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Tuesday, May 11, 2010

CLUSTER HEADACHES AND SLEEP APNEA: CAUSE AND EFFECT AND/OR CURE?

Cluster Headache patients please pay close attention. Sleep apnea has a major statistical connection to your pain. Sleep apnea is a TMJ disorder according to the NIH report (http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf) CARDIOVASCULAR AND SLEEP-RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS. Oral appliances can treat sleep apnea (http://www.ihatecpap.com) and migraines, chronic daily headaches, and tension-type headaches. Cluster headaches are much more frequent with sleep apnea; diagnosis and treatment is advised.

THIS IS A SLIGHTLY OLDER STUDY (pubmed abstract below) looking at the prevelance of sleep apnea in cluster headache. 80% (25 of 31patients) of patients with cluster headache did have sleep apnea with an average index (RDI) of 19.

The authors concluded that: "The data closely approximate those of Chervin et al, where 80% had RDI > 5. The relationship sleep apnea has in the perpetuation or precipitation of cluster headache is still to be determined."

While they did not say there was a cause and effect this was because this was not a prospective study where patients are watched to see if they develop cluster headaches. ( see below)

"There are some reports that treatment stops the cluster but there is no prospective study. The high incidence (80.64%) seen in this population suggests the cluster patient should receive a sleep evaluation and perhaps intervention with continuous positive airway pressure (CPAP) or an appropriate dental device.


Headache. 2004 Jun;44(6):607-10.
Obstructive sleep apnea and cluster headache.
Graff-Radford SB, Newman A.

The Pain Center, Cedars Sinai Medical Center and UCLA School of Dentistry, Los Angeles, CA 90048, USA.
Abstract
A patient with cluster headache often wakes from sleep. The relationship to sleep apnea has been described. This study sought to confirm the relationship cluster may have with sleep apnea. METHODS: Thirty-nine consecutive patients diagnosed with episodic cluster headache according to the International Headache Society (IHS) criteria were sent for polysomnographic studies. All patients were in an active phase when they were in the study. Patients were told of the proposed relationship and were allowed to choose a sleep laboratory close to their home. RESULTS: Thirty-one patients with episodic cluster headache completed an overnight polysomnographic study. Twenty-three were male and eight female. The average age was 51 years (range 33 to 78 years). The average weight was 173 pounds (range 117 to 260 pounds). A total of 80.64% had sleep apnea (25/31). Average respiratory depression index (RDI) was 19.0 (SD 14.6) with 6 patients having no apnea, 10 having mild, 11 having moderate, and 4 having severe apnea (RDI < 5 = none; RDI 5 to 20 mild; RDI 20 to 40 moderate; RDI > 40 severe). Oxygen saturation decreased on average to 88.4% SD 4.5. Sleep efficiency was 76.2% (SD 13.4). CONCLUSIONS: The data closely approximate those of Chervin et al, where 80% had RDI > 5. The relationship sleep apnea has in the perpetuation or precipitation of cluster headache is still to be determined. There are some reports that treatment stops the cluster but there is no prospective study. The high incidence (80.64%) seen in this population suggests the cluster patient should receive a sleep evaluation and perhaps intervention with continuous positive airway pressure (CPAP) or an appropriate dental device.

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posted by Dr Shapira at 12:47 PM

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