Migraine and sleep:
when the headand rest go together.

Sleep and headache, a two-way relationship

The brain systems that regulate sleep and process pain share circuits, so it is no coincidence that people who sleep badly get more headaches — and that pain, in turn, spoils sleep. It is a relationshipbidirectional.

On the one hand, thelack of sleep, excess or irregular schedulesare well-known triggers of migraine. On the other hand, there are headaches directly linked to sleep: pains that wake up at dawn,morning headacheassociated with apnoea, or jaw painbruxismnocturnal

When the head and sleep go hand in hand, treating only the pain falls short. Studying rest may be the missing piece.

What is migraine?

Migraine is a chronic neurological disease that manifests itself in the form of episodes of headache to which other symptoms are usually associated. It is estimated that it affects at least12% of the world population(approximately1 in 8 people), being more frequent in women and of active working age.

The frequency of episodes is highly variable: from a few a year to daily headaches. Some factors have been related to a greater likelihood of chronicity, such as excessive intake of painkillers, mood disorders or a worse night's rest. Many of them are potentially reversible.

Migraine symptoms

Attacks are often simplified by the pain phase, but a migraine attack can have up to four phases:

Prodromal symptoms.They can appear up to 48 hours before the pain. They are diverse and not very specific: yawning, drowsiness, fatigue (even without worse rest the night before), mood changes (irritability, desire to cry), changes in appetite (loss of appetite or greater desire for sweets), greater sensitivity to light or noise and cervical stiffness.

Aura it appears in approximately 1 in 5 patients. It usually lasts a few minutes and manifests itself with visual, sensory or language problems. It may precede the pain or start at the same time.

Pain phase. it does not have to be the same in all patients or in all crises. The most common is a throbbing or throbbing pain, predominantly in one half of the head (hemicranial) and high intensity. It is usually accompanied by nausea and vomiting, increased sensitivity to light, noise and even smells, and a need to seek rest because movement increases pain.

Postdromal phase.Known as a hangover. It manifests itself with fatigue, difficulty concentrating and irritability.

How do I know if I have migraines?

The diagnosis of migraine is reached after a correct clinical history or anamnesis, based on the presence of different symptoms and the absence of others. It is important to collect possible triggering factors—such as hormonal factors—and those chronic factors or comorbidities that influence treatment.

To date, there is no test that surpasses the clinical method in diagnosing migraine. However, in the event of atypical symptoms or age of presentation, or in patients with a high frequency of seizures, complementary tests are performed whose fundamental objective isexclude other causesof headache.

Furthermore, given the high prevalence of other diseases in patients with migraine—sleep apnoea-hypopnea syndrome, anxiety and depression, bruxism, fibromyalgia—it is often necessary to complete the study and consult other specialists for better control.

Difference between headache and migraine

Headache it is a broad medical term that refers to the symptom headache. There are more than 100 known causes of headache, making it an ambiguous and imprecise concept. Themigraine, on the other hand, is more than a headache: it is a specific disease that differs from the rest due to its clinical characteristics, associated symptoms and triggering factors.

Characteristic features of migraine, although not exclusive or essential for diagnosis:

• Pain: it is usually located in anterior regions (forehead, temple, eye) and on one side only; sometimes it is pulsatile; high intensity; The patient seeks rest because the slightest movement increases the pain (kinesiphobia).
• Duration:episodes last, in the absence of analgesia,between 4 hours and 3 days.
• Associated symptoms:nausea, vomiting, sensitivity to light, noise and, above all, odors.
• Triggering factors:Stress is common to many headaches, but changes in sleeping and eating routine, and hormonal factors are more common in migraine.

What does a sleep study for migraine involve?

The relationship between migraine and sleep isbidireccional: A sleep disorder can trigger an attack, and people with migraine frequently describe symptoms compatible with a sleep disorder. Studying rest is key when pain and sleep go hand in hand.

Insomnia, defined as difficulty falling asleep at the right time, occurs in at least2/3 of patients with chronic formsof the disease—headache in at least15 days of the month—. Underlying this difficulty can hide underdiagnosed sleep disorders, such as restless legs syndrome, for which a test is performed to confirm.immobilization test.

In patients who snore and present recent worsening of pain, predominantly morning attacks, daytime sleepiness or lower concentration, a possibleapnea-hypopnea syndrome of sleep. Thepolysomnography it also allows evaluating the quality of sleep according to the distribution of the phases and detecting parasomnias such as sleepwalking, which are more common in the pediatric population with migraine.