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Primary headaches are closely related to sleep. Modifications in the patterns of arousal during sleep have been reported in migraine, especially in the nights preceding a headache attack. We aimed at evaluating the pattern of arousal from sleep in a group of patients affected by sleep- related migraine. We enrolled 10 consecutive patients, three males and seven females, aged between 20 and 62 years, who presented frequent attacks of migraine without aura (more than five per month), closely related to sleep (more than one- half of the attacks occurred during sleep, causing an awakening). A control group was studied, matched for age and sex. Patients and controls underwent a fullnight polysomnographic study, following adaptation; arousal pattern was studied by the scoring of the high- frequency EEG arousal and by the cyclic alternating pattern (CAP). Migraineurs showed a lower CAP rate in non- rapid eye movement (NREM) sleep and, in particular, a lower number of A1 phases (low- frequency, high- amplitude EEG bursts) compared with the controls. Migraineurs also showed a lower Zndex of high- frequency EEG arousals during rapid eye movement (REM) sleep. The reduction in the CAP rate indicates a lower level of arousal fluctuation in NREM sleep. The reduced arousal index in REM suggests a dysfunction in neural structures involved in both the control of REM sleep and the pathophysiology of migraine, such as the hypothalamus and the brainstem.
Primary headaches are closely related to sleep. Modifications in the patterns of arousal during sleep have been reported in migraine, especially in the nights preceding a headache attack. We aimed at evaluating the pattern of arousal from sleep in a group of patients affected by sleep- related migraine. We enrolled 10 consecutive patients, three males and seven females, aged between 20 and 62 years, who presented frequent attacks of migraine without aura (more than five per month), closely related to sleep (more than one-half of the Attack occurred during sleep, causing an awakening). A control group was studied, matched for age and sex. A control group was studied, matched for age and sex. a control pattern was studied by the scoring of the high- frequency EEG arousal and by The cyclic alternating pattern (CAP). Migraineurs showed a lower CAP rate in non- rapid eye movement (NREM) sleep and, in particular, a lower number of A1 phases , high amplitude EEG bursts) compared with the controls. Migraineurs also showed a lower Zndex of high- frequency EEG arousals during rapid eye movement (REM) sleep. The reduction in the CAP rate indicates a lower level of arousal fluctuation in NREM sleep. The reduced arousal index in REM suggests a dysfunction in neural structures involved in both the control of REM sleep and the pathophysiology of migraine, such as the hypothalamus and the brainstem.