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October 9, 2025Open Access

Sleep bruxism and sleep architecture in chronic migraine: A polysomnographic study

Key Points

Patients with chronic migraine exhibited reduced REM sleep duration, suggesting significant sleep architecture changes.
Severe sleep bruxism showed an odds ratio of 2.68 for being associated with migraine with aura.
The presence of mixed bruxism at a frequency above 0.4 episodes per hour increased the likelihood of chronic migraine.
While many migraine patients have sleep bruxism, a direct association with chronic migraine was not established substantially.

Abstract

Despite the fact that sleep bruxism (SB) is common in migraine, and that patients with migraine often report poor sleep quality, SB and sleep architecture in chronic migraine (CM) have not been fully explored. The aim of the study was to establish the association between SB and CM, with an assessment of sleep structure alterations in CM. The diagnosis of migraine was made using the 3rd edition of the International Classification of Headache Disorders (ICHD-3). Sleep bruxism and sleep structure were assessed using polysomnography, according to the American Academy of Sleep Medicine (AASM) Guidelines. All results were adjusted for medication use in the treatment of migraine, which may interfere with sleep and SB. A total of 110 patients with migraine (mean age: 39.3 years; 88% female) were evaluated, including 65 individuals with CM and 45 episodic migraine (EM) patients. The patients with CM had lower REM sleep duration when compared to those with EM (median (Me): 21.4% of total sleep time (TST) vs. 24.4% of TST, p = 0.008), while REM sleep below 23.1% of TST was associated with increased odds of CM (odds ratio (OR): 3.61 (95% confidence interval (CI): 1.60; 8.15), p = 0.002). Seventy-six out of 110 (69%) participants were diagnosed with SB. The presence of mixed bruxism at a frequency of above 0.4 episodes per hour (n/h) was associated with increased odds of CM (OR: 2.40 (95% CI: 1.06; 5.46), p = 0.048). However, severe SB (bruxism episode index (BEI) >4) was associated with increased odds of migraine with aura (MwA) (OR: 2.68 (95% CI: 1.05; 6.83), p = 0.044). Migraine without aura showed a weak, negative correlation with BEI (r = -0.293, p = 0.002). A decrease in the REM stage of sleep was associated with CM. Despite the high prevalence of SB in patients with migraine, SB was not associated with CM, while severe bruxism was associated with MwA. Therefore, if any association between SB and migraine exists, it is more likely related to aura phenomena than to migraine chronification.

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