Chronic Migraine Impacts Sleep Quality and Increases Risk of RLS

I have an increased risk for restless legs syndrome (RLS) due to having fibromyalgia. Frankly, that does a number on sleep quality as it is. However, I came across a lot of research showing how migraine disease impacts sleep as well.

I have known for a long time that lack of sleep is one of my worst migraine triggers. It has always been a problem for me because fibromyalgia causes me such severe insomnia. However, it also seems that migraine disease increases a person’s risk for developing RLS.

Chronic migraine has always impacted my sleep, and lack of sleep has also always been a trigger for migraine attacks. I knew migraine disease certainly didn't help my sleep or sleep disorders, but I had not realized it may be a cause or impact their severity.

Migraine and sleep disorders

Migraine disease impacts sleep quality and can cause insomnia. With sleep apnea, migraine attacks can be triggered in the morning. Migraines increase the risk of sleepwalking in children. Bruxism and TMD are comorbid with migraine. And, lastly, the majority of studies find an increased risk of RLS with migraine as well as increased severity of RLS.1

Migraine impacts sleep

I have chronic migraine disease and this drastically impacts sleep. Sleep issues increase the frequency of attacks, and those with chronic migraine can have insomnia almost daily. Insomnia is actually a risk factor for increased frequency of migraine attacks.2

Sleep impacts migraine

In addition to that, poor sleep quality is one factor that can cause a person to go from episodic migraine attacks (less than 15 attacks a month) to chronic migraine attacks (more than 15 a month). Poor sleep quality includes issues like early morning wakings, sleep disruption, and difficulty in falling asleep.2

Restless legs syndrome and migraine

In over 24 studies since 2018, it has been shown that there is an increased risk of RLS with migraine disease. They show the link between dopamine in migraine disease and RLS both.1

With migraine disease, dopamine is a factor in the prodrome symptoms of the migraine attack, which is possibly hypothalamic in origin. With RLS it is possibly dysfunction of the dopaminergic system.1

Migraine prodrome and dopamine

During the migraine prodrome (prodrome is the stage we can experience prior to the aura and before the headache stage), people with migraine disease are hypersensitive to dopamine agonists. Dopamine agonists are a compound that activates dopamine receptors.

This can cause some of the prodrome symptoms we can experience with a migraine attack:

  • Yawning
  • Nausea
  • Drowsiness
  • Food cravings
  • Mood changes
  • Vomiting
  • Hypotension

According to research in 2008, these specific dopaminergic prodrome symptoms occur in about 20 percent of people with migraine disease.3

I am not sure how accurate that is, given how variable migraine symptoms can be over time in my experience. What I take away from that research isn't how many people experience it but that those are specific dopaminergic prodrome symptoms we can have.

Migraine postdrome and dopamine

Postdrome symptoms (last stage of an attack) such as mood changes, drowsiness, and tiredness could also be due to dopaminergic activation. According to the research, the prevalence of RLS in people with dopaminergic prodrome symptoms is 5 times greater than migraine patients without those prodrome symptoms.3

So I gather if we are prone to having those symptoms, we are more at risk for RLS. I know those are definitely symptoms I experience often.

RLS severity and poor sleep

My RLS is insanely severe, and I have no theory as to why that is the case. I have speculated it was a medication that I have since stopped. Perhaps even past medications used for migraine prevention could have been an issue. Or the fact I have both fibromyalgia and migraine disease, which both factor in with RLS. Possibly the fact both cause poor sleep.

There is research from 2016 that suggests not only does migraine increase the prevalence of RLS but also increases the severity of it, as well as poor sleep quality.4 Poor sleep quality itself is a factor for increasing the severity of RLS. Perhaps this is an answer to why mine is as severe as it is.

Effects of dopamine imbalance

With my chronic migraine disease, if you consider the dopamine imbalances in the prodrome causing issues with RLS and then also chronic migraine sleep issues, that is a bit of a problem. In fact, that research concluded, "the likelihood that migraineurs could be affected lifetime by disorders related to dopaminergic imbalance like RLS."3

Perhaps that is accurate given I also developed periodic limb movement disorder. I can begin to see how some things can complicate RLS and definitely when I consider the complications of my chronic migraine disease.

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