Migraine is a complex and debilitating disorder that affects more than 10 million people in the UK.
People with migraine often suffer from insomnia, and lack of sleep can, in turn, trigger a migraine. Treating the insomnia can break this cycle, and one of the best treatments is cognitive behaviour therapy (CBT), which teaches people to change their sleep behaviours and thoughts/worries about sleep loss. In this project, Dr Crawford is evaluating a digital form of CBT for insomnia to see whether it is effective in improving sleep in people with migraine.
A strong proposal in an under-researched area, this project was recommended for funding following rigorous assessment as part of our competitive grant round. Based on a solid body of preliminary research, the project was recommended for its strong potential to deliver real benefit to people with migraine in the near term.
Migraine is one of the most common neurological conditions, affecting more than 10 million people in the UK. It is a complex and disabling disorder with a variety of symptoms, usually featuring a severe headache. Other symptoms can include disturbed vision, nausea, and increased sensitivity to light and sound.
People with migraine often have problems falling or staying asleep. These are symptoms of insomnia. It is thought that these sleeping problems are due to the way that people try to find relief from their migraines. Often, when a migraine strikes, people try to find a dark, quiet room and try to sleep. However, sleeping in the daytime can disrupt sleep at night and this, in turn, can trigger a migraine the next day. The result is a vicious cycle of migraines and insomnia.
One way to stop the cycle of migraines and insomnia is to treat the insomnia, and one of the best treatments for this is cognitive behaviour therapy.
Cognitive behaviour therapy for insomnia (CBT-I) teaches people to change their sleep behaviour and unhelpful thoughts. CBT-I works well but there are not many trained therapists who can deliver it. Digital CBT-I, provided through an app or website, addresses this problem and has the added benefit that the patient can access it in their own time, in their own home, and does not have to travel to see a therapist.
In a small pilot study, the team found that people with migraine liked digital CBT-I, and that it improved both their insomnia and their migraines.
As an essential precursor to a much larger study, which will establish the effectiveness of digital CBT-I in reducing migraines and provide greater insight into which aspects of behaviour have the greatest effect on reducing insomnia and migraine, the team is now carrying out a trial run. In particular, they need to understand how much variability there is in people’s sleep and migraine patterns. This will help inform decisions about the design of the future study and how many participants will be needed.
This trial run will include 88 participants, who will be randomly allocated to either the digital CBT-I group or a control group. The team will measure changes in insomnia and migraines at three time points: mid treatment, right after treatment, and six months after the start of treatment in both groups. They will also track certain behaviours - such as daytime napping throughout treatment - to understand how improvements in sleep are related to changes in migraines. And they will collect information about how many and why individuals want to take part in the study, and how many and why individuals drop out of the study.
People with chronic migraine can struggle with day-to-day life. They find it hard to work, spend time with family, or exercise. Many people with migraine have trouble sleeping, and this in turn exacerbates their migraines.
Some small studies are demonstrating that improving insomnia can offer patients something to prevent migraines, and this work by Dr Crawford and team will help establish whether improving insomnia by using a digital CBT-I intervention can reduce migraines. It will aid the design of a subsequent, larger trial which - if successful - could enable digital CBT-I to be offered as a treatment to patients with migraine, with the potential to significantly improve their quality of life.
Dr Megan Crawford is a researcher in the University of Strathclyde Sleep Research Unit. She has over 13 years experience in sleep research.
As well as her colleague Dr Leanne Fleming, Director of the Sleep Research Unit, who has experience in carrying out studies to improve sleep in medical conditions such as cancer, the project team includes neurologists Dr Mona Ghadiri-Sani (Walton Centre for Neurology & Neurosurgery, Liverpool) and Dr George Gorrie (Queen Elizabeth University Hospital, Glasgow), who both treat patients with chronic migraine and will refer interested patients.
Headache and facial pain is one of our current research priorities, reflecting the large unmet need in this area. Our aim is to fund research to advance understanding of the underlying causes and mechanisms of headache and facial pain, and help advance diagnosis and treatment.
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