Roni Sharon, Krithi Nathan and Paul G. Mathew
Objective: Case report of chronic migraine with comorbid sleep apnea that regressed to low-frequency migraine after tonsillectomy
Background: According to the International Classification of Headache Disorders III (ICHD-3), sleep apnea can be a cause of headache or a trigger for the chronification of migraine. Large tonsils that obstruct airways contribute to tonsillolith formation, halitosis, periodic tonsillitis and occasionally cause sleep apnea. Adequate treatment of sleep apnea can result in the improvement of migraine frequency and intensity, and reduce the risk of cardiovascular and cerebrovascular comorbidities.
Results: The patient is a 24 years old woman with a past medical history of obesity and asthma, with a chief complaint of ICHD-3 chronic migraine without aura. She experienced a frequency of 15-20 headache days per month, frequently with morning headaches and 3-5 sleep interruptions per night. She noted a history of snoring, feeling poorly rested and having daytime drowsiness. After tonsillectomy, the patient experienced significant improvement of her migraines and her sleep apnea associated symptoms, including spontaneous arousals, feeling poorly rested and daytime drowsiness.
Conclusions: In patients complaining of chronic migraine and sleep dysfunction, visualizing the posterior pharynx should be incorporated into the physical examination. Tonsillectomy is a well-tolerated, same day surgical procedure, which can be an effective treatment for reducing airway resistance in patients diagnosed obstructive sleep apnea, and can improve the frequency and intensity of co-morbid migraine.
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