The Corpus Callosum

There’s a href="http://www.medpagetoday.com/Neurology/Migraines/tb/3663">brief
article on Medpage Today, about a small study that suggests
that improving sleep can improve the course of a particular type of
headache.  (A nicety to the article is that it provides 0.25
CME’s.)

They write specifically about href="http://www.achenet.org/articles/purdy.php" rel="tag">transformed
migraine
, which is a kind of headache that occurs
daily, with the daily headaches developing after a
person has had some episodic migraines.  

…The study included 43 women with transformed
migraine treated at a single center. They were randomized to usual
medical care with behavioral sleep modification or usual medical care
plus sham behavioral instructions. All sleep medications were
discontinued during the study.

Behavioral sleep modification included scheduling consistent bedtime
that allows eight hours in bed, eliminating TV watching and other such
activities in bed, the use of visualization techniques, moving dinner
to at least four hours before bedtime, limiting fluid intake within two
hours of bedtime, and discontinuing naps.

Sham instructions included things that would sound plausible to the
patient but not impact sleep hygiene, such as to schedule a consistent
dinner time, and have one protein serving at breakfast.

The behavioral sleep medication group had a greater reduction in
migraine frequency from 24.2 episodes in 28 days at baseline down to
about 17 in 28 days compared to an increase in frequency for the sham
group from 23.2 episodes in 28 days at baseline to about 24 in 28 days
(P=0.001).

Headache index scores decreased significantly in the treatment group
compared to the control arm: a decrease from 46.7 to 28.3 compared to a
decrease from 50.2 to 44.1 (P<0.01).

Of the 23 patients who received behavioral sleep modification
instructions, 35% reverted back to having episodic rather than daily
migraines while none of the sham group reverted to episodic migraines
(P=0.029)…

The nice thing about this is that it is inexpensive, and it can’t hurt.
 I do wonder, though, whether it was actually the improved
sleep, or some other factor that was important.  I am
particularly suspicious of the role of television-watching.  

Maybe if everyone turned off their TV, they would have fewer migraines.