Headache and sleep: clinical and therapeutical aspects

Sleep disorders and headache are frequently comorbid. Anatomical, biochemical and physiologic common features and pathways could explain the bidirectional influence between sleep disorders and headache. One of the troubles often encountered in the evaluation of the comorbidity between sleep and headache disorders is that patients referring to tertiary headache centres are mainly concerned about their pain and generally do not tend to spontaneously report their possible sleep problems. But when they are specifically asked, very interesting data do emerge. The comorbidity headache-insomnia offers clinicians the opportunity to choose drugs able to control both disorders, avoiding molecules which could make insomnia worse while improving headache. A polysomnographic recording should be performed when a sleep apnoea headache is suspected and if diagnosis is confirmed, headache therapy should consist of the therapy of sleep apnoea itself. Morning headache in patients with periodic limb movements disorder during sleep is not responsive to standard headache therapy but needs to be treated with specific dopamine agonists which improve headache while relieving nocturnal movements.