Migraines and Sleep

Migraines are extraordinarily common, affecting over one billion people worldwide. Nearly 1 in 4 U.S. households have at least one person who regularly experiences migraines.

Migraines--and most chronic headache disorders--have been proven to be comorbid with sleep disorders. If you experience migraines, you are between 2 and 8 times more likely to experience sleep disorders than those who don't. What’s more, sleep disorders often exacerbate the symptoms of migraines and may increase their frequency. If left unaddressed, this can create a vicious cycle in which the two conditions feed off and trigger one another.

However, there are many methods--both medical and non-medical--for people who experience migraines to stop that cycle. In this article, we will delve into the subject of migraines, explaining what migraines actually are, how they interact with sleep, and what you can do to improve your quality of life if you are living with migraines and/or sleep disorders.

What are Migraines?

Migraines are generally experienced as a severe throbbing pain on one side of the head (though sometimes the pain is felt on both sides of the head.) They are often accompanied by nausea, vomiting, and severe stimulus sensitivity, especially to light and sound.

A person can develop migraines at any point in life, but most frequently, migraine sufferers start to experience them in childhood, adolescence, or early adulthood. Migraines are very common, with approximately 39 million migraine sufferers in the US. They are particularly common among women: of those 39 million people with migraines, 28 million are women. 18% of all US women suffer from migraines, as opposed to 6% of men.

Migraines can last for hours to days and can come in quick succession of one another. The severity of symptoms varies from person to person, but in some cases, they can completely disrupt the activities of everyday life. They can render a person unable to work, interact with others, or even function on a basic level.

Like many other health conditions, migraines are often profoundly influenced by sleep, and in some people, sleep is profoundly affected by migraines. Migraines can cause so much pain that a person is unable to sleep, or can exhaust them so much that it causes them to sleep more than usual. However, these sorts of sleep disturbances are also a trigger for migraines. This can create a “chicken and egg” scenario, wherein you don’t know if the sleep issue is causing the migraine, or the migraine is causing the sleep issue.

What Causes Migraines?

woman with migraine

Migraines have a long history. They were mentioned in the medical documents of the Egyptians, as early as 1200 BCE, making them one of the oldest recorded diseases of all time. Initially, like many other conditions, they were stigmatized and considered a spiritual or moral defect. Once they were recognized as a medical disorder, there were many theories about what caused them. Some theorized that the cause had to do with an injured connection between the stomach and the brain, due to the combination of neurological and gastrological symptoms. During the first half of the 20th century, Dr. Harold G. Wolff laid the groundwork for a vascular theory of migraines, proposing that they are caused by dilation and constriction of the blood vessels in the head.

That theory has recently been superseded by a genetic, neurogenic theory of migraines. It is still not fully known exactly what causes migraines. However, they are now believed to be a neurological disorder involving changes in neural pathways and brain chemicals. Migraines have been linked to changes in the brainstem and how it interacts with the trigeminal nerve (the major pain center in the brain), as well as other neurotransmitters (such as calcitonin gene-related peptide, or CGRP) and brain chemicals (such as serotonin). It has also been proven that migraines are hereditary.

In people who are predisposed to migraines, they can occur with no external cause. However, they can also be triggered by environmental factors.

Common triggers for people who experience migraines include:

  • Hormonal changes in women, such as menstruation, menopause, pregnancy, and/or the use of hormonal contraceptives and hormone replacement therapy
  • Caffeine
  • Alcohol
  • Stress
  • Sensory stimuli, such as bright lights, strong smells, and loud sounds
  • Intense physical activity
  • Changes in weather or barometric pressure
  • Certain foods (including aged cheeses and salty food) and food additives (including aspartame and MSG).
  • Changes in eating habits, such as skipping meals or fasting
  • Certain medications (including vasodilators, such as nitroglycerin)

As mentioned above, one of the most common triggers for migraines is sleep disturbance, including getting too much sleep, getting too little sleep, or environmental disruptions like jet lag.

Types of Headaches

Not all headaches are the same. In fact, there are over 300 different types of headaches. What’s more, only about 10 percent of headaches have a known cause. However, all headaches fall into one of two categories: primary headaches, and secondary headaches. Primary headaches and secondary headaches have different characteristics and different effects on sleep.

Primary Headaches: Primary headaches are the result of problems with the pain-sensitive structures in your head. They are not a symptom of a separate, underlying disease or condition. There are four common types of primary headache:

Secondary Headaches: A secondary headache is a headache that occurs as a symptom of an underlying disease or condition that activates the pain-sensitive nerves in the head.

There are several types of secondary headache. They include:

  • External compression headaches caused by wearing something too tightly on your head
  • Ice cream headaches or “brain freeze”
  • Sinus headaches caused by inflammation/congestion in the sinus cavities
  • Spinal headaches caused by issues with spinal fluid loss or low spinal fluid pressure
  • Thunderclap headaches or sudden, severe headaches caused by multiple disorders

There are many, many conditions that cause secondary headaches, and both the conditions and the headaches they cause vary greatly in severity and seriousness. Relatively minor issues like ear infections, sinus infections, dehydration, hangovers, and the flu can all cause headaches, as can more potentially serious conditions, such as strokes, aneurysms, brain tumors, encephalitis, and meningitis. For a more extensive list of things that can cause secondary headaches, please consult this site.

The Relationship Between Sleep and Migraines

Sleep and migraines are intimately linked in the majority of migraine sufferers. As we mentioned above, migraines can cause sleep disturbances, and sleep disturbances can trigger migraines. It is for this reason that migraine sufferers are 2 to 8 times more likely to experience sleep problems, including insomnia, sleep apnea, and excessive daytime sleepiness.

