Migraine linked with sleep problems and fatigue

Recent findings confirm that excessive daytime sleepiness is more frequent in people who get migraines than in those who don't. However the findings tend to discount the theory that the underlying cause involves the hypothalamus, an area of the brain that produces hormones that control thirst, hunger, body temperature and sleep. Rather, the investigators suggest that problems may arise "from the complex burden" of the migraine.

"Excessive daytime sleepiness, defined as difficulty in maintaining a desired level of wakefulness, can be a disabling symptom," Dr. Piero Barbanti, of IRCCS San Raffaele, Rome, and colleagues write in the journal Cephalalgia.

In a previous study, Peres et al. found that in patients with episodic or chronic migraine, a high percentage reported experiencing excessive daytime sleepiness.

"To investigate further, Barbanti's group compared sleep quality and rates of anxiety and depression in 100 patients with episodic migraine and 100 age- and sex-matched healthy subjects used as a comparison group.

The researchers found that excessive daytime sleepiness was three-times more frequent in patients with migraine than in controls. However, the frequency was lower than previously reported (36.3 percent in episodic and 55.1 percent in chronic migraine patients).

However, a correlation was observed between excessive daytime sleepiness and migraine disability, sleep problems, and anxiety.

The excessive daytime sleepiness finding, and most important, the lack of correlation between scores on a sleepiness scale and the presence or absence of sleepiness during the migraine attack weaken the hypothesis that the hypothalamus mediates excessive daytime sleepiness in migraine patients, Barbanti's group concludes.

Our data therefore suggest that excessive daytime sleepiness is probably a consequence of the migraine itself, and includes migraine-related disability, anxiety and sleep problems.

SOURCE: Cephalalgia, October 2007.