**1. Introduction**

86 Sleep Disorders

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Sleep and headache are two realities known to be linked in a bidirectional way [01]. Clinical research correlates specific headache diagnoses and sleep disorders with chronobiologic patterns and sleep processes, implicating that common anatomic structures and neurochemical processes are involved in the regulation of both sleep and headache. Sleep and pain perception share several structures, such as the thalamus, the hypothalamus, and a number of mesencephalic, pontine and bulbar nuclei, some of which are also involved in breathing regulation.

The respiratory parameters during sleep at night may play a important role in modifying susceptibility to various pathological conditions, including headache. Morning headache was found to be more frequent among Obstructive Sleep Apnea Syndrome (OSAS) patients with a direct relationship with the severity of the sleep breathing disorder: apnoea hypopnoea index (AHI) has been found higher in OSAS patients with morning headache compared with those without morning headaches and also mean oxygen saturation value (SpO2) during total sleep time has been found significantly lower in OSAS patients with morning headache [02]. Furthermore, it has been observed that morning headache may be largely resolved with nasal continuous positive airway pressure.

The relevance of respiratory disturbances during sleep in subjects with primary headaches has not been clearly evaluated.

Additionally, in a previous study we found that subjects with headache, and particularly those with headache-related cutaneous allodynia, had alterations in sleep behaviour [03].

Consequently, a possible link between sleep behavior disturbances, respiratory disorders during sleep and primary headaches may be hypothesized.

<sup>\*</sup> M. Zardoni1, D. D'Amico3, M. Pecis2, L. Giani1, E. Raimondi1, P. Bertora1, D. Legnani2, G. Bussone3, C. Mariani1

<sup>1</sup>*Department of Neurology and Headache Unit, L. Sacco Hospital, Milan, Italy 2Department of Pneumology , L. Sacco Hospital, Milan, Italy* 

*<sup>3</sup>Headache Centre, Departement of Clinical Neurosciences and Headache Unit,* 

*C. Besta Neurological Institute Foundation, Milan, Italy*

Breathing Sleep Disturbances and Migraine: A Dangerous Synergy or a Favorable Antagonism? 89


Student T test with Bonferroni correction was used to compare mean ages, mean AHI, mean T<90% and mean SpO2, between groups (subjects with or without headache, with or

Chi square test was applied to compare the distribution of different sleep behavior aspects

Among the enrolled subjects, 198 did not suffer from headache (mean age 60.3 ± 12.7 years, 159 men and 39 women) and 104 had history of headache (mean age 51.4 ± 12.3 years, 66 men and 38 women) of which 67 migraineurs (Mig - mean age 50.8 ± 14.9 years, 37 men and 30 women) and 37 with tension type headache (TTH - mean age 51.4 ± 13.3 years, 29 men

Out of 104 subjects with headache, 50 were allodynic. Allodynia was found in 41 out of 67

In our population, headache was present in 34.4% of the studied subjects (104 out of 302 individuals, of which 67 with migraine and 37 with tension type headache ) and allodynia during pain attacks was present in 48% of headache patients (50 out of 104 subjects). Allodynia was more frequent among migraineurs (41 out of 67) than in tension type patients

After grouping by gender, headache was present in 29,3% of men and in 49,3% of women. Migraine was found in 30 out of 39 female headache patients (30 out of 116 enrolled women, 25% of the female cohort) and in 37 out of 159 male patients with headache (37 out of 225 observed men, 16% of the male population studied). Headache distributions in the different

104 with headache migraine 67 37/30 55 45 50,8

As summarized in Table 2, respiratory parameters among subjects with headache were

Table 1. Presence of headache in subjects who underwent a full cardiopulmonary

monitoring for presumed respiratory problems during sleep.

*Respiratory sleep parameters in different diagnostic groups* 

always better than in subjects without headache.

Total sample 302 225/77 75 25 57,0 Without headache 198 159/39 80 20 60,3

tension type headache 37 29/8 78 22 51,4

**n° M/F M** (%) **<sup>F</sup>**(%) **Mean age** 

(years)

pletismography, and a gyroscopic body position detection device.

migraineurs and in 9 out of 37 patients with tension type headache.

*Statistics* 

without allodynia).

**4. Results** 

and 8 women).

(9 out of 37).

groups are shown in Table 1.

between different diagnostic groups.

*Headache and allodynia distribution in the sample* 
