Headache phenotypes in insomnia, obstructive sleep apnea, and COMISA: Impact on diagnosis and therapy
Year: 2025
Type: article
Abstract: Headache associated with comorbid insomnia and sleep apnea (COMISA) may represent a distinct clinical phenotype.Its severity, refractoriness and unique characteristics necessitate a comprehensive, integrative therapeutic approach.Headache and sleep disorders frequently coexist and interrelate, but are often managed in silos despite overlapping neurophysiological pathways.1 The relationships between insomnia, obstructive sleep apnea (OSA) and primary headache disorders -particularly migraine 2 and tension-type headache (TTH) 3 -have long been observed, but remain poorly characterized.More recently, the comorbidity of insomnia and OSA, termed COMISA (comorbid insomnia and sleep apnea), has emerged as a distinct and clinically relevant phenotype, 4 yet its implications for headache diagnosis and therapy are still underexplored.5 A recent large trial regarding COMISA and neurological comorbidities excluded headaches from the data analysis, reporting a lack of information on sleep disorders from headache clinics.5 The International Classification of Headache Disorders, 3 rd edition (ICHD-3), includes several types of sleeprelated headache, but ones associated with insomnia and COMISA are not yet clearly defined as distinct headache categories.1,6 According to the recently revised International Classification of Sleep Disorders (ICSD-3-TR), insomnia is marked by difficulty initiating or maintaining sleep despite adequate opportunity, leading to daytime impairment.7 It is closely associated with increased cortical excitability, sympathetic nervous system overactivation and the dysregulation of the hypothalamic-pituitaryadrenal axis.8 These alterations heighten pain perception and are strongly implicated in central sensitization, contributing to increased vulnerability to TTH and migraine attacks.9 Insomnia increases the risk of both TTH and migraine, the frequency of both types of headaches, as well as the disability associated with them.10 Hyperarousal mechanisms in insomnia interfere with descending pain inhibitory pathways, often rendering headaches more resistant to pharmaco logical preventive treatment.11 In OSA, recurrent upper airway obstruction during sleep results in intermittent hypoxia, sleep fragmentation and sympathetic surges.12 Headaches
Source: Dental and Medical Problems
DOI: 10.17219/dmp/207666
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4416793833