Premium
Can Circadian Dysregulation Exacerbate Migraines?
Author(s) -
Ong Jason C.,
Taylor Hannah L.,
Park Margaret,
Burgess Helen J.,
Fox Rina S.,
Snyder Sarah,
Rains Jeanetta C.,
Espie Colin A.,
Wyatt James K.
Publication year - 2018
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/head.13310
Subject(s) - circadian rhythm , melatonin , actigraphy , migraine , medicine , sleep (system call) , sleep disorder , dark therapy , endocrinology , audiology , insomnia , psychiatry , computer science , operating system
Objective This observational pilot study examined objective circadian phase and sleep timing in chronic migraine (CM) and healthy controls (HC) and the impact of circadian factors on migraine frequency and severity. Background Sleep disturbance has been identified as a risk factor in the development and maintenance of CM but the biological mechanisms linking sleep and migraine remain largely theoretical. Methods Twenty women with CM and 20 age‐matched HC completed a protocol that included a 7 day sleep assessment at home using wrist actigraphy followed by a circadian phase assessment using salivary melatonin. We compared CM vs HC on sleep parameters and circadian factors. Subsequently, we examined associations between dim‐light melatonin onset (DLMO), the midpoint of the sleep episode, and the phase angle (time from DLMO to sleep midpoint) with the number of migraine days per month and the migraine disability assessment scale (MIDAS). Results CM and HC did not differ on measures of sleep or circadian phase. Within the CM group, more frequent migraine days per month was significantly correlated with DLMO ( r = .49, P = .039) and later sleep episode ( r = .47, P = .037). In addition, a greater phase angle (ie, circadian misalignment) was significantly correlated with more severe migraine‐related disability ( r = .48, P = .042). These relationships remained significant after adjusting for total sleep time. Conclusions This pilot study revealed that circadian misalignment and delayed sleep timing are associated with higher migraine frequency and severity, which was not better accounted for by the amount of sleep. These findings support the plausibility and need for further investigation of a circadian pathway in the development and maintenance of chronic headaches. Specifically, circadian misalignment and delayed sleep timing could serve as an exacerbating factor in chronic migraines when combined with biological predispositions or environmental factors.