REM and Cluster Headache
Acta Neurol Scand. 1986 Apr;73(4):403-7.
Onset of nocturnal attacks of chronic cluster headache in relation to
sleep stages.
Pfaffenrath V, Pollmann W, Ruther E, Lund R, Hajak G
Nocturnal attacks are symptomatic of numerous primary headache syndromes. It has
proven possible to verify, with polygraphic sleep recordings, a strict
correlation between the onset of headache attacks and the rapid eye movements
(REM) stage for migraineurs, patients with chronic paroxysmal hemicrania and
cluster headache (CH). The purpose of this study was to investigate the
correlation between attack onset of chronic CH and sleep stages, the REM stage
in particular. Nine patients from our headache outpatient service with a
diagnosis of CH were examined in this study. All medication was discontinued at
least one week prior to sleep polygraphias, which were conducted in a sleep
laboratory on two consecutive nights. Any attacks were treated with oxygen
inhalation during the drug-free period. EEG, EMG, and EOG were continuously
monitored during the sleep polygraphias. Eight patients had 25 CH attacks during
12 of the 17 nights recorded. Only three of these patients had arousals with
attacks in the REM stage and these amounted to five of the 25 recorded attacks.
Eleven attacks were in stage 2, four in stage 1 and two in stage 3. These
results correlate with recent findings according to which headache attacks were
often related to REM in episodic CH, but rarely in the chronic type. Whether or
not different pathogenic mechanisms are involved in the episodic and the chronic
type of CH is a matter for further discussion.
PMID: 3727916
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