in nurses: results from a longitudinal study. J Occup Environ Med 54:820–825CrossRefPubMed

22.

Mulligan EP, Brunette M, Shirley Z, Khazzam M (2015) Sleep quality and nocturnal pain in patients with shoulder disorders. J Shoulder Elbow Surg 24:1452–1457. https://doi.org/10.1016/j.jse.2015.02.013CrossRefPubMed

23.

Marty M, Rozenberg S, Duplan B et al (2008) Quality of sleep in patients with chronic low back pain: a case-control study. Eur Spine J 17:839–844. https://doi.org/10.1007/s00586-008-0660-7CrossRefPubMedPubMedCentral

24.

Keilani M, Crevenna R, Dorner TE (2018) Sleep quality in subjects suffering from chronic pain. Wien Klin Wochenschr 130:31–36. https://doi.org/10.1007/s00508-017-1256-1CrossRefPubMed

25.

Bjurstrom MF, Irwin MR (2016) Polysomnographic characteristics in nonmalignant chronic pain populations: a review of controlled studies. Sleep Med Rev 26:74–86. https://doi.org/10.1016/j.smrv.2015.03.004CrossRefPubMed

26.

Wylde V, Rooker J, Halliday L, Blom A (2011) Acute postoperative pain at rest after hip and knee arthroplasty: severity, sensory qualities and impact on sleep. Orthop Traumatol Surg Res 97:139–144. https://doi.org/10.1016/j.otsr.2010.12.003CrossRefPubMed

27.

Alstadhaug KB, Bekkelund S, Salvesen R (2007) Circannual periodicity of migraine? Eur J Neurol 14:983–988. https://doi.org/10.1111/j.1468-1331.2007.01828.xCrossRefPubMed

28.

Fino E, Mazzetti M (2019) Monitoring healthy and disturbed sleep through smartphone applications: a review of experimental evidence. Sleep Breath 23:13–24. https://doi.org/10.1007/s11325-018-1661-3CrossRefPubMed

29.

Headache Classification Committee of the International Headache Society (IHS) (2018) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 38:1–211. https://doi.org/10.1177/0333102417738202CrossRef

30.

Matthews R (2001) Why should clinicians care about Bayesian methods? J Stat Plan Inference 94:43–58. https://doi.org/10.1016/S0378-3758(00)00232-9CrossRef

31.

Amrhein V, Greenland S, McShane B (2019) Scientists rise up against statistical significance. Nature 567:305–307. https://doi.org/10.1038/d41586-019-00857-9CrossRefPubMed

32.

Baldwin SA, Larson MJ (2017) An introduction to using Bayesian linear regression with clinical data. Behav Res Ther 98:58–75. https://doi.org/10.1016/j.brat.2016.12.016CrossRefPubMed

33.

Dorffner G, Vitr M, Anderer P (2015) The Effects of Aging on Sleep Architecture in Healthy Subjects. In: Vlamos P, Alexiou A (eds) GeNeDis 2014. Springer International Publishing, Cham, pp 93–100CrossRef

34.

Steiner TJ, Stovner LJ (2023) Global epidemiology of migraine and its implications for public health and health policy. Nat Rev Neurol 19:109–117. https://doi.org/10.1038/s41582-022-00763-1CrossRefPubMed

35.

Iacovides S, George K, Kamerman P, Baker FC (2017) Sleep fragmentation hypersensitizes healthy young women to deep and superficial experimental pain. J Pain 18:844–854. https://doi.org/10.1016/j.jpain.2017.02.436CrossRefPubMed

36.

Rosseland R, Pallesen S, Nordhus IH et al (2018) Effects of sleep fragmentation and induced mood on pain tolerance and pain sensitivity in young healthy adults. Front Psychol 9:2089CrossRefPubMedPubMedCentral

37.

Inamorato E, Minatti-Hannuch SN, Zukerman E (1993) The role of sleep in migraine attacks. Arq Neuropsiquiatr 51:429–432. https://doi.org/10.1590/S0004-282X1993000400001CrossRefPubMed

38.

Heyer GL, Rose SC, Merison K et al (2014) Specific headache factors predict sleep disturbances among youth with migraine. Pediatr Neurol 51:489–493. https://doi.org/10.1016/j.pediatrneurol.2014.07.001CrossRefPubMed

39.

Xie L, Kang H, Xu Q et al (2013) Sleep drives metabolite clearance from the adult brain. Science 342:373–377. https://doi.org/10.1126/science.1241224CrossRefPubMed

40.

Grech O, Mollan SP, Wakerley BR et al (2021) The role of metabolism in migraine pathophysiology and susceptibility. Life 11:415. https://doi.org/10.3390/life11050415CrossRefPubMedPubMedCentral

41.

Schain AJ, Melo-Carrillo A, Strassman AM, Burstein R (2017) Cortical spreading depression closes paravascular space and impairs glymphatic flow: implications for migraine headache. J Neurosci 37:2904–2915. https://doi.org/10.1523/JNEUROSCI.3390-16.2017CrossRefPubMedPubMedCentral

42.

Cui Y, Kataoka Y, Inui T et al (2008) Up-regulated neuronal COX-2 expression after cortical spreading depression is involved in non-REM sleep induction in rats. J Neurosci Res 86:929–936. https://doi.org/10.1002/jnr.21531CrossRefPubMed

43.

