Morning headaches in patients with sleep disorders: a systematic polysomnographic study.
OBJECTIVE
Patients with sleep disorders suffer more often from headache after awakening than healthy subjects. However, it still is a matter of controversy whether this applies only to patients with sleep apnea syndrome (SAS) or also to patients with other diagnoses of sleep disorders.


METHODS
We asked all patients in our sleep laboratory about the frequency of past headaches and also ascertained the occurrence of morning headaches after awakening in the sleep laboratory. Polysomnographic recordings from nights before morning headache were compared with nights without following headache. Four hundred and thirty-two patients with sleep disorders (age range 18-86 years, 37% women) and 30 healthy subjects (age range 24-55 years, 27% women) participated in this prospective study.


RESULTS
The reported frequency of past headaches and the frequency of morning headache in the sleep laboratory were significantly increased in patients with SAS and other sleep disorders compared with healthy subjects. The occurrence of morning headache in the sleep laboratory was associated polysomnographically with a decrease in total sleep time, sleep efficiency and amount of rapid eye movement sleep and with an increase in the wake-time during the preceding night.


CONCLUSIONS
We conclude that morning headaches in patients with sleep disorders might be associated with particular disturbances of the preceding night's sleep. We speculate that dysregulation in anatomically identical central regions modulating sleep and nociception might be relevant to morning headache, rather than one particular sleep disorder such as SAS.
Göder
Robert
R
Department of Psychiatry and Psychotherapy, Christian-Albrechts-University of Kiel, Niemannsweg 147, D-24105 Kiel, Germany. rgoeder@psychiatry.uni-kiel.de
Friege
Lars
L
Fritzer
Gunther
G
Strenge
Hans
H
Aldenhoff
Josef B
JB
Hinze-Selch
Dunja
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002940:Circadian Rhythm; D005260:Female; D006261:Headache / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011446:Prospective Studies; D012890:Sleep; D012891:Sleep Apnea Syndromes / Q000150:complications; D012893:Sleep Wake Disorders / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D012895:Sleep, REM; D018781:Tension-Type Headache / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors; D014851:Wakefulness