A study of migraine in Kleine-Levin syndrome

Abstract: Kleine-Levin syndrome (KLS) is a rare sleep disorder first described in the 1920s. The primary feature is recurrent hypersomnia, with additional components including derealisation, behavioural changes and megaphagia. Episodes typically manifest at least once a year and may last days to many weeks. KLS often first appears during adolescence and can severely disrupt normal development, integration and academic performance. The aetiology remains unclear, but current opinion favours a dysregulation of hypothalamic pathways. Patients and their relatives often describe severe headache during episodes. However headache as a symptom of KLS is rarely described in published reports, including the International Classification of Sleep Disorders (ICSD) classification. Similarly, intolerances to light and sound are frequently present in patient descriptions but not in literature searches. Migraine as a risk marker, a phenotypic feature or an aetiological factor may have been overlooked in the characterisation of KLS. This study investigates the frequency and features of migraine in a cohort of 16 KLS patients. Structured interviews have been designed to identify typical migrainous symptoms and associations. There is currently little in the way of treatment available for KLS patients. Stimulants, antidepressants and mood stabilisers have thus far yielded poor results. Investigation into migraine as a potential component of KLS can stimulate discussion around novel therapeutic strategies.