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Migraines may be linked/caused with sleep apnea in kids; other headaches probably implicated, viscious cycle

This activity is not sanctioned by, nor a part of, the American Academy of Neurology.

From Medscape Medical News

Migraine Linked to Sleep Apnea in Children and Teens

Kathleen Louden

Authors and Disclosures

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April 22, 2008 (Chicago, Illinois) — In children and teenagers with both headaches and sleep complaints, a new study using polysomnography showed an association between migraine and sleep-disordered breathing and between tension headache and bruxism.

Patients in this study were evaluated at St. Christopher Hospital for Children, Drexel University, in Philadelphia, Pennsylvania. Ninety patients with headache and sleep problems aged 5 to 19 years underwent polysomnography, an electroencephalography-based sleep test. Migraine was the most common type of headache, occurring in 60 of the 90 patients. Another 11 patients had chronic daily headache, 6 had tension headache, and 13 had nonspecific headache, such as morning headache. Sleep-disordered breathing, including obstructive sleep apnea, was about twice as common in the migraineurs as in patients with other types of headache (56% vs 30%, respectively), the authors found.

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"Parents and doctors need to be aware of the strong likelihood of sleep disorders in children with migraine," said lead author Martina Vendrame, MD, PhD, from the department of neurology at Temple University, also in Philadelphia.

Dr. Vendrame presented the results at the American Academy of Neurology (AAN) 60th Annual Meeting.

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A neurologist who did not participate in the study called it "a good step in recognizing the broad reach of disordered sleep." Bradley V. Vaughn, MD, professor of neurology at the University of North Carolina at Chapel Hill, moderated the highlights session on sleep disorders at the meeting.

"Children with headache should be questioned about symptoms of sleep disorders because there's a high incidence of them in this group," Dr. Vaughn told Medscape Neurology & Neurosurgery.

During a press briefing, Dr. Vendrame said physicians should ask parents of children with migraine about snoring, frequent awakening during sleep, and daytime sleepiness.

When asked whether the fact that all of their patients had reported sleep problems could have biased the study results, Dr. Vendrame agreed it was possible. She told Medscape Neurology & Neurosurgery, "We want to repeat the study in a general population of children or in children who have headache but do not report sleep complaints."

However, polysomnograms showed disturbed sleep architecture in the study patients with severe migraine and with chronic daily headache (occurring more than 15 days a month). These children and teens took a longer time to fall asleep, had shorter rapid eye movement (REM) sleep, and slept less total time than did those with milder or less frequent migraine, she reported.

"Children with migraines take naps, and that can affect sleep architecture," Dr. Vendrame said at the press conference. "But headache may contribute to sleep disorders in children. We think they share common mechanisms, which may be related to REM sleep."

The authors observed other sleep disturbances. Three (50%) of the patients with tension headache had bruxism, whereas only 2.4% of the patients with other types of headache ground their teeth during sleep, according to the abstract.


"Teeth grinding is related to dysfunction of the temporomandibular joint, and these children need to be referred to a dental specialist," Dr. Vendrame said.

Most of the children with sleep apnea needed referral to an ear-nose-throat (ENT) specialist, and about 50% of those children underwent tonsillectomy, the author said. "After surgery, about 80% had less severe and less frequent migraine," she said. "This needs more follow-up."

American Academy of Pediatrics guidelines for children with symptoms of sleep disorders are to refer them for a sleep study, according to Dr. Vaughn. "However, there are not as many sleep centers that do sleep studies in children as there are for adults," he said. "As a backup plan, have an ENT evaluate the child."

Polysomnography is not part of the usual migraine workup in children. The sleep test monitors the brain, eye movements, breathing, cardiac rhythm, and muscle activity.

Drs. Vendrame and Vaughn report no relevant financial disclosures.

American Academy of Neurology 60th Annual Meeting:" target="_blank">Abstract S49.008. Presented April 17, 2008.

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I am a pediatrician specializing in General Pediatrics, International Adoption Medicine, and in the diagnosis and coaching of families pursuing joy.