title: Preferential occurrence of attacks during night sleep and/or upon awakening negatively affects migraine clinical presentation.
abstract: It is well known that migraine attacks can preferentially occur during night sleep and/or upon awakening, however the possible implications of this timing on migraine clinical presentation remain unclear. The aim of this study was to assess the possible consequences of sleep-related migraine (defined as ≥ 75% of migraine attacks occurring during night sleep and/or upon awakening) on the migraine clinical picture (i.e. migraine-related disability, attack severity, use of symptomatic drugs), subjective sleep quality, excessive daytime sleepiness and fatigue. Two hundred consecutive migraine without aura patients were enrolled; patients with comorbid disorders or chronic medication use were excluded. 39% of the migraineurs included in the study received a diagnosis of sleep-related migraine. The mean frequency of migraine attacks (days per month) did not significantly differ between the patients with and those without sleep-related migraine, whereas migraine-related disability (p<0.0001), mean attack severity (p<0.0001), and monthly intake of symptomatic drugs (p<0.0001) were significantly higher in patients with migraine preferentially occurring at night-time and/or upon awakening. Subjective sleep quality and excessive daytime sleepiness did not differ significantly between the two groups, whereas fatigue was significantly more present in the patients with sleep-related migraine (p=0.0001). These data seem to support the hypothesis that patients with sleep-related migraine represent a subset of individuals with a more severe and disabling clinical presentation of migraine and greater impairment of daily functioning, as suggested by the higher degree of fatigue. Migraineurs with night-time attacks Preferential occurrence of attacks during night sleep and/or upon awakening negatively affects migraine clinical presentation also showed a greater use of symptomatic drugs, possibly related to delayed use of symptomatic treatment. The identification of subtypes of patients with a higher disability risk profile could have crucial implications for individually tailored management of migraine patients.
authors.forename: Sara
authors.initials: S
authors.lastname: Gori
authors.forename: Cinzia
authors.initials: C
authors.lastname: Lucchesi
authors.forename: Filippo
authors.initials: F
authors.lastname: Baldacci
authors.forename: Ubaldo
authors.initials: U
authors.lastname: Bonuccelli
mesh_terms: D000328:Adult; D000368:Aged; D005221:Fatigue / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020326:Migraine without Aura / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D012890:Sleep; D055815:Young Adult