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The Relationship Of Nocturnal Headaches To Sleep Stage Patterns

J. D. Dexter, E. Weitzman
Published 1970 · Medicine

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THE EXISTENCE of a temporal relationship between sleep and the migraine syndrome has long been reported in the literature. One of the best descriptions is by Bingl who stated, “Sometimes it (migraine) descends upon the patient like a bolt from the blue, when the latter goes to bed with a free head and in a general state of well-being in the evening, and wakes up in the morning with a bad headache.” Migraine can also occur during the middle of the patient’s nocturnal sleep period and frequently follows brief periods of diurnal sleep. Some attacks of nocturnal headache are reported to occur during dreams, and occasionally, the aura of attacks of classic migraine are incorporated into the content of a dream which precedes the arousal with the severe headache. In the late 1940s, Gans2#3 recognized this relationship between sleep and migraine and, by selectively depriving patients of nocturnal “deep sleep,” reported a decrease in both frequency and severity of the migraine attacks. He states: “As soon as he (the patient) showed the faintest sign of falling into deep sleep (unnatural body posture, sinking back of the head, or snoring) he was gently touched, whereupon he immediately returned to the superficial deep level.” The precise stages of sleep which were “rationed are not known due to the absence of electroencephalographic monitoring; however, this procedure may have had the effect of decreasing both stages 3 and 4 (slow-wave sleep) and rapid eye movement sleep (REM) .4 In view of this long-recognized clinical relationship between migraine and sleep, we felt it would be of considerable interest to investigate the nocturnal sleep patterns of patients who had the onset of migraine during nocturnal sleep and to determine if a relationship might exist between the headache attack and a stage of sleep.
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