Meta-analysis Finds Migraineurs Suffer From Reduced Sleep Quality

Results of a meta-analysis published in Neurology, the medical journal of the American Academy of Neurology, revealed both adults and children with migraine have significantly poorer subjective sleep quality and altered sleep architecture compared with those without migraine.

Although previous research has identified a relationship between sleep and migraine, the nature of this link remains poorly understood, while “a clearer understanding of the profile of sleep in migraine and its relation to migraine-related disability is important, to enable clinicians to support those with migraine and deliver effective sleep interventions,” the authors wrote.

To address this knowledge gap, they aggregated data from multiple studies assessing differences in subjective sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI), and objective sleep architecture measured via polysomnography in migraineurs and healthy controls.

The investigators then addressed the relationship between sleep quality and migraine-related disability by combining PSQI and Migraine Disability Assessment Test (MIDAS) scores, they explained.

The researchers searched Embase, MEDLINE, Global Health, APA PsycINFO, and APA PsycArticles databases for relevant studies from the time of inception to the current date. Any pregnant study participants or those with other headache disorders (ie, cluster headache, tension type headache) were excluded from the analysis, and only studies published in English were assessed.

The meta-analysis consisted of 32 studies (23 case-control and 9 cross-sectional), while, due to a lack of available data, no participants under the age of 18 were included in the PSQI analysis or the MIDAS and PSQI correlational analysis.

Twenty-one studies measured PSQI and/or MIDAS in adults, 6 measured PSG in adults, and 5 measured PSG in children. A total of 10,243 individuals were included. “The overall mean study quality score was 5/9, and this did not moderate any of the results, and there was no risk of publication bias,” the authors added.

Analyses revealed:

• Adults with migraine had higher PSQI scores than healthy controls (g = 0.75; 95% CI, 0.54-0.96; P <.01)
• This effect was larger in those with chronic rather than episodic migraine (g = 1.03; 95% CI, 0.37-1.01; P <.001 vs g = 0.63; 95% CI, 0.38-0.88; P <.001, respectively)
• For PSG studies, adults and children with migraine displayed a lower percentage of rapid eye movement sleep (g= –0.22; 95% CI, –0.41 to –0.04; P = .017 vs g = –0.71; 95% CI, –1.34 to –0.10; P = .025, respectively) than controls
• Pediatric patients displayed less total sleep time (g = –1.37; 95% CI, –2.66 to –0.10; P = .039), more wake time (g = 0.52; 95% CI, 0.08-0.79; P <.001), and shorter sleep onset latency (g = –0.37; 95% CI, –0.54 to –0.21; P <.001) than controls

The researchers also found no significant overall correlation between PSQI and MIDAS scores among migraineurs. This is surprising, as previous studies have reported significant correlations between sleep disturbances and migraine-related disability, they explained. However, “this [finding] may reflect the small number of studies and high heterogeneity,” they added.

Many studies included in the analysis did not state whether patients on medication were excluded, marking a limitation to the meta-analysis as these treatments can affect the sleep cycle.

Due to the nature of the analysis, causality could not be determined, nor could an answer to the question, “Do people with migraine experience poor sleep due to attacks or are they experiencing attacks due to poor sleep?” Additional sleep measures including sleepiness or insomnia were also not captured and comorbid mental illnesses—also not reported—could have affected patients’ sleep cycles.

“These findings highlight that sleep should play an integrated role in migraine treatment. Clinicians should prioritize sleep interventions and consider sleep when prescribing medication,” the researchers concluded.

“Future studies should analyze the interplay between migraine and subjective sleep on a large scale, as well as use standardized, population-based approaches to sleep architecture to minimize variability.”

Reference

Stanyer EC, Creeney H, Nesbitt AD, Holland PRR, and Hoffman J. Subjective sleep quality and sleep architecture in patients with migraine: a meta-analysis. Neurology. Published online September 22, 2021. doi:10.1212/WNL.0000000000012701