Insomnia and Circadian Variation of Attacks in Episodic Migraine

Headache. 2007 Sep;47(8):1184-8. doi: 10.1111/j.1526-4610.2007.00858.x.

Abstract

Objectives: To assess the influence of insomnia on the 24-hour temporal pattern of migraine.

Background: Migraine attacks have been reported to occur in a harmonic (monophasic) or a biphasic 24-hour cyclic manner, and in some studies to have preponderance in the morning hours. The influence of insomnia on the circadian pattern has not been evaluated.

Method: Based on a previous study of the circadian variation in migraine, an explorative data analysis was made to compare the circadian pattern of insomnia-related migraine attacks to the circadian pattern of migraine attacks not related to insomnia. If the patients reported difficulties in falling asleep and/or maintaining sleep the night prior to the reported attack or the night the attack occurred, the attack was defined as insomnia-related. Relapses were not counted as distinctive attacks.

Results: Sixty-eight female migraineurs (mean +/- SD age: 35.5 +/- 7.0) prospectively recorded 1869 migraine attacks. Five hundred-and-thirty-three attacks (29%) were insomnia-related. Insomnia-related attacks had a biphasic temporal pattern with one peak in the morning hours and one peak after noon. They had a preponderance in the morning hours compared to attacks not related to insomnia (t= 3.27, df = 62, P= .002). In 79% of attacks insomnia was experienced prior to the headache.

Conclusions: Episodic morning migraine is associated with insomnia. The cause and consequences of insomnia in migraine is not clarified, but sleep obviously protects against attacks rather than provokes them.

MeSH terms

  • Adolescent
  • Adult
  • Circadian Rhythm*
  • Female
  • Humans
  • Middle Aged
  • Migraine Disorders / complications*
  • Prospective Studies
  • Seasons*
  • Sleep Initiation and Maintenance Disorders / complications*