UNC Health Care

Improving sleep behaviors reduces frequency and intensity of headaches, UNC study shows

Women who suffer from “transformed migraine” experienced a significant reduction in headache frequency and intensity after taking simple steps to improve their sleep behaviors, a University of North Carolina at Chapel Hill study has found.

“Transformed migraine is the most common form of chronic daily headache, and is the most common reason that patients seek treatment at headache clinics.”

“Transformed migraine is the most common form of chronic daily headache, and is the most common reason that patients seek treatment at headache clinics,” said Dr. Anne Calhoun, the study’s lead author and associate professor in the UNC School of Medicine’s department of neurology. Transformed migraine develops in individuals with episodic or occasional migraine, but these headaches progress over months or years to a daily or near-daily frequency and are particularly difficult to treat.

Calhoun and co-author Dr. Sutapa Ford, a clinical neuropsychologist at UNC, are presenting their results today (Friday, June 23) at the annual scientific meeting of the American Headache Society in Los Angeles.

Previous research shows that nonrestorative sleep and poor sleep habits are almost universally prevalent in women with transformed migraines. However, no prior study had investigated whether behavioral sleep modifications – such as eliminating TV watching or reading in bed and moving supper to at least 4 hours before bedtime – would have any beneficial effects for transformed migraine sufferers, Calhoun said.

To investigate this question, Calhoun and Ford recruited 43 women who were being treated for transformed migraine in the headache clinic at UNC Hospitals to participate in their study. Of these, 23 were randomized to receive behavioral sleep modification (BSM) instructions. Their instructions were to go to bed at the same time every night, at a time that allows for eight hours time in bed; eliminate TV watching, reading or listening to music while in bed; use visualization techniques to shorten the amount of time it took them to fall asleep; eat supper at least four hours before going to bed and limit fluid intake within two hours of bedtime; and do not take naps.

The remaining 23 women were randomized into the control group and received the following “sham” instructions: schedule a consistent suppertime, perform acupressure above the elbow for two minutes twice a day, record liquid consumption for three consecutive days, do five minutes of gentle range of motion exercises every morning, and have one protein serving at breakfast.

All of the women in the study recorded their headaches in standardized diaries and all received the usual medical care for their headaches in addition to the behavioral intervention. They received two follow-up visits, with the first one six weeks after beginning the behavioral intervention.

At the second visit, the BSM group reported a statistically significant 29 percent reduction in headache frequency and 40 percent reduction in headache intensity. They were also more likely to break out of the near-daily pattern of transformed migraine and revert to having only episodic migraine again. In contrast, the group who followed the “sham” instructions did not report any improvement, and no control group members reverted from transformed migraine to episodic.

After the second visit, the women in the control group were given the same BSM instructions as the other group. By the third and final visit, 43.6 percent of the women who received those instructions had reverted from transformed migraine to episodic migraine.

“We found that beneficial changes in sleep habits were associated with reduction in headache frequency and severity and with reversion to episodic migraine,” Calhoun said. “Therefore, behavioral sleep modification appears to be an effective treatment for transformed migraine when coupled with standard medical care.”

Financial support for the study was provided by the National Headache Foundation.