Exploring the Connection Between Sleep and Cluster Headache: A Narrative Review
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REVIEW
Exploring the Connection Between Sleep and Cluster Headache: A Narrative Review Joseph V. Pergolizzi Jr. . Peter Magnusson . Jo Ann LeQuang . Charles Wollmuth . Robert Taylor Jr. . Frank Breve
Received: March 31, 2020 Ó The Author(s) 2020
ABSTRACT Cluster headache is a rare form of headache associated with sleep and even speculated to be a manifestation of a sleep disorder rather than a primary headache. Cluster headache exhibits both circadian and circannual rhythmicity. While attacks often occur during sleep, the implication that cluster headaches might be involved with rapid eye movement (REM) sleep phases has neither been fully established nor
Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12173517. J. V. Pergolizzi Jr. J. A. LeQuang (&) C. Wollmuth R. Taylor Jr. NEMA Research, Inc., Naples, FL, USA e-mail: [email protected] P. Magnusson Cardiology Research Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden P. Magnusson Centre for Research and Development, Uppsala University/Region Ga¨vleborg, Ga¨vle, Sweden F. Breve Department of Pharmacy Practice, School of Pharmacy, Temple University, Philadelphia, PA, USA
refuted. The regulatory mechanisms governing sleep including hypothalamic activity and the autonomic nervous system response may play a role. Hypothalamic activation has been observed in cluster headache patients during positron emission tomography testing, but only during attacks. While sleep apnea is associated with morning headaches in general, the link between sleep-disordered respiration and cluster headache remains elusive. Hypoarousal during sleep and periods of hypoxia are associated with cluster headache, the latter likely involving inflammatory processes rather than apnea. Further study is needed, as cluster headaches represent a serious primary cephalgia that is incompletely understood.
Keywords: Chronic cluster headache; Cluster headache; Cluster headache syndrome; Sleep
Pain Ther
Key Summary Points The onset of cluster headache often occurs during sleep and cluster headaches have a diurnal and circannual rhythm. Cluster headaches are characterized by agitation, wakefulness, and a desire to move around or pace, making somnography challenging. The relationship between rapid eye movement (REM) sleep and cluster headache is controversial. Insufficient, erratic, or disordered sleep may trigger cluster headaches in susceptible individuals. People without cluster headache arouse 7-15 times an hour during healthy sleep but those with cluster headache arouse less often, possibly due to reduced hypothalamic activity. The connection between sleep-disordered breathing and headache is well established, but it is not clear if cluster headaches are related to erratic breathing patterns during sleep. Pain in cluster headache can be very severe and is the result of a cascade of event culminating in neurovascular inflammation involving the trigeminal nerve.
INTRODUCTION The International Classification of Sleep
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