Klinische Neurophysiologie 2011; 42 - P278
DOI: 10.1055/s-0031-1272725

Serial polysomnography in cluster headache shows no association with a particular sleep stage and may be aggravated by sleep apnea

S. Zaremba 1, D. Holle 1, T. Wessendorf 1, C. Gaul 1, H.C. Diener 1, Z. Katsarava 1, M. Obermann 1
  • 1Essen

Objective: To identify associations of specific sleep stages with the occurrence of nocturnal headache in patients with cluster headache.

Background: Cluster headache [CH] is a rare primary headache disorder. Relation to sleep in general and relation to REM-sleep in particular was reported. However, sequential analysis of CH attacks during or related to sleep have not been reported in literature so far.

Design/Methods: We performed polysomnography in three patients with episodic CH according to the diagnostic criteria of the International Headache Society (ICHD-II) in four consecutive nights. An independent, experienced sleep medicine specialist blinded to the diagnosis evaluated a total of 12 nights, leading to 9 nights with typical attacks of cluster headache. The findings will be reconfirmed by investigation of 2–3 additional patients suffering from episodic CH, and will be compared to the findings in 5–6 additional patients with chronic CH.

Results: We report data of three patients with episodic CH, each of them investigated during four consecutive nights. We found no association of the occurrence of typical cluster headache attacks with a particular sleep phase. Headache onset was arbitrarily distributed to Non-REM sleep stages. This patients had 13 headache attacks in 9 nights whereat headache appeared during sleep stage 2 in 9 cases, and during sleep stage 3 in 3 cases. Furthermore one typical CH attack was reported after waking up from light sleep (stage 1). Two patients reported more than one headache attack per night, during three nights.

One patient had obstructive sleep apnea syndrome where headache reappeared after introduction of CPAP mask therapy but was reported as less severe (NRS 3) compared to headache attacks without CPAP (NRS 5–6).

Conclusion/Relevance: The occurrence of CH attacks is not associated with a particular sleep phase, neither REM nor any one of the Non-REM sleep stages. The underlying pathophysiology remains uncertain, but is obviously not dependent on REM sleep.

Low oxygen levels, as found during OSA, might be able to aggravate CH during night and may be improved by adequate CPAP therapy.