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.

Injury to the neck vertebrae can cause headaches

In rare cases, injury to the vertebral disc in the lower neck will not only lead to neck pain and pain radiating into the arm, but also to headaches, the results of a new study indicate.

Prolapse of a vertebral disc in the lower part of the neck (cervical spine), a condition sometimes referred to as a "slipped disc," is known to cause a variety of symptoms.

The cervical disc protrudes and compresses a portion of the spinal cord, causing pain that may limit neck movement. The pain radiates through the shoulder into the arm, and numbness or paralysis of the fingers may also occur.

Now, investigators add headache to the list of possible symptoms.

Their report indicates that the headache, along with the other types of pain, "improves or resolves after successful surgery," Dr. Hans C. Diener of University Duisburg-Essen, Germany, told Reuters Health.

Therefore, patients with a headache that coincides with neck pain and pain radiating into one arm should undergo MRI of the cervical spine, Diener said.

In the journal Cephalagia this month, Diener and colleagues report that 12 of 50 (24 percent) patients with disc prolapse in one of the lower cervical discs complained of new-onset neck pain and headache, compared with 2 of 50 (4 percent) another group of patients with a disc injury in the lower back.

Seven of the 12 (58 percent) patients with headache fulfilled 3 out of 4 International Headache Society criteria for cervicogenic headache (or headache emanating from the upper spine). The headaches in the two patients with the lower back injuries did not meet these criteria.

As mentioned, the physicians also found that removal of the prolapsed disc by surgery led to a significant reduction or disappearance of pain and headache in 80 percent of patients. The pain was relieved 1 week after surgery and was still gone after 3 months, they note.

Diener's team points out that cervicogenic headache caused by irritation or pressure to the upper cervical disc has been "well described." The current findings now suggest that pain in the lower cervical roots can converge with other nerves to cause pain extending through the arm and into the head, the researchers conclude.

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