Sleep problems are one of the most frustrating symptoms of migraines. Migraines interrupt sleep, while lack of sleep causes migraines. Like the proverbial chicken-and-egg, one might wonder: which came first, the sleep issues or the migraines?
Around 36 million sufferers people in the U.S suffers from Migraine.
In this article, we’ll cover the complex relationship between migraines and sleep problems. Then, we’ll provide advice on how to get better sleep, which, in turn, may reduce migraine symptoms.
What are migraines?
Migraines are much more than just a bad headache. They’re an extreme headache accompanied by multiple other symptoms that completely incapacitate the sufferer, such as:
- Recurring, throbbing, moderate to severe head pain across the head or concentrated to one side
- Sensitivity to light (often described as auras, these flashes of light or blind spots are a common warning sign that a migraine is coming on)
- Blurred vision
- Nausea and stomach pain or upset
- Reduced appetite
Migraines can last from a few hours to a few days. Meanwhile, the symptoms are debilitating. People can barely function when they’re experiencing a migraine. Symptoms can change from migraine to migraine, as can their intensity.
Because so many mistakenly believe it is “just a headache,” more than half of migraine sufferers never receive a diagnosis and self-medicate with over-the-counter pain medications.
Doctors still don’t know what causes migraines. Migraine is a common disabling primary headache disorder, according to the International Classification of Headache Disorders 3rd Edition. One research showed that both migraine sufferers and individuals with advanced sleep phase syndrome (having a sleep pattern that’s shifted much earlier than normal) have the same gene mutation. Studies such as these help support the argument that migraines are a neurological problem.
Migraines tend to run in families but can also be brought on by environmental factors like changes in weather, altitude, and sleep.
Migraines and sleep problems
Migraine sufferers are 2 to 8 times more likely to experience sleep issues, according to the American Migraine Foundation. The worse the migraines, the worse the sleep problems.
The largest barriers to relief often involve insomnia and resulting sleep deprivation. When you are in the middle of a migraine, it is difficult to do anything, including sleep. As a consequence, a late night migraine can make people have a harder time going to bed. In the long-term this can lead to chronic sleep deprivation, which has a host of mental, emotional, and physical health problems of its own, including being a trigger for migraines.
Another common migraine trigger besides sleep loss? Oversleeping to try to make up for it. Sudden changes to your sleep schedule can also cause migraines, including jet lag.
Insomnia describes difficulty falling or staying asleep. People with insomnia typically spend fewer than 6 hours asleep on average, which is significantly below the recommended 7 to 9 hours for adults.
As a result, insomniacs are sleep deprived. They feel irritable during the day, tired and unfocused, and may develop depression or anxiety. These conditions create a stressful daily life, and stress itself is a headache trigger.
Over a third of people with migraines report getting only 6 hours of sleep on average per night. Problematically, shorter sleepers (those who sleep 6 hours or less) are more likely to have more frequent and severe migraines, as well as morning headaches. In another study, 80% of participants with migraines reported feeling tired upon waking up.
There is a clear correlation between lack of sleep and incidence of migraines:
Snoring and sleep apnea
During sleep, snoring is loud breathing. OSA is a more severe type of sleep-disordered breathing where the person usually due to a blockage or narrowing of their airways, literally stops breathing momentarily during sleep. While all snorers do not eventually develop sleep apnea, it is a first warning sign, and both contribute to the kind of less restful sleep that eventually becomes sleep deprivation, which triggers migraines.
Almost half of the migraines are known as “awakening headaches” as they occur between 4 a.m. and 9 a.m. 71% of migraine sufferers experience this type of headache.
When this happens on a regular basis, it’s often a sign of a sleep disorder.
Hypnic headaches, also known as “alarm clock” headaches, are a rare type of headache disorder that affects older adults 50 and above. The pain is significant enough to wake the person up, and can last up to 3 hours after waking.
To be diagnosed as hypnic headache, the headaches must occur at a consistent time each night, typically between 1 to 3 am, and the person must experience them at least 10 days per month. Doctors suspect hypnic headache takes place during REM sleep.
Hypnic headaches are distinct from awakening headaches as well as migraines triggered by sleep apnea.
Diagnosing migraine-related sleep disorders
If you’re concerned your migraines are related to a sleep disorder, review the following questions. If you answer yes to more than one, it may be time to talk to your doctor:
- Do you wake up regularly with headaches?
- Do you often feel tired during the day, even when you think you’re getting enough sleep?
- Do you feel depressed or irritable?
- Are you having trouble focusing during the day?
Your doctor will ask you additional questions. If they believe you may have a sleep disorder like sleep apnea, they will refer you to an overnight sleep lab for observation. There, a sleep technician monitors your breathing, brain waves, and more while you are sleeping. In the days following your test, a doctor who has been trained in sleep medicine will examine the results for symptoms of sleep disorder.
What’s the connection between sleep and migraines?
The same areas of your brain control your sleep and pain, which is why migraines and sleep are so interconnected.
The same parts of your brain regulate sleep and pain, which is why migraines and sleep are so intertwined. The more sleep you get, the better you are at emotionally and physically managing the pain caused by your migraines. The less sleep you get, the more painful your migraines feel.
