title: Effect of withdrawal of misused medication on sleep disturbances in migraine sufferers with chronic daily headache.
abstract: OBJECTIVE
  To evaluate the sleep pattern of migraineurs with chronic daily headache and to determine whether and to what degree it is improved by withdrawal of medication, and to reconfirm relief of headache by withdrawal of medications in migraineurs with chronic daily headache due to medication misuse.
  
  
  BACKGROUND
  Misuse of ergotamine and analgesics by migraineurs is one of the causes of chronic daily headache. The latter is alleviated or abolished in these patients by abrupt withdrawal of the misused medication. In common with patients with chronic daily headache, migraineurs frequently complain of insomnia, usually verifiable by polysomnography.
  
  
  METHODS
  Twenty-six women with migraine, aged 18 to 49 years, with chronic daily headache due to medication misuse, voluntarily discontinued ergotamine and analgesics, and were followed at monthly intervals for 3 months. In 25 subjects, polysomnography was performed before withdrawal of medication and 3 months after withdrawal. All subjects filled out a standard sleep questionnaire on those two occasions and a daily self-assessment questionnaire focused on headaches.
  
  
  RESULTS
  After 3 months, a significant decrease in mean headache frequency (P<.001) and intensity (P<.001) was demonstrated. Polysomnography performed 3 months after medication withdrawal showed significant improvement in total sleep time (P<.05), sleep efficiency (P<.05), and number of arousals (P<.001). The score of the sleep questionnaire was also significantly improved (P<.01).
  
  
  CONCLUSIONS
  In migraineurs with chronic daily headache due to medication misuse, withdrawal of the misused medications alleviates the associated sleep disturbance along with diminution in frequency and intensity of chronic daily headache.
authors.affiliation: Headache Unit, Department of Neurology, Meir General Hospital, Sapir Medical Center, Kfar Saba, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Hering-Hanit
authors.forename: A
authors.initials: A
authors.lastname: Yavetz
authors.forename: Y
authors.initials: Y
authors.lastname: Dagan
mesh_terms: D000328:Adult; D000700:Analgesics / Q000008:administration & dosage* / Q000627:therapeutic use; D002908:Chronic Disease; D004878:Ergotamine / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006300:Health Services Misuse; D006801:Humans; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications* / Q000188:drug therapy*; D012893:Sleep Wake Disorders / Q000209:etiology* / Q000503:physiopathology*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D000700:Analgesics; D014662:Vasoconstrictor Agents; D004878:Ergotamine