Sleep and Migraine Interactions in Episodic and Chronic Migraine: A Hospital-Based Cross-Sectional Study

Migraine and sleep disturbances frequently coexist. The study aimed at characterizing sleep disturbances and their association with migraine characteristics.

In this cross-sectional study, 253 patients with migraine [patients with episodic migraine (pEM) = 103 and patients with chronic migraine (pCM) = 150] were assessed. Migraine-related disability was measured using the Migraine Disability Assessment (MIDAS). Sleep-related parameters were measured using the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and the Berlin Questionnaire. Depression and anxiety were assessed using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7).

Poor sleep quality was found in 18.4% of pEM and 58.7% of pCM. Headache and sleep disturbances frequently coexisted, with bidirectional triggering in some patients and independent coexistence in others. Sleep health domains (ISI and PSQI subscales) were significantly affected in pCM than in pEM. Excessive sleep-triggered migraine attacks were associated with poorer sleep than inadequate sleep-triggered attacks. On multivariable analysis, a higher MIDAS score, increasing age, and constipation as a prodrome for migraine attacks were each independently associated with poor sleep. In sensitivity analysis, daytime sleepiness (ESS) was significantly associated with migraine disability (MIDAS) (ρ ≈ 0.514, P < 0.001) and poor sleep quality (PSQI) (ρ ≈ 0.682, P < 0.001).

Sleep disturbances are common in patients with migraine and are associated with migraine-related disability. Constipation in the prodromal phase of migraine was associated with poor sleep quality, suggesting a potential role of the gut-brain axis in the pathogenesis of sleep disturbances in migraine.