Guest Blog by Deborah Wardly, MD
A new study done at UCSF showed that women with migraine were 2.6 times more likely to have babies with colic. They suggested that colic might be a manifestation of early migraine and that the predisposition to migraine may include a hypersensitive nervous system which manifests as colic in the infant. They mention earlier studies which showed that children with migraine were more likely to have had colic as infants.
What does this have to do with sleep disordered breathing (SDB)?
Well, we know that people with UARS tend to have migraine, and that morning headache is a typical sign of OSA. We know that people with UARS have a heightened nervous system and tend to be hypersensitive to light, noise, and sometimes odor. (If you are spending 1/3 of your life suffocating in your sleep, then of course you will be constantly “en garde” and all your senses will be turned up in order to deal with the threat.) Therefore it may be that many women with migraine actually have undiagnosed sleep disordered breathing. If this is the case, we know that there is a 50% chance that they will pass their narrowed upper airway anatomy down to their child, which may manifest as SDB in the child.
Infants are born with what we call the palate-epiglottis lockup. There is a good picture in Dr. Steven Park’s book, Sleep Interrupted which shows this. Because of the overlap of the soft palate and the epiglottis, the infant is an obligate nose-breather; they cannot breath through their mouths unless they open very wide or cry. If they are having difficulty breathing through their noses, due to nasal congestion or an inherited nasal narrowing, they might spend quite a bit of time crying. Especially, when they are supposed to be sleeping. If they cannot breathe in their sleep, they might end up crying instead; babies with colic cry at night when they are supposed to be sleeping. Any sleep disordered breathing will increase GE reflux, something very common in infants, which will only compound the crying, as well as the nasal congestion as stomach contents get suctioned into the nose and cause inflammation. Many colicky infants are diagnosed with GE reflux and treated with acid blockers. I am suggesting that the GE reflux might be only a consequence of the underlying problem in colic, and the acid blockers only a bandaid. Alternatively, with how common GE reflux is in infants such that we consider it to be a normal physiologic state, it may be that the nasal inflammation which results from GE reflux is the cause of the very common nasal congestion we see in neonates, which will then trigger the breathing problem which I am suggesting may cause colic. This infant nasal congestion resolves between 2-3 months of age. Colic resolves by 3 months of age. The palate-epiglottis lockup opens between 2-3 months of age. Does anyone else see the connection here? Until the lockup opens and a baby can mouth breathe to compensate for a narrowed nose, they may cry a lot just in order to breathe: hence, colic.
This recent paper showed that infant colic is associated with emotional and behavioral disorders in the toddler, such as sleep disorders, feeding problems, temper tantrums, chronic fussiness and excessive clinginess. Specifically, the authors say: “Dysfunctional sleep-wake organization is typically associated with excessive crying in the first 3 months (95.5% of age group). At around the sixth month of life, diurnal problems of sleep-wake organization give way to nighttime sleep disorders, which are the most frequent diagnoses in all age cohorts.”
Doesn’t all this suggest that babies with colic actually have sleep disordered breathing? And that the risk for migraine that is associated with colic is actually secondary to the sleep disordered breathing, NOT that colic itself is early migraine?