How Sleep Restriction Impacts Cortical Inhibition in Patients With Migraine

Researchers sought to assess the short-term benefit and risk of ticagrelor with aspirin in patients with acute mild-moderate ischemic stroke or high-risk transient ischemic attack.

Among individuals with migraine in the period between migraine attacks, the activity of the neurons that selectively offset the action of other neurons (GABAergic cortical inhibition) is reduced by sleep restriction, according to study findings published recently in Clinical Neurophysiology.

The functional changes accompanying migraine are not clearly understood, and although lack of sleep is associated with migraine, the relationship between sleep shortage and migraine is unresolved. The objective of the current study is to examine how insufficient sleep affects migraine.

The researchers conducted a randomized, blind, crossover study that included 75 adult participants, of whom 29 (27 female; 36.9±12.1 years of age) were in the healthy control cohort and 46 (41 female; 37.5±11.2 years of age) were patients with migraine (usual mean duration 21.6 hours; mean 2.2 migraine attacks/month in the previous 6 months; mean history of migraine greater than 20 years). During 2 nights of 8-hour sleep and 2 nights of 4-hour sleep, participants underwent recordings of cortical silent period, short- and long-interval intracortical inhibition, intracortical facilitation, and short-latency afferent inhibition, the researchers explained.

The migraine cohort compared to the control individuals cohort revealed that during the time between migraine episodes, and following sleep restriction, cortical silent period duration was reduced (P =.046). Reductions were even greater for migraine with aura (P =.017) and for nonsleep related migraine (P =.002). These reductions were associated with hypersensitivity symptoms during migraine (photophobia: P =.017). Yawning, a predictive dopaminergic symptom, was associated with the silent period (P =.034), and mood changes, another predictive dopaminergic symptom, were also associated with the silent period (P =.004).

Study limitations included being underpowered for subgroup analysis, no correction being made for multiple analyses, using 24- instead of 48-hour cut off for the interictal phase, confounding caffeine withdrawal, using biphasic instead of monophasic waveforms, and selection bias in the control individuals cohort.

Researchers concluded that, “Sleep restriction reduces GABAergic cortical inhibition during the interictal period in individuals with migraine.” Sleep changes in adults with no-sleep related migraine affect the cortical inhibition differently than sleep changes in adults with sleep related migraine.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Mykland MS, Uglem M, Neverdahl JP, et al. Sleep restriction alters cortical inhibition in migraine: A transcranial magnetic stimulation study. Clin Neurophysiol. Published online April 20, 2022. doi: 10.1016/j.clinph.2022.04.004