Materials methods

Population

We enrolled a sample of 302 subjects (225 men and 77 women) presenting consecutively at the Unit of Pneumology of the Luigi Sacco Hospital of Milan, for a full cardiopulmonary monitoring during sleep.

Methods

- History of headache was evaluated in each subject, and headache diagnosis was clinically made according to the ICHD-II criteria.

- The presence of allodynia was assessed by a set of semistructured questions, that had been used by our group in previous studies [04, 05]. This tool investigates if the patient experiences abnormal scalp sensitiveness and/or discomfort during headache episodes and which activities are able to enhance this symptom, such as touching head skin, combing hair, brushing hair, wearing glasses, and so on.

Patients were asked to give written yes/no responses to written questions as follows: (1) Has the patient experienced abnormal scalp sensitivity or discomfort during headache attacks? If yes, does this abnormal sensitivity or discomfort arise from (a) touching head skin; (b) touching hair; (c) combing hair; (d) brushing hair; (e) wearing glasses; (f) using a hair-band, curlers or elastic for forming a ponytail; (g) lying with head resting on the pain side? Patients replying yes to the first question and at least to one of questions (a-f) were considered to have headache-associated allodynia

- Sleep behavior was evaluated through semi-structured ad hoc questionnaire exploring the mean latency of sleep onset (more or less of 30 min), the frequency of nights with nocturnal wake-up (<2 or >3 nights/month) and the subjective perception of sleep quality (satisfied/not-satisfied).

- Full cardiopulmonary monitoring with SaO2, T90 and AHI determination, was performed by SOMNO check ® effort (WEINMANN) that includes: a nasal respiratory device to reveal air flow and snoring, a pulse oxymeter to measure SaO2 and cardiac rate, an abdominal and a thoracic belt for the inductive thoraco-abdominal pletismography, and a gyroscopic body position detection device.

Statistics

Student T test with Bonferroni correction was used to compare mean ages, mean AHI, mean T<90% and mean SpO2, between groups (subjects with or without headache, with or without allodynia).

Chi square test was applied to compare the distribution of different sleep behavior aspects between different diagnostic groups.

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