title: Sleep quality, arousal and pain thresholds in migraineurs: a blinded controlled polysomnographic study.
abstract: BACKGROUND
  Our aim was to compare subjective and objective sleep quality and arousal in migraine and to evaluate the relationship between sleep quality and pain thresholds (PT) in controls, interictal, preictal and postictal migraine.
  
  
  METHODS
  Polysomnography and PT (to pressure, heat and cold) measurements were done in 34 healthy controls and 50 migraineurs. Subjective sleep quality was assessed by sleep diaries, Epworth sleepiness scale, Karolinska sleep questionnaire and Pittsburgh sleep quality index. Migraineurs who had their sleep registration more than 48 h from an attack were classified as interictal while those who were less than 48 h from an attack were classified as either preictal or postictal.
  
  
  RESULTS
  Migraineurs reported more insomnia and other sleep-related symptoms than controls, but the objective sleep differences were smaller and we found no differences in daytime sleepiness. Interictal migraineurs had more awakenings (p=0.048), a strong tendency for more slow-wave sleep (p=0.050), lower thermal pain thresholds (TPT) (heat pain thresholds p=0.043 and cold pain thresholds p=0.031) than controls. Migraineurs in the preictal phase had shorter latency to sleep onset than controls (p=0.003). Slow-wave sleep correlated negatively with pressure PT and slow bursts correlated negatively with TPT.
  
  
  CONCLUSIONS
  Lower PT in interictal migraineurs seems related to increased sleep pressure. We hypothesize that migraineurs on the average suffer from a relative sleep deprivation and need more sleep than healthy controls. Lack of adequate rest might be an attack-precipitating- and hyperalgesia-inducing factor.
authors.affiliation: Department of Clinical Neurosciences, Norwegian University of Science and Technology, Trondheim, N-7489, Norway. morten.engstrom@ntnu.no
authors.forename: Morten
authors.initials: M
authors.lastname: Engstrøm
authors.forename: Knut
authors.initials: K
authors.lastname: Hagen
authors.forename: Marte Helene
authors.initials: MH
authors.lastname: Bjørk
authors.forename: Lars Jacob
authors.initials: LJ
authors.lastname: Stovner
authors.forename: Gøril Bruvik
authors.initials: GB
authors.lastname: Gravdahl
authors.forename: Marit
authors.initials: M
authors.lastname: Stjern
authors.forename: Trond
authors.initials: T
authors.lastname: Sand
mesh_terms: D000293:Adolescent; D000328:Adult; D001143:Arousal / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications / Q000503:physiopathology*; D017288:Pain Threshold / Q000502:physiology*; D017286:Polysomnography; D012890:Sleep / Q000502:physiology*; D055815:Young Adult
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