Treatment of insomnia in elderly patients with headaches

Abstract

The article describes  clinical cases of elderly patients with primary headaches and insomnia  managed in neurological practice. The first clinical case provides  details  of the  typical medical  history of a female  patient  with acute  insomnia  and episodic tension-type headache, the  second  one describes  the  typical medical  history of a patient  with chronic insomnia  and chronic migraine. Clinical examples  demonstrate common errors in the management of patients with insomnia  and primary headaches in real-life medical practice. The influence  of psychosocial  (stress, anxiety, negative  misconceptions about the disease,  dysfunctional   behaviour,  symptom  catastrophizing)  and  iatrogenic   (ordering  excessive   additional diagnostic   tests, over-diagnosing of detected structural changes  in the spine, neck vessels, brain, diagnostic  errors, prescribing  of ineffective treatment) factors on the development of insomnia and increase  of headaches in frequency is shown. The features  of the presented  clinical cases  are to demonstrate the relationship between insomnia  and increased frequency of primary headaches. Patients were  treated using  the  interdisciplinary program  comprising  non-drug  treatments and  drug  therapy. It has  been shown that the treatment of insomnia can not only improve the quality of sleep, but also reduce the frequency of headaches.SonNorm Duo containing melatonin, motherwort extract  and peppermint leaf oil was used as a drug therapy  for acute  and chronic insomnia. Melatonin  and substances of plant  origin have a high level of effectiveness in the treatment of insomnia and are recommended as drugs to be used first to treat  insomnia. The drug therapy of acute  and chronic insomnia  was combined  with highly effective  non-drug  treatments: an educational program  to improve sleep  hygiene, cognitive  behavioural therapy, and relaxation exercises. During treatment, patients reported an improvement in their sleep quality as early as in the first month. A stable  normalization of sleep  and a significant decrease in headache frequency in a patient  with acute  insomnia and episodic  tension-type headache occurred  after  the  fifth week of treatment and in a patient  with chronic insomnia and chronic migraine after the second month of treatment. A 12-month follow-up of patients showed that the positive effect of the treatment was maintained.