Transformed Migraine Related To Sleep Problems

by Teri Robert, Lead Expert

Although sleep issues have been linked with headaches and Migraine for more than 100 years, information about the types and prevalence of specific sleep problems in adults with transformed Migraine (TM) has been scarce. Now the findings have been published on a study to look at the connection between nonrestorative sleep and TM. The study was conducted at the University of North Carolina in Chapel Hill, led by Dr. Anne Calhoun.

Study objectives: "It is our clinical observation that patients with transformed migraine (TM) almost invariably report nonrestorative sleep. In this study we sought first to validate that clinical observation, then to describe the prevalence and spectrum of factors that might contribute to nonrestorative sleep in a TM population."

Study methods:

  • Researchers conducted detailed sleep interviews with 147 women with TM.
  • The quality of the subjects' sleep was assessed by asking patients to describe how they felt upon awakening as either "refreshed" or "tired.

Study results:

  • The mean age of study participants was 39.47-years-old.
  • The median length of time participants had been experiencing chronic headache was 66 months.
  • 0 patients responded that they awakened feeling "refreshed."
  • 87% responded that they awakened feeling "tired."
  • Various sleep complaints were prevalent.
  • Difficulty falling asleep was reported by 2/3 of study participants.
  • The reason most commonly reported for disruption of sleep was getting up to urinate.
  • More than 50% of the study participants used sleep medications, with benzodiazapines (the family that includes medication such as Valium and Xanax) being the most commonly used and the users reporting excessive night movements.
  • 73% of the participants reported medication overuse, and these were the participants most likely to report disrupted sleep and awakening during the night. They were also the participants most likely to nap during the day.

Study conclusions: "Although the relationship between pain and sleep is complex and ill understood, we found a very high prevalence of nonrestorative sleep and a similarly high prevalence of modifiable poor sleep habits in patients with TM. Since behavioral approaches have been found effective in improving sleep quality in patients with poor sleep hygiene, we propose that studies be undertaken to assess the impact of such treatment on TM."

We know that too much, too little, disrupted, or poor quality sleep can be a Migraine trigger for many Migraineurs, not just those experiencing TM. Given the study results, it logically follows that addressing sleep problems earlier rather than later might help Migraineurs avoid TM. Certainly, eliminating sleep problems as a trigger could only help any Migraineur.

Ask yourself the study question -- Do you awaken feeling "refreshed" or "tired." Another question often asked when screening for sleep problems is whether you get sleepy during the day and feel the need to nap. Don't wait for your doctor to ask you about the quality of your sleep. If you have sleep problems, talk to your doctor and get help.


Calhoun, Anne H., Ford, Sutapa, Finkel, Alan G., Kahn, Kevin A. & Mann, J. Douglas (2006) "The Prevalence and Spectrum of Sleep Problems in Women With Transformed Migraine." Headache: The Journal of Head and Face Pain 46 (4), 604-610. doi: 10.1111/j.1526-4610.2006.00410.x

Reuters Health. "Sleep Problems Common in Women With Transformed Migraine." May 12, 2006.

© Teri Robert, 2007

Last updated November 4, 2007.