Nearly half of all migraines are known as “awakening headaches”, meaning that they occur between 4 AM and 9 AM, waking people from their sleep. The majority of migraine sufferers (71%) have experienced this type of migraine. These headaches often disturb or prevent REM sleep, which leads to chronic sleep deprivation and more severe migraines.

In addition, there are two types of chronic headache that are specifically involved with sleep: cluster headaches and hypnic headaches. We mentioned before that cluster headaches tend to reach the attack phase within one to two hours of falling asleep. Hypnic headaches are headaches that occur only during sleep. The reason these two headaches only attack during sleep may be explained by certain changes the brain goes through during sleep, including the silencing of anti-nociceptive networks (or, networks that block the detection of pain by sensory neurons). When those networks are silenced, the brain is more susceptible to headaches.

There are several other ways in which sleep and migraines influence one another, and by which sleep disturbances can affect the severity of migraines. One study showed that sleep deprivation activates several proteins (specifically, P38, PKA, and P2X3) that lower the threshold for the activation of many of the nerves involved in pain transmission during migraines.

The close relationship between sleep and migraines also has to do with the concept of homeostasis, and how important it is to get good, restful sleep. Homeostasis basically means a well-functioning “body clock”, or a body’s intricate system with which it balances sleep and wakefulness. If the timing of your sleep is set off course from the natural, circadian rhythms of your body clock, the system will try and compensate. One theory holds that triggering a migraine may be a part of that compensation mechanism: migraines caused by too little sleep may be the body’s way of getting you to seek a dark place and lie down, while migraines caused by too much sleep that keep you awake may be the body’s way of trying to reset the sleep-wakefulness equilibrium.

Yet another key association between sleep and migraines has to do with medications commonly used to treat migraines. These medications essentially fall into two categories: those that abort or stop migraine symptoms from progressing once they begin, and those that attempt to prevent migraines from beginning in the first place. In both of those categories, prescription and non-prescription (OTC) medications are commonly used.

Drugs in the first category include OTC pain meds like Aspirin, Naproxen (Naprosyn, Anaprox), Ibuprofen (Motrin), and acetaminophen (Tylenol), as well as prescription barbiturates (such as butalbital). Most OTC and prescription pain medications wear off in 4-8 hours. This makes people vulnerable in the early morning, since the effects of the medication wear off while the person is still asleep. Additionally, overuse of OTC and prescription pain medications can actually cause secondary headaches, and can be a trigger for migraines.

Many sorts of drugs are used in the second category (preventative, or prophylactic), and some of them may also have effects on sleep. Specifically, amitriptyline and propranolol have been shown to suppress rapid eye movement and disturb REM sleep.

Hormonal Migraines and Sleep Loss in Women

For many women, migraines are also linked to hormonal changes, which is one reason why women experience migraines at 2 to 3 times the rate as men. Different hormonal changes, including menstruation, pregnancy, menopause, and the use of hormonal contraception, can affect migraines in different ways.

Every increase in the frequency or severity of migraines affects sleep. In each of these instances, specific treatment plans should be considered with your doctor in order to lessen the impact.

How to Get to Sleep When You Suffer From Migraine

Clearly, sleep has an impact on migraines, and vice versa. However, there are many things that people with migraines can do to improve their quality of sleep. Here are the things that are most commonly advised to migraine sufferers to help them get better, healthier, and more restful sleep.

It is also important to remember that certain headaches and migraines need urgent medical attention. The vast majority of headaches do not need emergency care, but it is crucial to be aware of the ones that do. Contact a doctor or your closest emergency care center if:

  1. Your headache is unusually severe or steadily worsens uncharacteristically
  2. Your headache follows a blow to the head or any other head injury.
  3. Your hear headache is accompanied by a stiff neck, confusion, fever, slurred speech, seizures, or uncharacteristic weakness, visual disturbances, or numbness.

Learn More About Migraines and Sleep

Migraines can be absolutely devastating and overwhelming, and it’s easy to feel like it’s all too much. However, you are not alone. There are many resources for people with migraines, and a vast network of people who know what you’re going through and want to help.

  • Migraine Research Foundation: An organization focused on migraine research, as well as advocacy and support for people with migraines.
  • American Migraine Foundation: Founded by the American Headache Society, this group focuses specifically on research and education that will lead to an improvement in the lives and treatment of people with migraines.
  • Speak Your Migraine: This combination migraine advocacy site and resource center allows you to find migraine-specific doctors and migraine tracking tools, as well as sharing your personal story about how migraines affect your life.
  • Danielle Byron Henry Migraine Foundation: Come here for support and access to treatment for migraine patients, with a specific focus on children and young adults.
  • Best Headache and Migraine Blogs of 2019: Healthline.com’s  annual compilation of the best blogs by, for, and about people with headaches and migraines, including The Migraine Diva, My Migraine Life, and The Migraine Mantras.
  • MigraineAgain.com: This is a private network of people who experience migraines and those who love them. It is a safe, understanding social space where you can talk through the migraine struggle.
  • Migraine.org: A comprehensive network with a well-researched body of articles and a vetted list of migraine-educated medical professionals.
  • Yoga for Migraine Headaches: A very well curated series of instructional videos with stretches that may relieve various migraine symptoms.
  • More to Migraine: A reliable source of tips for living your best life while managing migraines.
  • List of Comprehensive Headache Centers: The Migraine Research Foundation’s list of vetted, multidisciplinary centers that treat chronic headache and migraine conditions.

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