Sleep Disorders Common in Medication Overuse Headache

TOPLINESleep disorders, particularly chronic insomnia and restless legs syndrome (RLS), were more prevalent in individuals with medication overuse headache (MOH) than in those without the condition, a new study showed. Investigators also found that treatment for MOH was associated with a significantly lower risk for sleep disorders and reductions in headache frequency and analgesic use.METHODOLOGYThis prospective case-control study, conducted at a single center in Russia from 2021 to 2024, included 171 adult patients with MOH and 173 age- and sex-matched individuals with headache but without MOH (control group).Participants underwent semi-structured interviews and overnight polysomnography when clinically indicated; completed standardized assessments, including the Insomnia Severity Index and Epworth Sleepiness Scale; and maintained headache and sleep calendars.Patients were prescribed headache-prevention treatment during the first consultation. Patients with MOH received treatment according to the European Academy of Neurology guideline, including education, abrupt analgesic withdrawal without detoxification, and preventive pharmacotherapy. No specific sleep medications were prescribed, but sleep hygiene practices were recommended to all participants.Follow-up assessments were conducted for 87 patients with MOH (mean follow-up duration, 24.2 months) and 70 control individuals (mean follow-up duration, 26.4 months) through structured telephone interviews. The primary outcome was the prevalence of sleep disorders. Factors associated with chronic insomnia and outcomes after headache treatment were also assessed.TAKEAWAYChronic insomnia was significantly more prevalent in patients with MOH than in the control group (60.2% vs 47.4%; odds ratio [OR], 1.7; P = .03). RLS was also more prevalent in patients with MOH (37.4% vs 22%; OR, 2.1; P = .003). The prevalence of obstructive sleep apnea was comparable between the groups.Factors associated with chronic insomnia in patients with MOH included nocturnal headache (OR, 2; P = .04), nighttime analgesic use (OR, 2.5; P = .005), overweight (OR, 2.7; P = .003), low physical activity (OR, 2.1; P = .03), high-frequency dosing (OR, 2.3; P = .008), arterial hypertension (OR, 2.6; P = .009), subjective cognitive impairment (OR, 2.1; P = .04) and a history of COVID (OR, 2; P = .04).Following treatment, there was a significant decrease in the prevalence of chronic insomnia (66.7%-33.3%; OR, 3; P < .001) and RLS (39.1%-14.9%; OR, 3.4; P < .001) in patients with MOH, but the decreases in the control group didn’t reach statistical significance.During follow-up after treatment, nocturnal headache, headache frequency of at least 15 days per month, analgesic use of at least 10 days per month, and nighttime analgesic use decreased significantly in both groups but did not differ significantly between the groups.IN PRACTICE“This is the first study to demonstrate high sleep disorder prevalence in MOH and its reversibility following headache treatment. Early screening for sleep disorders in MOH patients is recommended,” the investigators of the study wrote.SOURCEThe study was led by Elena R. Lebedeva, Ural State Medical University, Yekaterinburg, Russia. It was published online on July 16 in the European Journal of Neurology.LIMITATIONSLoss of participants to follow-up was significant. The predominance of women in the study population may have led to an overestimation of insomnia prevalence. Polysomnography was performed only when clinically indicated, potentially leading to an underestimation of the prevalence of obstructive sleep apnea. No validated severity scale was used for RLS. The study was conducted during the COVID pandemic, which may have contributed to new-onset sleep disorders. Finally, parasomnias were not evaluated, and recruitment from a tertiary headache center may have limited the generalizability of the findings.DISCLOSURESThe study received no funding. The investigators reported no relevant conflicts of interest.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.