Primary headaches in patients with obstructive sleep apnea syndrome receiving continuous positive airway pressure therapy

Abstract

Chronic headache is often comorbid with obstructive sleep apnea syndrome (OSAS). We investigated the prevalence of primary headaches and also evaluated the effect of continuous positive airway pressure (CPAP) on the primary headaches. A total of 235 patients with OSAS (190 M, 45F ; mean age 54.8±11.6 years) receiving CPAP therapy were participated in this study. Primary headaches were diagnosed according to the International Classification of Headache Disorders, 2nd edition (ICHD–2). Sleep apnea headache was diagnosed based on ICHD–3 beta. Of 235 OSAS patients, chronic headaches were observed in 105 (44.7%) : 18 migraines (7.7%) ; 55 tension–type headaches (23.4%) ; 1 cluster headache (0.4%) and 31 unclassified headaches (13.2%). Patients with chronic headache showed higher scores for sleep disturbances, daytime sleepiness and depressive symptoms compared with patients without chronic headache. Of 105 patients with chronic headaches, 39 (37.1%) had sleep apnea headache. CPAP treatment was effective in reducing headaches in 12 patients with migraine (8 with comorbid sleep apnea headache, 66.7%) and in 33 patients with tension–type headache (16 with comorbid sleep apnea headache, 48.5%). Among OSAS patients with chronic headaches after exclusion of patients with sleep apnea headache (n＝66), CPAP–responsive headache group (n＝36) had a significant longer daily CPAP use compared to CPAP–non responsive headache group (n＝30). In patients with OSAS, chronic headache was frequently observed. Our study results showed that CPAP therapy can ameliorate concomitant primary headaches not fulfilling the diagnostic criteria of sleep apnea headache in patients with OSAS.