title: Sleep quality and arousal in migraine and tension-type headache: the headache-sleep study.
abstract: OBJECTIVE
  The present paper summarizes and compares data from our studies on subjective and objective sleep quality and pain thresholds in tension-type headache (TTH), migraine, and controls.
  
  
  METHODS
  In a blinded controlled explorative study, we recorded polysomnography (PSG) and pressure, heat, and cold pain thresholds in 34 controls, 20 TTH, and 53 migraine patients. Sleep quality was assessed by questionnaires, sleep diaries, and PSG. Migraineurs who had their recordings more than 2 days from an attack were classified as interictal while the rest were classified as either preictal or postictal. Interictal migraineurs (n=33) were also divided into two groups if their headache onsets mainly were during sleep and awakening (sleep migraine, SM), or during daytime and no regular onset pattern (non-sleep migraine, NSM). TTH patients were divided into a chronic or episodic group according to headache days per month.
  
  
  RESULTS
  Compared to controls, all headache groups reported more anxiety and sleep-related symptoms. TTH and NSM patients reported more daytime tiredness and tended to have lower pain thresholds. Despite normal sleep times in diary, TTH and NSM had increased slow-wave sleep as seen after sleep deprivation. Migraineurs in the preictal phase had shorter latency to sleep onset than controls. Except for a slight but significantly increased awakening index SM, patients differed little from controls in objective measurements.
  
  
  CONCLUSIONS
  We hypothesize that TTH and NSM patients on the average need more sleep than healthy controls. SM patients seem more susceptible to sleep disturbances. Inadequate rest might be an attack-precipitating- and hyperalgesia-inducing factor.
authors.affiliation: Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway.
authors.forename: M
authors.initials: M
authors.lastname: Engstrøm
authors.forename: K
authors.initials: K
authors.lastname: Hagen
authors.forename: M H
authors.initials: MH
authors.lastname: Bjørk
authors.forename: L J
authors.initials: LJ
authors.lastname: Stovner
authors.forename: T
authors.initials: T
authors.lastname: Sand
mesh_terms: D000328:Adult; D000368:Aged; 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; D012890:Sleep / Q000502:physiology*; D012893:Sleep Wake Disorders / Q000150:complications / Q000503:physiopathology*; D011795:Surveys and Questionnaires; D018781:Tension-Type Headache / Q000150:complications / Q000503:physiopathology*; D055815:Young Adult
keywords: arousal; migraine; pain thresholds; polysomnography; sleep; tension-type headache