Faraguna U, Nelson A, Vyazovskiy VV et al (2010) Unilateral cortical spreading depression affects sleep need and induces molecular and electrophysiological signs of synaptic potentiation In Vivo. Cereb Cortex 20:2939–2947. https://doi.org/10.1093/cercor/bhq041CrossRefPubMedPubMedCentral

44.

Ong JC, Taylor HL, Park M et al (2018) Can circadian dysregulation exacerbate migraines? Headache J Head Face Pain 58:1040–1051. https://doi.org/10.1111/head.13310CrossRef

45.

Charles A (2018) The pathophysiology of migraine: implications for clinical management. Lancet Neurol 17:174–182. https://doi.org/10.1016/S1474-4422(17)30435-0CrossRefPubMed

46.

Campbell SS, Murphy PJ, Stauble TN (2005) Effects of a Nap on nighttime sleep and waking function in older subjects. J Am Geriatr Soc 53:48–53. https://doi.org/10.1111/j.1532-5415.2005.53009.xCrossRefPubMed

47.

McDevitt EA, Alaynick WA, Mednick SC (2012) The effect of nap frequency on daytime sleep architecture. Physiol Behav 107:40–44. https://doi.org/10.1016/j.physbeh.2012.05.021CrossRefPubMedPubMedCentral

48.

Seidler A, Weihrich KS, Bes F et al (2023) Seasonality of human sleep: Polysomnographic data of a neuropsychiatric sleep clinic. Front Neurosci 17:1105233CrossRefPubMedPubMedCentral

49.

Alstadhaug K, Salvesen R, Bekkelund S (2005) Seasonal Variation in Migraine. Cephalalgia 25:811–816. https://doi.org/10.1111/j.1468-2982.2005.01018.xCrossRefPubMed

50.

Park J-W, Chu MK, Kim J-M et al (2016) Analysis of trigger factors in episodic migraineurs using a smartphone headache diary applications. PLOS ONE 11:e0149577. https://doi.org/10.1371/journal.pone.0149577CrossRefPubMedPubMedCentral

51.

Viticchi G, Falsetti L, Paolucci M et al (2019) Influence of chronotype on migraine characteristics. Neurol Sci 40:1841–1848CrossRefPubMed

52.

Chu S, Wu Z, Wu Z et al (2021) Association between insomnia and migraine risk: a case-control and bidirectional Mendelian randomization study. Pharmacogenomics Pers Med 14:971–976. https://doi.org/10.2147/PGPM.S305780CrossRef

53.

Antonaci F, Nappi G, Galli F et al (2011) Migraine and psychiatric comorbidity: a review of clinical findings. J Headache Pain 12:115–125. https://doi.org/10.1007/s10194-010-0282-4CrossRefPubMedPubMedCentral

54.

Martelletti P, Bentivegna E, Spuntarelli V, Luciani M (2021) Long-COVID headache. SN Compr. Clin Med 3:1704–1706. https://doi.org/10.1007/s42399-021-00964-7CrossRef

55.

Caronna E, Ballvé A, Llauradó A et al (2020) Headache: A striking prodromal and persistent symptom, predictive of COVID-19 clinical evolution. Cephalalgia 40:1410–1421. https://doi.org/10.1177/0333102420965157CrossRefPubMedPubMedCentral

56.

Zhdanova IV, Wurtman RJ, Morabito C et al (1996) Effects of low oral doses of Melatonin, given 2–4 hours before habitual bedtime, on sleep in normal young humans. Sleep 19:423–431. https://doi.org/10.1093/sleep/19.5.423CrossRefPubMed

57.

Pistoia F, Salfi F, Saporito G et al (2022) Behavioral and psychological factors in individuals with migraine without psychiatric comorbidities. J Headache Pain 23:110. https://doi.org/10.1186/s10194-022-01485-xCrossRefPubMedPubMedCentral

58.

Walker D, Zhang N, Natbony LR (2023) Insomnia and migraine: a review of evidence-based, biobehavioral interventions. Curr Pain Headache Rep 27:19–25. https://doi.org/10.1007/s11916-023-01100-xCrossRefPubMed

59.

Stanyer EC, Baniqued PDE, Awais M et al (2022) The impact of acoustic stimulation during sleep on memory and sleep architecture: a meta-analysis. J Sleep Res 31:e13385. https://doi.org/10.1111/jsr.13385CrossRefPubMed

Title: Investigating the relationship between sleep and migraine in a global sample: a Bayesian cross-sectional approach
Authors: Emily C. Stanyer
Jack Brookes
Jia Rong Pang
Alexandre Urani
Philip R. Holland
Jan Hoffmann
Publication date: 01-12-2023
Publisher: Springer Milan
Keywords: Migraine
Headache
Published in: The Journal of Headache and Pain / Issue 1/2023
Print ISSN: 1129-2369
Electronic ISSN: 1129-2377
DOI: https://doi.org/10.1186/s10194-023-01638-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Investigating the relationship between sleep and migraine in a global sample: a Bayesian cross-sectional approach

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2023

Parahippocampus hypertrophy drives gray matter morphological alterations in migraine patients without aura

Mechanisms of initiation of cortical spreading depression

Efficacy and safety of intranasal agents for the acute treatment of migraine: a systematic review and network meta-analysis

Impact of a reimbursement policy change on treatment with erenumab in migraine – a real-world experience from Germany

Headache disorders and relevant sex and socioeconomic patterns in adolescents and young adults across 204 countries and territories: an updated global analysis

Changes of migraine aura with advancing age of patients