[Sleeping behaviour and headache attacks in cases of primary headache. Possible pathological mechanisms].
Headache is connected with sleep quality, e.g. hypnic headache and chronic paroxysmal headache attacks occur preferentially during REM sleep; this is possibly also true for cluster headache and migraine. REM sleep is typically characterized by the occurrence of ponto-geniculo-occipital spikes (PGOs). These PGOs should be able to trigger cortical spreading depression (CSD), which, although often clinically silent, is assumed to be an essential element of a migraine attack and possibly also of other forms of headache. CSDs are considered a correlate of migraine aura. They could lead to the secondary activation of trigeminovascular afferences, which would then induce a headache. Interestingly, illnesses that are comorbid with migraine cause an increase in the amount of REM sleep; conversely, various drugs administered prophylactically for these illnesses reduce the quantity of REM sleep.
Straube
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A
Neurologische Klinik der Universität München, Standort Grosshadern. astraube@nefo.med.uni-muenchen.de
Förderreuther
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S
D002908:Chronic Disease; D006261:Headache / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D008881:Migraine Disorders / Q000503:physiopathology; D012890:Sleep / Q000502:physiology*; D012893:Sleep Wake Disorders / Q000209:etiology*; D012895:Sleep, REM / Q000502:physiology