Interventions for Migraine and Sleep: A Systematic Review Exploring Their Bidirectional Association

Area of Science:

• Neurology
• Sleep Medicine
• Clinical Research

Background:

• Migraine and sleep disturbances have a complex, bidirectional relationship.
• Interventions targeting one condition may impact the other.
• Understanding these interactions is crucial for effective patient management.

Purpose of the Study:

• To systematically review interventions for migraine and their effects on sleep.
• To examine interventions for sleep and their effects on migraine outcomes.
• To synthesize evidence on integrated treatment approaches.

Main Methods:

• Systematic literature search across six databases (PubMed, Medline, Scopus, Embase, PsycINFO, CINAHL) until December 5, 2023.
• Inclusion of Randomized Clinical Trials, Controlled Clinical Trials, and observational studies in adults.
• Risk of bias assessment using RoB 2 and ROBINS-E tools.

Main Results:

• Pharmacological migraine treatments (erenumab, amitriptyline, propranolol, onabotulinumtoxinA) reduced migraine frequency/pain but had variable sleep effects; melatonin was ineffective.
• Non-pharmacological migraine interventions (nerve stimulation, nerve blocks, green light, binaural beats, mindfulness, diet) improved both migraine and sleep.
• Digital Cognitive-Behavioral Therapy for Insomnia (CBT-I) improved headache days and sleep; standard CBT-I showed mixed results.

Conclusions:

• Integrated approaches combining migraine and sleep interventions show potential for symptom management.
• Study heterogeneity, small sample sizes, and outcome variability limit generalizability.
• Further research is needed to refine strategies and assess long-term effects of combined treatments.