Polysomnographic Findings in Children With Headaches

Although previous studies suggested a relationship between headache and sleep disturbances, polysomnographic findings in children with headache are rarely described. We investigated polysomnographic findings in children with headaches, and correlated them with headache type and severity, body mass index, and medical treatment. Analysis of polysomnographic findings of 90 children with migraine (60), chronic migraine (11), tension headache (6), and nonspecific headache (13) indicated that sleep-disordered breathing was more frequent among children with migraine (56.6%) and nonspecific headache (54%) vs chronic migraine (27%). Tension headache was not associated with sleep-disordered breathing. In the nonspecific headache group, children with sleep-disordered breathing had higher body mass indexes (P = 0.008). Severe migraine and chronic migraine were associated with shorter sleep time, longer sleep latency, and shorter rapid eye movement and slow-wave sleep. Fifty percent of children with tension headache manifested bruxism vs 2.4% of children with nontension headache (odds ratio, 1.95; 95% confidence interval, 1.2-4.34). Our results support an association between migraine and sleep-disordered breathing, and between tension headache and bruxism, in children. Moreover, disrupted sleep architecture with reduced rapid eye movement and slow-wave sleep in severe and chronic migraine headaches may support an intrinsic relationship between sleep and headache disorders.

Introduction

It is widely accepted that headaches and sleep disorders share common pathophysiologic features and have mutual clinical interactions [1]. Lack of sleep is known to trigger migraine attacks and predispose individuals to other headache syndromes, whereas adequate sleep may often relieve headaches. Patients with obstructive sleep apnea often complain of morning headache [2], [3], and an association between severity of obstructive sleep apnea and occurrence and severity of headache has been a subject of speculation [4]. Specific types of headache are recognized as sleep-related, i.e., migraine headache, cluster headache, chronic paroxysmal hemicrania, exploding headache syndrome, and hypnic headaches [5]. Clinical studies performed in adult populations indicate that certain headache types may be related to specific sleep stages. For instance, migraine was associated with excessive slow-wave sleep and rapid eye movement sleep time [6], and other studies demonstrated that cluster headaches can be triggered by rapid eye movement sleep [7]. In addition, patients with chronic paroxysmal hemicrania undergo a significant disruption of nocturnal sleep architecture, with decreased total sleep time and rapid eye movement sleep [8]. Patients with nonsleep-specific headaches such as tension headache exhibit reduced total sleep time and sleep latency, and frequent awakenings [9].

The few studies conducted in pediatric populations indicate an association between headaches and sleep disturbances, including primary snoring, obstructive sleep apnea, and parasomnias [10], [11], [12], [13]. Some investigators observed that children with migraine may exhibit disrupted sleep architecture, i.e., abnormal total sleep time and sleep latency compared with healthy control subjects [14], [15], [16]. In children, however, misperception of disturbed sleep may lead the parent and the clinician to underestimate the signs. Nevertheless, no polysomnographic studies have been published on children with headaches.

The objectives of this study were to characterize polysomnographic findings in children manifesting headaches (including migraine headache, chronic migraine headache, tension headache, and nonspecific headache) and complaints of sleep problems, and to describe differences in the children's sleep architecture in relation to specific headache diagnoses.