Children with Migraine More Likely to Have Sleep and Behaviour Problems
Children with migraine are more likely to suffer sleep and behaviour problems than non-migraineur children. These problems were greater in those children with severe migraine.
Parents of children aged 6-18 years were recruited through a neurology clinic in Canada were asked to complete questionnaires for their child with migraine, the second for their child without migraine. In each case and control, three questionnaires were completed.
The first questionnaire determined age, gender, other chronic conditions, medications used and time off school in the previous 4 months, headache frequency and severity. The second asked about their children’s sleep habits, including delay in the time to sleep, sleep duration, sleep anxiety, parasomnias, sleep-disordered breathing, daytime sleepiness and night wakenings. The final questionnaire considered behaviour.
Of the 51 completed questionnaires, it was determined that the average age of the child with migraine was 12.2 years with 32% having headaches less than monthly, 40% monthly to weekly and 26% weekly to daily. Severe migraines occurred weekly or more frequently in 28% of cases.
Among those with migraine the total sleep score was higher, indicating greater sleep disturbance (p < 0.2), with more daytime sleepiness (p < 0.01) and delayed onset of sleep (p < 0.3), compared with their sibling controls. Those using prophylactic medication also had higher total sleep scores than those not using prophylaxis (p < 0.2), as did those with severe migraine (p < 0.1).
For behaviour, only the internalising problems score (covering anxiety, depression and somatisation) was higher for those with migraine, compared to their siblings (p < 0.02). However, those children with higher total sleep scores had behaviour problems on all 4 behaviour measurement scales, including poorer functioning. It is unclear whether sleep disturbances cause behaviour problems, or the other way around.
The reason behind this is that frequent headaches can prevent children from getting to sleep or cause night wakening. Also, many children with migraine can find their symptoms resolved if they sleep during a daytime attack, interrupting the normal sleep-wake cycle.
The authors suggest that sleep disorders should be routinely queried in children suffering migraine and advice on sleep hygiene provided.
Heng K, Wirrell E. Sleep disturbance in children with migraine. J Child Neurol 2006; 21: 761-766.
What the WHA thinks:
- A useful study, albeit quite small, that may help parents understand any behavioural difficulties with their migraine-suffering children.
- The recommendation that child migraine sufferers be offered advice on sleep hygiene is to be welcomed
- However, as the parents recorded the degree of sleep disturbance and behaviour it may be that these effects are underestimated. A child diary or physiologic measures could help give a clearer picture of the impact of migraine on sleep disturbance and behaviour