Optimizing circadian cycles and behavioral insomnia treatment in migraine.

Sleep regulation may play a key role in headache management for individuals with migraine. At least among individuals with a predisposition to headache, episodes may be provoked by sleep deprivation or excess, as well as by sleep disorders. Chronobiological patterns have been identified in some forms of headache, including migraine. Insomnia is the most common sleep disorder in headache clinic populations, observed in half to two thirds of migraineurs. Recent evidence suggests migraine may improve with regulation of sleep. Because sleep represents a potentially modifiable vulnerability to headache, practitioners may wish to consider strategies that restore sleep homeostasis. Behavioral strategies are effective for regulation of sleep and may be abbreviated for headache medical practice settings. This article discusses the nature and prevalence of sleep complaints in migraineurs, conceptualization, and behavioral management of insomnia in the headache practice setting.