Comment Observation and Rebuttals
Headache and Sleep: Also Assess Circadian Rhythm Sleep Disorders: A Response
Article first published online: 8 JAN 2014
© 2014 American Headache Society
Headache: The Journal of Head and Face Pain
Volume 54, Issue 1, page 178, January 2014
How to Cite
Freedom, T. (2014), Headache and Sleep: Also Assess Circadian Rhythm Sleep Disorders: A Response. Headache: The Journal of Head and Face Pain, 54: 178. doi: 10.1111/head.12221
- Issue published online: 8 JAN 2014
- Article first published online: 8 JAN 2014
The author thanks Dr. Rovers, Dr. Smits, and Dr. Duffy for their comments regarding the expert opinion article, Headache and Sleep.[1, 2] The evaluation of circadian rhythm disorders could play an important role in the management of migraine in patients with these disorders. I believe that the methods suggested in our article, starting with the BEARS screening, and if positive, proceeding with a more detailed sleep history, questionnaires, and sleep logs, would uncover most circadian disturbances. As pointed out by Rovers and colleagues, actigraphy could also be useful in confirming diagnosis.
Melatonin has been shown to play a role in nociception in general, including headaches. Melatonin may have a role in the treatment of migraine in patients with circadian disorders. The results of Rovers et al are promising, but data from a placebo/control group were not shown. A randomized controlled trial (RCT) duplicating these results would provide stronger evidence.
While I agree with the potential of melatonin in managing migraine in patients with circadian rhythm disorders, and that DLMO could be useful in migraine patients with suspected circadian disorders, it is not clear that the case has been made for routine monitoring of DLMO in all migraine patients.
- 1Headache and sleep: Also assess circadian rhythm sleep disorders. Headache. 10.1111/head.12217., , .
- 3Sleep quality, chronotypes and preferential timing of attacks in migraine without aura. J Headache Pain. 2005;6:58-60., , , , , .
- 10The use of exogenous melatonin in delayed sleep phase disorder: A meta-analysis. Sleep. 2010;33:1605-1614., , .