Interventions for Migraine and Sleep: A Systematic Review Exploring Their Bidirectional Association

BACKGROUND: Migraine and sleep disturbances share a bidirectional relationship, influencing each other's frequency and severity. The aim of this systematic review is to examine the effects of migraine-targeted interventions on both migraine outcomes and sleep parameters (including sleep quality and insomnia symptoms), as well as the effects of sleep-focused interventions on both sleep and migraine outcomes. METHODS: Following PRISMA 2020 guidelines, a systematic search was conducted across six databases (PubMed, Medline, Scopus, Embase, PsycINFO, CINAHL) for studies published until December 5, 2023. Eligible studies included Randomized Clinical Trials, Controlled Clinical Trials, and observational studies assessing migraine and/or sleep-targeted interventions in adults. The risk of bias was evaluated using RoB 2 and ROBINS-E tools. RESULTS: Twenty-three studies (1941 participants) were included. Pharmacological treatments such as erenumab, amitriptyline, propranolol, and onabotulinumtoxinA reduced migraine frequency and pain intensity, with variable effects on sleep quality. Melatonin showed no significant impact. Among non-pharmacological treatments, percutaneous electrical nerve stimulation, greater occipital nerve block, green light therapy, binaural beats, mindfulness, and dietary modifications improved both migraine symptoms and sleep. Digital Cognitive-Behavioral Therapy for Insomnia (CBT-I) significantly reduced headache days and improved sleep parameters, whereas evidence on standard CBT-I was mixed. LIMITATIONS: Study heterogeneity, small sample sizes, and variability in outcome measures limit generalizability. Few studies focused on sleep-targeted interventions and their effects on migraine, highlighting a research gap. CONCLUSIONS: Integrated approaches combining migraine and sleep interventions show promise for symptom management. Further research is needed to refine treatment strategies and assess long-term effects. REGISTRATION: CRD42024617217.