Effect of withdrawal of misused medication on sleep disturbances in migraine sufferers with chronic daily headache.
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.
Hering-Hanit
R
R
Headache Unit, Department of Neurology, Meir General Hospital, Sapir Medical Center, Kfar Saba, Israel.
Yavetz
A
A
Dagan
Y
Y
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
D000700:Analgesics; D014662:Vasoconstrictor Agents; D004878:Ergotamine