Associations between migraine attacks and nightly sleep characteristics among adults with episodic migraine: a prospective cohort study

Study Objectives: Given the unknown immediate impact of migraine on nighttime sleep, we prospectively examined whether migraine headaches were associated with subsequent shorter sleep duration, higher fragmentation, and poorer quality in a cohort of 98 adults with episodic migraine. Methods: Participants completed twice-daily electronic diaries and wore actigraphs continuously for 6 weeks. We examined whether days with headaches were associated with changes in that night's sleep characteristics compared with headache-free days, using adjusted multivariable linear mixed models with subject-specific intercepts. Results: Participants were 35 +/- 12 years old, 88% women, with an average of five migraine headaches per month. Over 4,406 days, we observed 1,077 headache days, representing 823 discrete headaches. Average nightly objective sleep duration was 7.3 +/- 1.2 hr, efficiency 89.5 +/- 3.3%, and wake after sleep onset (WASO) 44.8 +/- 17.0 min. Objective sleep duration was 7.3 min (95% CI: 1.5, 13.0) longer on nights following a headache day compared with nights on a headache-free day. Objective sleep efficiency, WASO, and reported sleep quality were not significantly different on headache days compared with headache-free days (sleep efficiency: -0.06 min, 95% CI: -0.3, 0.2; WASO 1.5 min, 95% CI: 0.0, 3.0; sleep quality: 1.0, 95% CI: 0.8, 1.3). Conclusions: Sleep periods immediately following migraine headaches are not associated with shorter duration, higher disruption, or poorer sleep quality in patients with episodic migraine. These results suggest that clinical evaluation of sleep disturbance in patients with episodic migraine should be approached independently of their migraine status. Statement of Significance Our findings suggest that occurrence of headache is not associated with poorer nightly sleep in adults with episodic migraine. Specifically, subsequent sleep is not characterized by shorter sleep duration, higher sleep disruption, or lower sleep quality. Therefore, occurrence of migraine headaches does not explain sleep disturbances commonly reported by those with episodic migraine. Clinical evaluation and treatment of sleep problems in patients with episodic migraine should occur independently of migraine status; it should not be assumed that treatment of migraine headaches may improve sleep symptoms.