Fig. 3
Interaction between migraine and obstructive sleep apnea. Although available studies failed to find a causal relationship between obstructive sleep apnea (OSA) and migraine, little evidence suggests that OSA may be a trigger of migraine in selected patients and facilitate migraine progression. For this reason it would be reasonable check for the presence of signs or symptoms attributable to OSA in migraine patients, especially in those reporting morning headache, habitual snoring, apnea episodes during sleep, obesity, craniofacial morphology and oral anatomy, neuromuscular disorders, and substances use. Clinicians should screen and select patients to be studied with polysomnography upon suspicion of sleep-related breathing disorder. Patients with OSA diagnosis should receive the guideline recommended treatments. Since available evidence suggests that obesity is a major risk factor for OSA development and progression and for migraine chronification, appraisal of a normal weight (body mass index=18.5-24.9 Kg/m2) should be strongly encouraged in patients with comorbid OSA and migraine since an improvement of both OSA severity and migraine frequency might be expected