title: Heart rate variability in sleep-related migraine without aura.
abstract: OBJECTIVE
  This is an observational study aimed to investigate the activity of autonomic nervous system during sleep in patients with sleep-related migraine.
  
  
  METHODS
  Eight consecutive migraineurs without aura were enrolled (6 women and 2 men), aged 30 to 62 years (mean 48.1 ± 9.3 years). Inclusion criteria were: high frequency of attacks (> 5 per month) and occurrence of more than 75% of the attacks during sleep causing an awakening. Patients were compared with a control group of 55 healthy subjects (23 men and 32 women, mean age 54.2 ± 13.0 years), and with a further control group of 8 age- and gender-matched healthy controls. Patient and controls underwent polysomnography and heart rate variability analysis.
  
  
  RESULTS
  A significant reduction of the LF/HF ratio during N2 and N3 sleep stages was observed in migraineurs compared with controls. No differences in sleep macrostructure were observed; cyclic alternating pattern (CAP) time and CAP rate were lower in migraineurs than in controls.
  
  
  CONCLUSIONS
  These findings indicate a peculiar modification of the autonomic balance during sleep in sleep-related migraine. The reduction of LF/HF ratio in NREM sleep was observed in controls, but it was quantitatively much more evident in migraineurs. Changes in LF/HF could be consequent to an autonomic unbalance which could manifest selectively (or alternatively become more evident) during sleep. These findings, together with the reduction in CAP rate, could be an expression of reduced arousability during sleep in patients with sleep-related migraine. The simultaneous involvement of the autonomic, arousal, and pain systems might suggest involvement of the hypothalamic pathways.
authors.affiliation: Institute of Neurology, Catholic University, Rome, Italy. lvol@libero.it
authors.forename: Catello
authors.initials: C
authors.lastname: Vollono
authors.forename: Valentina
authors.initials: V
authors.lastname: Gnoni
authors.forename: Elisa
authors.initials: E
authors.lastname: Testani
authors.forename: Serena
authors.initials: S
authors.lastname: Dittoni
authors.forename: Anna
authors.initials: A
authors.lastname: Losurdo
authors.forename: Salvatore
authors.initials: S
authors.lastname: Colicchio
authors.forename: Chiara
authors.initials: C
authors.lastname: Di Blasi
authors.forename: Salvatore
authors.initials: S
authors.lastname: Mazza
authors.forename: Benedetto
authors.initials: B
authors.lastname: Farina
authors.forename: Giacomo
authors.initials: G
authors.lastname: Della Marca
mesh_terms: D000328:Adult; D001341:Autonomic Nervous System / Q000503:physiopathology*; D004569:Electroencephalography / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D020326:Migraine without Aura / Q000503:physiopathology*; D017286:Polysomnography / Q000379:methods; D012894:Sleep Stages / Q000502:physiology
keywords: Autonomic nervous system; cyclic alternating pattern; heart rate variability; hypothalamus; sleep-related migraine