In a large Korean population-based evaluation, migraine was reported in 46% and other headache forms in 33% of patients with impaired sleep duration, whereas only 20% of controls suffered from headaches. All of these forms show a close relationship between onset of pain and sleep and are listed separately in appendix A of the ICSD3 (ICSD-32014). These include different types of headaches such as migraine, cluster headache, chronic paroxysmal hemicrania (CPH) and hypnic headache syndrome. However, sleep related headaches usually emerge during sleep and may be accompanied by insomnia (according to ICSD3 ). The International Headache Society (IHS) differentiates more than 200 forms of headaches in the International Classification of Headache Disorders, which are mainly unrelated to sleep. Insomnias have a strong impact on quality of life, cognition and physical well-being and therefore need special consideration for diagnosis and therapy. pain, depression, anxiety) and some specific medication result in insomnia and/or other sleep problems. Secondary insomnia may originate from neurodegenerative, inflammatory, traumatic or ischemic damage in sleep regulating brainstem and hypothalamic nuclei with consecutive changes of neurotransmitters. The underlying causes of many insomnias have not been fully elucidated, yet. Insomnias with difficulties of initiating and maintaining sleep, excessive daytime sleepiness, motor disorders during sleep and parasomnias, early awakening and impaired sleep quality frequently accompany neurological diseases as secondary or comorbid conditions. For patients with dementia suffering from insomnia trazodone, light therapy and physical exercise are recommended. Patients with insomnia after stroke can be treated with benzodiazepine receptor agonists and sedating antidepressants. Melatonin may improve insomnia symptoms in children with epilepsies. CBTi is recommended in patients with MS, traumatic brain injury and. Insomnia is a frequent precursor of MS symptoms by up to 10 years. Patients may benefit from CBTi, antidepressants (trazodone, doxepin), melatonin and gaba-agonists. Insomnia is one of the most frequent sleep complaints in neurodegenerative movement disorders. ![]() The most important new recommendations are: Cognitive behavioral therapy (CBTi) is recommended to treat acute and chronic insomnia in headache patients. ![]() This guideline focuses on insomnias in headaches, neurodegenerative movement disorders, multiple sclerosis, traumatic brain injury, epilepsies, stroke, neuromuscular disease and dementia. pain, depression, anxiety) and some disease-specific pharmaceuticals may cause insomnia and/or other sleep problems. ![]() Symptoms of neurological disorders (i.e motor deficits), co-morbidities (i.e. Comorbid insomnia originates from neurodegenerative, inflammatory, traumatic or ischemic changes in sleep regulating brainstem and hypothalamic nuclei with consecutive changes of neurotransmitters. These components of insomnia – namely persistent sleep difficulties despite of adequate sleep opportunity resulting in daytime dysfunction - appear secondary or co-morbid to neurological diseases. Insomnia is defined as difficulties of initiating and maintaining sleep, early awakening and poor subjective sleep quality despite adequate opportunity and circumstances for sleep with impairment of daytime performance.
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