Comorbidities in Headache Disorders by Maria Adele Giamberardino & Paolo Martelletti

Author:Maria Adele Giamberardino & Paolo Martelletti
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

6.2.9.3 Restless Legs Syndrome

Restless legs syndrome (RLS) is commonly represented by an urge to move the legs, accompanied by unpleasant leg sensations, occurring at night, worsened by rest, and improved by movements [155].

There is evidence that restless legs syndrome (RLS) is another condition frequently reported by migraine patients [21]. RLS prevalence in migraine ranged from 8.7 to 39.0 % with no apparent differences based on gender and aura status, while migraine prevalence in RLS ranged from 15.1 to 62.6 % [54].

The first study suggesting an association between RLS and migraine in the pediatric population was conducted by Seidel et al. [134] and assessed the frequency of RLS in children and adolescents with migraine compared to headache-free controls. The authors included two control groups. The first group was recruited from an outpatient clinic of pediatrics and adolescent medicine (group 1). These children and adolescents were exclusively screened at follow-up after recovery from a minor illness and did not suffer from a significant medical, neurological, or psychiatric condition at the time they were included in this study. The second control group was recruited from primary school (group 2); the aim of the study and the objects of the questionnaires were explained to the children and teachers.

In 111 consecutive patients with a sole diagnosis of migraine with or without aura and 73 headache-free controls, the frequency of RLS in migraine patients was significantly higher (22 % vs. 5 % [p < 0.001] group 1 and 8 % [p < 0.001] group 2 [134]).

A common pathophysiological origin for migraine and RLS has been proposed [21], and a link involving a disturbance of iron metabolism has been considered. A recent study investigated daytime dysfunction in children with RLS and the effects of treatment primarily with iron supplements on RLS symptoms and daytime dysfunction in 25 children with RLS showing that after treatment, participants’ daytime function had improved to levels similar to those of controls. Sixteen out of 23 cases were successfully treated primarily with iron supplement [57].

A link between RLS and a dysfunction within the dopaminergic system has also been suggested [21, 54, 155]. It is supported by the rapid improvement of RLS symptoms after treatment with dopaminergic agents. Dopamine is also involved in migraine pathophysiology. Dopaminergic symptoms (DPS) like yawning, irritability, and mood changes as well as nausea and vomiting occurring both during the premonitory and headache phases are present in 47.6 % migraine patients with RLS vs.13.1 % of those without RLS (p < 0.001). A further support to a “dopaminergic link” between migraine and RLS is the observation that antiemetics with antidopaminergic properties are effective in aborting migraine attacks [21].

The prevalence of both RLS and periodic limb movements in sleep (PLMS) increases with age. Complaints of morning or daytime headaches are three to five times more frequent in patients with RLS [145]. Fifty patients with severe headaches who qualified for the treatment with dopamine receptor-blocking agents had a prevalence of RLS of 34 %; this group had a higher risk of developing akathisia as a treatment side effect.

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