Sleep Behavioral Therapy May Relieve ‘Highly Debilitating’ Headache Burden in Breast Cancer Survivors

Patients with breast cancer are advised to get regular sleep, exercise often, stay hydrated and eat healthy and nutritious foods to prevent “highly debilitating” headaches, according to an expert from Stanford University School of Medicine.

Patients with breast cancer who were actively receiving chemotherapy achieved a significant reduction in headache burden after participating in a six-week sleep behavioral therapy program, according to recent study results.

The data — which were published in the journal Cancer — also showed an improvement in insomnia. Moreover, the results of the sleep behavioral therapy program had lasting positive effects after a year of follow-up.

Although cancer survivorship is increasing, many survivors experience a plethora of comorbidities including headache burden, according to Dr. Yohannes Woldeamanuel, a physician, research scientist and neurologist at Stanford University School of Medicine.

“(Headache burden is) highly stigmatized, it’s undertreated or even under diagnosed or misdiagnosed,” Woldeamanuel, who was the lead author on the study, said in an interview with CURE®.

He added that when someone has a migraine or headache, they might be told to just power through it. “But it’s highly debilitating,” he cautioned, and headaches can affect a survivor’s ability to think clearly, be physically active and increase sensitivity to light and sound.

“It is important to address this headache burden in cancer survivors, so as to improve their quality of life and to make them more productive,” he said.

Woldeamanuel, who works specifically in the division of headache and facial pain and collaborates with the survivorship research program, says that cancer survivors could experience the burden of headaches for many reasons, such as stress or side effects. But he mentioned that insomnia and headaches are directly associated.

“The presence of one leads to the presence of another so it’s bidirectional. If we reduce the insomnia, we can also reduce the migraine or headache component,” he said.

The authors also noted that treating chronic headache disorders in patients with cancer is quite difficult for a multitude of reasons. There is a chance that negative drug to drug interactions with chemotherapies or other cancer drugs could occur. And, the authors wrote, many patients are hesitant to add another drug to their treatment regimen.

As a result, the study authors wanted to examine the efficacy of behavioral interventions that target cancer-related insomnia to hopefully alleviate headache burden, reduce insomnia symptoms and improve their overall quality of life.

Patients were randomly assigned to receive either Brief Behavioral Therapy for Cancer-Related Insomnia (BBT-CI; 73 patients; median age, 52 years) or Healthy Eating Education Learning for healthy sleep (HEAL; 66 patients; median age, 49 years) during chemotherapy treatment. The patients were evaluated at the start of the trial and reevaluated at six weeks and, six and 12 months.

Brief Behavioral Therapy consists of a six-week program where participants maintain regular sleep, avoid stimulus before sleep, reduce coffee intake several hours before sleep, reduce light and electronic stimulation, and use the bedroom only for sleep and sex.

Those receiving BBT-CI achieved a significant reduction in headaches over time. The results indicated that there was a reduction in headache burden among patients receiving HEAL, however the authors highlighted that it was not significant.

“The message of the research is one, this sleep behavioral intervention can reduce the headache burden. (And) two, the type of headache burden that most of these patients face is similar to what is known as a migraine,” Woldeamanuel explained.

The data demonstrated that both groups experienced an immediate impact at week six. The decline in headache burden was sustained in the absence of further treatment in the BBT-CI group but increased at the one-year follow-up for those who received HEAL.

Among 12 patients with migraines the headache reduction was not significant.

The researchers advised patients with breast cancer to get regular sleep, exercise, stay hydrated to consume healthy and nutritious foods to optimize the nervous system and help prevent headaches.

Although this study focused primarily on breast cancer survivors, Woldeamanuel and his team anticipate that sleep therapy could relieve headache burden across all types of cancer survivors.

“Since insomnia is a common comorbidity in nearly half of all cancer types, and since insomnia and headache are closely inter-related/are bidirectional, a sleep behavioral intervention targeted to insomnia is expected to reduce headache burden in nearly half of patients of any cancer type,” he concluded.

However, more research is needed to prove this speculation.

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