According to new research from Nationwide Children’s Hospital, adolescents with migraines commonly experience sleep and emotional disorders, despite seemingly normal levels of the sleep and mood regulating chemical, serotonin.

Migraine headaches, which are characterized by significant head pain for hours or days, are common among adolescents, especially older teenagers. A minority of adolescents with migraines begin to experience them more frequently and become chronic migraine sufferers, often into adulthood.  The neurotransmitter, serotonin, has long been implicated in the development of migraines in children and adults. Studies in adults have shown that as platelet serotonin levels in the bloodstream decrease in migraine sufferers, frequency of headaches increases. Serotonin also promotes initiation and maintenance of sleep activity and sleep and curbs depression.

“Poor sleep can significantly negatively impact migraine frequency and severity and influence genesis of mood disorders,” said Ann Pakalnis, MD, neurologist at Nationwide Children’s and lead study author.  “Frequent headaches in and of themselves can impact depression and anxiety in headache sufferers, which can circuitously influence sleep. Keeping these important interrelationships in mind is crucial to effectively treat migraine.”

To help identify factors that may negatively influence headache disorders, investigators in the Section of Neurology, the Department of Psychology and the Sleep Medicine Center at Nationwide Children’s Hospital examined the relationship between migraines, sleep and emotional disorders and their correlation to serotonin levels and caffeine intake.

In the study, which appears in Headache, 25 patients with migraines and 18 patients without migraine history completed sleep questionnaires and underwent screening for emotional disorders.  Blood draws from each participant were used to evaluate whole blood serotonin levels. 

Results showed that sleep and emotional disorders were common in adolescents with migraines; sleep disorders and mild, chronic depression became more common as headaches became more frequent. However, serotonin levels were not significantly different among any of the participants. All participants who frequently consumed caffeine reported more depression complaints and were poorer sleepers. 

“Our study indicates that patients with migraines should be monitored for sleep and emotional disorders,” said Dr. Pakalnis.  “Although serotonin is an important sleep and mood regulator, these findings suggest that factors apart from this neurotransmitter may play a role in frequency of these disorders.  Also, minimizing caffeine consumption may benefit sleep and mood in headache patients and also decrease susceptibility to migraine attacks.”  The study authors agree that further research in larger groups of patients could help clarify contributing factors, especially post-pharmacologic treatment. 

Pakalnis A, Splaingard M, Splaingard D, Kring D, Colvin A. Serotonin Effects on Sleep and Emotional Disorders in Adolescent Migraine. Headache. 2009 Mar 26. [Epub ahead of print]