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      Hypersomnia in children affected by migraine without aura: a questionnaire-based case-control study

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          The relationship between sleep and headache is meaningful and complex. Children affected by migraines tend to show many sleep disorders, such as insufficient sleep duration and excessive daytime somnolence. Therefore, the aim of this study is to assess the rate of reported sleep habits and self-reported sleepiness in a large pediatric sample of individuals affected by migraine without aura (MoA).


          The study population consisted of 271 children aged between 6 and 13 years affected by MoA. The control group was composed of 305 typically developing children. To assess the sleep habits of all individuals (MoA and control), parents filled out the Sleep Disturbance Scale for Children, and to check the degree of subjective perceived daytime sleepiness, all subjects were administered the Pediatric Daytime Sleepiness Scale.


          The two study groups were matched for age ( P = 0.124), sex distribution ( P = 0.775), and body mass index z-score ( P = 0.107). Parents of children affected by MoA reported a higher total score of sleep disorder symptoms ( P <0.001), disorders of initiating and maintaining ( P < 0.001), and disorders of arousal ( P < 0.001) than did parents of controls. No significant differences were found in disorders of excessive somnolence. Conversely, in the Pediatric Daytime Sleepiness Scale, migraine children had higher scores (24.67 ± 3.19 vs 11.94 ± 4.81; P < 0.001) and a reduction in referred total sleep time mean duration (469.83 ± 98.112 vs 527.94 ± 83.02; P < 0.001) than typically developing children.


          Our study identified differences in sleep habits and found a high prevalence of daytime somnolence in children affected by MoA, suggesting the need for routine sleep screening in the pediatric management of children with migraines.

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          Most cited references 11

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          Headaches and sleep problems among adults in the United States: findings from the National Comorbidity Survey-Replication study.

          Several studies have demonstrated an association between headache and disturbed sleep. None have examined this association across the headache spectrum. Our goal was to determine whether migraine and migraine with aura differ from nonmigraine headache in terms of associated insomnia complaints or severity of sleep problems. A probability sample of US adults was used. A structured interview administered by trained interviewers was used. Diagnostic criteria for migraine and migraine with aura were based on the International Headache Society classification. The presence or absence of four forms of sleep disturbance associated with an insomnia diagnosis was ascertained. There was a significant association between frequent severe headache, including migraine with and without aura, and disordered sleep. Adults with headache reported more frequently difficulty initiating sleep (odds ratio [confidence interval] = 2.0 [1.6-2.5]), difficulty staying asleep (2.5 [2.1-3]), early morning awakening (2.0 [1.7-2.5]) and daytime fatigue (2.6 [2.2-3.2]) and also were more than twice as likely to report three or more of these symptoms(2.5 [2-3.1]) compared to the individuals without headache. Adults with severe headache are at significantly higher risk of also suffering from sleep problems, when compared with the general population, regardless of specific headache type. Optimal treatment of headache must include investigation for sleep disorders and vice versa.
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            Excessive daytime sleepiness in migraine patients.

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              Sleep and headache: a bidirectional relationship.

              Sleep and pain perception are two phylogenetically well-conserved functions, strictly influenced by environmental and psychological factors, and are able to interact reciprocally both in physiological and pathological situations. Sleep and head-pain perception share the involvement of several structures, such as the thalamus, the hypothalamus and brainstem nuclei, including the locus coeruleus and raphe nuclei. There ais clinical evidence indicating that sleep disorders can precede the appearance of certain headaches and that head pain, especially when frequent, can, in turn, affect sleep quality. In the present work the anatomy, physiology and pathology of sleep and head-pain perception will be reviewed with the aim of highlighting the points of contact and possible unifying treatment strategies.

                Author and article information

                Neuropsychiatr Dis Treat
                Neuropsychiatr Dis Treat
                Neuropsychiatric Disease and Treatment
                Neuropsychiatric Disease and Treatment
                Dove Medical Press
                21 February 2013
                : 9
                : 289-294
                [1 ]Center for Childhood Headache, Unit of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical, and Preventive Medicine, Second University of Naples, Naples, Italy
                [2 ]Child Neuropsychiatry, Department of Psychology, University of Palermo, Palermo, Italy
                [3 ]Unit of Child and Adolescent Neuropsychiatry, University of Perugia, Perugia, Italy
                Author notes
                Correspondence: Marco Carotenuto Center for Childhood Headache, Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Via Sergio Pansini 5 PAD XI, 80131 Naples, Italy Tel +39 8 1566 6988 Fax +39 8 1566 6694 Email marco.carotenuto@
                © 2013 Esposito et al, publisher and licensee Dove Medical Press Ltd

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                Original Research


                children, excessive daytime sleepiness, drowsiness, sleep disorders, migraine without aura


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