Examining Sleep as a Moderator of Physiological Response to Stress Among Migraineurs

Stress and sleep disturbance are among the most frequently reported triggers of migraine. Several studies have found migraineurs have heightened physiological response and decreased rates of habituation to stressors compared to those without headache. A smaller body of literature suggests that poor sleep and high stress can interact to influence migraine, though a larger literature across chronic pain populations and the general population also supports an interactive effect between stress and sleep. No study to date has examined the extent to which sleep disturbance moderates physiological response to stress among migraineurs, the findings of which may help to inform understanding of migraine mechanisms and treatment development strategies. The present study sought to experimentally examine the effect of sleep quantity and quality on cardiovascular reactivity to a repeated stressor (i.e., speech task) and to determine if an observed stress-sleep relationship varies as a function of headache diagnosis (i.e., migraine vs. non-headache). Results indicated that participants with migraine and those without headache had different systolic blood pressure in response to stress between timepoints depending on their quantity of sleep (F(2, 130) = 4.742, p = .010, R-squared change = .068), indicating a significant interaction effect. However, the nature of the interaction was different from expected, as there was an inverse relationship between sleep quantity and SBP during the initial stressor task among participants without headache, while no such relationship existed for migraineurs. Rather, migraineurs’ SBP during the initial stressor task was similar regardless of their sleep quantity. Interactive effects were not found for other physiological measures or for sleep quality. Results suggest that sleep may not be a protective factor against heightened stress response among migraineurs. Future studies are needed to further examine relationships between these factors and possible mechanisms behind any interaction effects