AAP EDUCATION

Clinical relationships between Sleep & Migraine, Sleep and LBP

Sleep & Migraine

Background

Being a clinician I am always keen to see what the researching body is producing that I can incorporate into my clinical practice. You may also find the following information of interest.


There is now a longstanding evidence-base demonstrating that headaches can be triggered by various sleep disorders, including obstructive sleep apnea [1], narcolepsy [2], insomnia [3], circadian rhythm disorders [4], and restless legs syndrome [5], as well as poor quality [6] and insufficient sleep [7] in general.

Management

A recent study by prospectively examined participant's sleep and migraine experiences over a 6 week period. The researchers found that participants who napped (most commonly on day 2 of the migraine) during the study period experienced 1.1 more days of migraine per month, than those that did not.

Early indications from a , are that CBTi is useful in the treatment of migraine and tension type HA, improving sleep domain features (ie duration, efficiency, and excessive sleepiness) reducing HA frequency. HA intensity results varied in the different included studies. We teach the application of Cognitive Behavioural Therapy for Insomnia (CBTi) as a key management strategy in our

References

Sleep and Low Back Pain

Background

This 3 year longitudinal study examined the relationship between sleep disturbance and low back pain for people living in a zone affected by the Great East Japan Earthquake. The earthquake and associated tsunami in 2011, caused a reduction in socioeconomic status and access to social networks. It was also noted there were increases in sleep disturbance and low back pain. This study found that the rate of LBP was nearly double (39.2% cf 20.6%) in those reporting sleep disturbances were associated. Furthermore, preceding sleep disturbance (i.e., sleep disturbance in year 1) was associated with the onset of low back pain. This effect was found to be exposure related. That is, the LBP onset was more likely to occur in those with increased frequency or duration (i.e., > 2 years exposure) of sleep disturbance.

Management

The cause of participants' sleep disturbance in this study was a natural disaster. Clinicians in Australia will be familiar with treating clients with similar backgrounds, either from flood or fire events and need to consider enquiring about sleep patterns for those presenting with spinal pain like LBP.

Other clients with ongoing/repeated symptoms of spinal pain, may have experienced or be experiencing stress from another source, and detailed questioning about their sleep profile is important. While sleep hygiene factors may be relevant, due to the chronic nature of their sleep disturbance, a more comprehensive diagnosis and treatment approach like CBTi may be necessary.

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