Rapid Eye Movement or REM sleep is the sweet spot of our sleep cycles, which is characterized by more dreaming, physical activity and faster heart rate and breathing than in other sleep stages. In a meta-analysis of 32 studies, adults and children with migraines were less likely than healthy people without migraines to have both subjectively and objectively poorer sleep quality. The results of the meta-analysis were published on Wednesday in Neurology, the medical journal of the American Academy of Neurology.
The research comes from experts wondering whether migraines cause poor quality sleep or whether poor sleep leads to migraines.
“We wanted to analyze recent research to get a clearer picture of how migraines affect sleep patterns and the severity of their headaches,” said one of the study’s authors, Dr. Jan Hoffman, Senior Clinical Lecturer in Neurology at King’s College London, in a statement.
“That way, clinicians can better support people with migraines and perform more effective sleep treatments,” added Hoffman, a member of the American Academy of Neurology. Hoffman advises, sits on the boards of several pharmaceutical companies, and has received honoraria from several pharmaceutical companies, but these activities, according to the authors, are unrelated to the work submitted.
Previously observed associations between insomnia and migraines have been difficult for researchers to unravel because changes in sleep can be a trigger, treatment, or symptom of migraines, the authors write.
Although migraines affect around 1 billion people and are a leading cause of disability worldwide, there isn’t much conclusive research on what migraineurs think about their sleep quality – and whether objective laboratory tests match their perceptions, according to a 2018 study, according to the study.The new meta-analysis included more than 10,000 adults and children who had participated in previous studies. Adults with migraines performed worse than healthy participants on the Pittsburgh Sleep Quality Index, a questionnaire that asks about sleep quality, how long it takes to fall asleep, how long and efficient it is, sleep disorders, sleep medication use, and daytime dysfunction. This finding was more common in adults with chronic than episodic migraines. Many of the participants had an overnight polysomnography, a sleep study that records certain bodily functions during sleep and is used to diagnose sleep disorders. These tests showed that adults and children with migraines had lower percentages of REM sleep than control groups. Children with migraines also needed less time to fall asleep, had less overall sleep time, and more waking time.
“This study was an association study. It wasn’t a causal study that will always have limitations, ”said Dr. Raj Dasgupta, assistant professor of clinical medicine at the University of Southern California’s Keck School of Medicine, who was not involved in the study. “It would be nice to know what you see in relation to the other sleep disorders like obstructive sleep apnea and other things.”
Headaches and migraines have also been linked to insomnia, sleepwalking, bruxism, restless legs syndrome, and narcolepsy, Dasgupta added, some of which may imply a genetic factor.
The studies included in the meta-analysis did not report whether migraineurs had migraines themselves while sleeping, and six studies did not include extra night for participants to adjust to the sleep laboratory, which can affect REM sleep. And the authors couldn’t fully explain potential psychological diagnoses or drug use, both of which could affect sleep, according to the study.
But her research is beginning to “provide a clearer understanding of migraines and how they affect sleep behavior,” Hoffman said.
Underlying factors and tips for sleep and pain
Previous research has reported reductions in REM sleep the night before a migraine attack, the authors wrote. One migraine symptom that has worsened after REM sleep deprivation is cutaneous allodynia, when someone feels pain after touching their skin in a way that normally doesn’t cause pain, according to the study. This suggests a possible dysfunction in REM sleep processes that could cause migraines.
Children with migraines who fell asleep faster than children without migraines may have done so because they might be sleep deprived, the authors said.
Both adults and children can try to relieve sleep-related migraine problems or migraine-related sleep problems.
For children, the American Academy of Pediatrics recommends maintaining sleep hygiene – including eight to ten hours each night and turning off technology an hour before bed – and eating healthy. If your child has trouble sleeping, a pediatrician may recommend tests for snoring or sleep disorders that have been linked to migraines, the AAP suggests. Eating three meals at the same times each day, staying hydrated, and avoiding highly processed foods that usually contain more migraine triggers – including sweeteners, additives, and artificial colors – can help.
The advice for adults is similar. “Sleep can improve headaches,” said Dasgupta, so it’s “important to have the right amount and quality of sleep. Remember, too much sleep can also trigger headaches like migraines.”
Try to go to bed and wake up at the same time each day to regulate your circadian cycle, spend more time in daylight, and avoid alcohol and smoking, suggests The Migraine Trust, a UK migraine charity that conducted this study has supported.