Many researchers believe that reduced REM sleep in particular is linked to migraines. Each night, a healthy person with normal sleep patterns goes through several 4 to 5 sleep cycles, cycling from light sleep to deep sleep to REM sleep. Our REM sleep is concentrated in the latter half of the night, meaning that we spend more of our sleep cycle in REM in the second half of the night.
When people don’t get enough sleep, they don’t get enough REM sleep either. Insomniacs who sleep fewer than 6 hours per night spend more time in that first half of sleep, so they experience less REM overall. If one’s sleep is disturbed due to a condition such as sleep apnea, their sleep cycle would also be interrupted, returning to light sleep earlier than would otherwise occurs.
During REM sleep, pain-managing neurotransmitters like serotonin and dopamine are released. If someone doesn’t spend sufficient time in REM, fewer of these “feel good” chemicals will be released, making migraines feel much worse later in the day. This is why SSRIs are often prescribed for the treatment of migraines (as well as associated insomnia depression).
Tips for sleeping with migraines
Better sleep means fewer, less painful headaches. Fortunately, behavioral sleep modifications have been shown to reduce both the frequency and intensity of migraines. Get started with the following tips.
1. Follow a regular sleep schedule.
Go to bed and wake up at the same time every day of the week. This will help entrain your circadian rhythms to a regular schedule, so your mind naturally makes you feel sleepier towards bedtime. Plus, setting and following a sleep schedule ensures you leave enough room for 7 hours of shuteye on a daily basis.
2. Create a bedtime routine.
A soothing bedtime routine calms your mind and body and prepares you for sleep. Try some of these ideas: taking a warm bath, drinking herbal tea, practicing meditation, or exploring aromatherapy. Inhalation of lavender essential oil in particular has been shown to moderate migraine symptoms and induce sleep.
Part of your routine could may be to turn your bedroom into a sleep haven. Switch off all electronics, or better yet, remove them from the room entirely. Keep the thermostat to a cool temperature. Clean up clutter that reminds you of your daytime concerns. Dedicate your bedroom to sleep, sex, and relaxation.
3. Watch what you eat and drink.
A healthy diet promotes healthy sleep. It’s best to generally avoid overly greasy, sugary, or fatty foods all the time, but it’s especially important at dinner. Heavy meals will disturb your stomach and make sleep more difficult.
Also avoid alcohol and caffeine later in the day. Both of these substances interfere with sleep. The only exception to this is if you have hypnic headaches. Caffeine before bedtime is an effective remedy and does not keep it awake in the case of hypnic headaches.
Avoid sleep medications, too – many of these can become addictive, and they may interfere with any medication you’re currently taking to manage your migraines.
4. Keep a sleep and headache diary.
It’s not uncommon for people to think they’re sleeping more than they actually are. Keep a diary where you note the following:
- When you went to bed and when you woke up (and calculate the total amount of time spent asleep)
- Any awakenings or disturbances
- Any migraines and associated symptoms
- What you are eating each day (certain foods could be triggering your migraines and worsening your symptoms)
5. Get help.
If you think you have a sleep disorder, talk to your doctor and share your sleep diary with them. They will ask you some diagnostic questions and may refer you to sleep clinic for further diagnosis.
If you have snoring or sleep apnea, treat those underlying conditions first. The same goes for insomnia.
Cognitive behavioural insomnia therapy (CBT-I) is an incredibly successful treatment that can require as little as 6 to 8 sessions. Your therapist will work with you to understand the negative thoughts you have about sleep, so that you can learn how to handle them and respond with healthier, sleep-promoting behaviours. CBT can also be helpful for addressing any fear you’ve developed of going to sleep and waking up with a migraine.
- “The Prevalence and Scope of Sleep Problems in Women With Transformed Migraine”: Researchers found that migraine sufferers are susceptible to bad sleeping patterns, but when behavioural improvements are made, their headache symptoms show improvement.
- “Headache and Sleep: Analysis of Sleep Habits and Symptoms in a Broad Clinical Sample of Migraines”: This study investigated the prevalence of various sleep problems among migraine patients and noted the positive relationship between worsened sleep problems with increased migraine intensity and frequency.
- “Primary Headache and Sleep Disturbances in Adolescents”: Studies have found that adolescents with migraines are more likely to suffer from daytime fatigue, trouble falling asleep, and increased overall sleep disturbance.
- “Migraine Headaches and Sleep Disturbances in Children”: This survey of parents noted that children with migraines are likelier to experience sleep problems including less sleep overall, sleep bruxism, and snoring.
- If you’re waking up with headaches but you’re not convinced migraines are the problem, learn more from our article on headaches and sleep.
- The American Migraine Foundation provides educational resources about migraines, a healthcare provider directory, and social media discussion groups and webinars.
- The Migraine Research Foundation is raising funds to fund research into finding a cure for migraines and improving treatment alternatives.The website includes a directory of adult and pediatric doctors certified in headache medicine and other helpful resources.
- Migraine.com is a leading online magazine dedicated to helping patients and their caregivers find relief from migraines.
- Connect with others and share your advice on online support forums such as the Migraine subreddit, Migraine.com Community forums, and Patient.info Migraine forums.
- Many migraine sufferers share their experience on personal blogs. Popular sites include Migraine Pal, Migraine Again, Migraine Ninja, and Migraine Diva.
Additional Sleepation Resources
If you want to learn more about sleep disorders and how to sleep well, visit our other Sleepation articles at the links below: