Open Access Research article

Sleep quality, arousal and pain thresholds in migraineurs: a blinded controlled polysomnographic study

Morten Engstrøm12*, Knut Hagen13, Marte Helene Bjørk45, Lars Jacob Stovner13, Gøril Bruvik Gravdahl23, Marit Stjern12 and Trond Sand12

Author Affiliations

1 Department of Clinical Neurosciences, Norwegian University of Science and Technology, Trondheim, N-7489, Norway

2 Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, N-7006, Norway

3 Norwegian National Headache Centre, St. Olavs Hospital, Trondheim, N-7006, Norway

4 Department of Neurology, Haukeland University Hospital, Bergen, N-5021, Norway

5 Department of Clinical Medicine, University of Bergen, Bergen, N-5021, Norway

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The Journal of Headache and Pain 2013, 14:12  doi:10.1186/1129-2377-14-12

Published: 14 February 2013

Abstract

Background

Our aim was to compare subjective and objective sleep quality and arousal in migraine and to evaluate the relationship between sleep quality and pain thresholds (PT) in controls, interictal, preictal and postictal migraine.

Methods

Polysomnography and PT (to pressure, heat and cold) measurements were done in 34 healthy controls and 50 migraineurs. Subjective sleep quality was assessed by sleep diaries, Epworth sleepiness scale, Karolinska sleep questionnaire and Pittsburgh sleep quality index. Migraineurs who had their sleep registration more than 48 h from an attack were classified as interictal while those who were less than 48 h from an attack were classified as either preictal or postictal.

Results

Migraineurs reported more insomnia and other sleep-related symptoms than controls, but the objective sleep differences were smaller and we found no differences in daytime sleepiness. Interictal migraineurs had more awakenings (p=0.048), a strong tendency for more slow-wave sleep (p=0.050), lower thermal pain thresholds (TPT) (heat pain thresholds p=0.043 and cold pain thresholds p=0.031) than controls. Migraineurs in the preictal phase had shorter latency to sleep onset than controls (p=0.003). Slow-wave sleep correlated negatively with pressure PT and slow bursts correlated negatively with TPT.

Conclusion

Lower PT in interictal migraineurs seems related to increased sleep pressure. We hypothesize that migraineurs on the average suffer from a relative sleep deprivation and need more sleep than healthy controls. Lack of adequate rest might be an attack-precipitating- and hyperalgesia-inducing factor.

Keywords:
Migraine phase; Sleep; Arousal; Pain thresholds