Sleep-related migraine occurrence increases with aging

A preferential occurrence of attacks at night-time or during early morning is documented in migraine without aura, suggesting a relationship between migraine and sleep and an impairment of circadian rhythms. The objective of this study was to verify the occurrence of sleep-related migraine in a large sample of migraineurs divided in different age groups and to evaluate the possible role of physiological variables (i.e., aging, gender) and comorbidities (i.e., psychiatric diseases). 734 patients (519 women and 215 males), aged 21-70 years, fulfilling IHS criteria (2004) for migraine without aura, were enrolled. The population was divided into five groups according to decades of life and it was evaluated the percentage of sleep-related migraine (at least 75% migraine attacks occurring during night sleep and/or upon awakening) in the different age groups. Headache clinical diary, Pittsburgh Sleep Quality Index and Beck Depression Inventory were also used. The preferential emergence of attacks during night sleep and/or upon awakening progressively increased with aging, without gender predilection; the percentage of patients with sleep-related migraine was: 16% between 20 and 30 years, 27% between 31 and 40 years, 38% between 41 and 50 years, 45% between 51 and 60 years, and 58% between 61 and 70 years, respectively. Poor sleep quality and depression did not account for night-time and/or awakening migraine collocation. These data suggest the main role of aging in order to favor nocturnal/early morning emergence of migraine without aura and support the hypothesis of an involvement of impaired chronobiological mechanisms and sleep regulation.