10 Things to Know About Migraines and Sleep

10 things to know about migraine and sleep

Migraine and sleep problems go hand in hand. If you suffer from migraine, you know how disruptive these painful headaches can be to your sleep. Sleeping poorly, and going without sufficient sleep, can make migraines more painful, last longer, and happen more frequently. And sometimes, sleep is the only thing that helps a migraine to pass.

There is A LOT to unpack in the relationship between sleep and migraine. Migraine affects the quality of our sleep, and migraine headaches often occur in tandem with several sleep disorders. Migraine and sleep problems have shared biological roots in the brain. And migraines are affected by circadian rhythms and our individual chronotype. Understanding the links between migraine and sleep disruption can help you manage both conditions more effectively, to reduce the debilitating experience of migraine flare-up, and sleep better.

The relationship between migraine and sleep is a complicated two-way street

Are migraines a cause of sleep problems, or a consequence of poor sleep? The answer is YES, to both.

Research shows that migraine sufferers are at particular risk for sleep deprivation, even among people who experience headaches. People with migraine often experience restless, interrupted sleep with frequent night awakenings, both before and during a migraine attack. And the aftermath of a migraine is often filled with sleep debt, fatigue, and a sleep-wake cycle that’s off its track.

In turn, research shows that a range of problems with sleep—including sleeping too little, sleeping too much, and experiencing restless, low-quality sleep—are linked to increased risk for migraine headache. Poor sleep can increase the intensity of migraine pain and the frequency of migraine attacks.

At the core of this relationship between sleep and migraine is the bi-directional relationship between sleep and pain. There’s a powerful body of research showing that poor quality sleep escalates pain, lowering pain thresholds and making us more sensitive to pain and that the presence of pain interferes with sleep, limiting sleep amounts and reducing sleep quality–leaving us feeling tired, unrefreshed, and less equipped to cope with ongoing pain during our waking life.

Here’s more to know about how pain and sleep interact, and how you can sleep better when dealing with some common types of chronic pain.

Poor sleep be an early signal of migraine already in progress

Migraine sufferers know their individual signals of a painful headache on the horizon. Tiredness, fatigue, sensitivity to light, irritability, low energy, nausea, and changes to appetite are common signs of an impending migraine. Difficulty falling asleep and staying asleep can also be alerts that a migraine is developing. Some research suggests that while poor sleep is considered a trigger for migraine, the disrupted sleep that precedes a migraine may in some cases be a sign of a migraine that is already underway.

About a third of migraines happen during sleep

Research estimates that between 24-42% of migraines occur specifically and exclusively during some part of the sleep phase, either during the night or upon waking.

There’s research that shows distinct sleep and pain differences between people with sleep-related migraine and non-sleep-related migraine. A 2013 study examined sleep and pain in migraine sufferers and found:

  • People with sleep-related migraine spend less time in deep, restorative slow wave sleep, and experience more frequent nighttime awakenings.
  • People with non-sleep-related migraine spend more time in slow-wave sleep and have fewer awakenings at night. Despite their more restorative sleep, they felt more tired during the day than people with sleep-related migraine.
  • Non-sleep migraine sufferers were found to have lower pain thresholds, compared to a control group used in the study. (Sleep-migraine sufferers did not have pain thresholds that differed from the control group.)

Other research has found that people with migraine spend less time in slow wave sleep and have lower sleep efficiency (which is often characterized by frequent waking throughout the night). And there’s also research showing that people with migraine tend to have lower pain thresholds. These findings suggest that underlying biological mechanisms regulating both sleep and pain processing contribute to migraines—but we don’t yet have a clear understanding about why some migraine onset happens only during sleep, and others occur during the waking day.

Migraines are affected by chronotype

Migraines have a distinct circadian rhythm, different from other headaches and other pain conditions. Migraine pain tends to peak in the morning and around midday. (Cluster headaches, on the other hand, tend to peak in the middle of the night, around 2 a.m.) And specific mutations of circadian clock genes are associated with the development of migraine, as well as with dysfunction of circadian sleep-wake rhythms.

There is emerging research that individual chronotype affects your risk for migraines and when migraines are most likely to occur. Research indicates that migraine sufferers are less likely to be a middle-of-the-road chronotype. Lions and Wolves—and Lions particular, Lions—are more likely to suffer from migraine than middle-of-the-road Bears.

  • Lions, aka morning types, tend to have migraine attacks in the morning
  • Wolves, aka evening types, are more likely to have migraine attacks in the late afternoon or early evening

Understanding your chronotype is essential for creating a consistently restorative sleep routine, one that aligns with your unique circadian rhythms. That chronotype-aligned routine of abundant, restful sleep can help you minimize the painful, disruptive impact of migraine in your life.

To find our your chronotype, take this short quiz: www.chronoquiz.com.

My new book, Energize!, is a step-by-step guide for using chronotype and body type together to create a daily routine that maximizes your energy and vitality, letting you do more, feel better, stronger, and healthier, and sleep more soundly, every day.

Migraine and insomnia commonly occur together

Insomnia is the most frequent sleep problem among people with migraine—it’s estimated that 50% of people with migraine also have insomnia. People with migraine are significantly more likely to experience insomnia than people without migraine. Having insomnia can make migraines more intensely painful and increase the disruption of migraine-pain on our ability to function. Insomnia is associated with more frequent migraine attacks and a higher risk for migraines becoming chronic.

A series of large, long-term related studies conducted in Norway found strong associations between between insomnia and migraine over time. At the end of an 11-year study period:

Treating insomnia now can help reduce risk for migraine down the road. And if you have migraine, there’s a 1 in 2 chance you’re also suffering from insomnia. Both conditions need your attention. There’s good news for people who experience both migraine and insomnia. Cognitive-behavioral therapy for insomnia, or CBT-I, is one of the most effective therapies for this sleep disorder. And research shows CBT-I is also an effective treatment for migraine, reducing the intensity of migraine pain and lowering the frequency of migraine attacks.

Sleep apnea and migraine share an important risk factor

Obesity is both a primary risk factor for obstructive sleep apnea and an under-recognized risk factor for migraine, particularly for chronic migraine.

The front-line treatment for sleep apnea—CPAP—has significant benefits for migraine, according to research. For people with sleep apnea and migraine, CPAP can:

  • Reduce the frequency of migraine attacks
  • Shorten the duration of migraine episodes
  • Reduce pain intensity, and lower reliance on medication
  • Improve sleep quality

Morning headaches are a common symptom among people with sleep apnea. If you’re experiencing a new or worsening headache in the morning, talk with your doctor about being screened for OSA. If you’re a person with both OSA and migraine, being consistent about using your CPAP can help alleviate not only your sleep apnea, but also your migraine pain and the frequency of your migraine attacks.

Migraine is linked to other sleep disorders

Restless leg syndrome: There’s a large body of research showing that people with restless leg syndrome (RLS) are at significantly increased risk for migraine, and that migraines are more severe and disabling among people with RLS. There’s also evidence that the presence of migraine is linked to more severe RLS symptoms. And some of the antidepressant medications that are prescribed for migraine may worsen symptoms of RLS.  

Narcolepsy: There’s not been substantial research investigating the links between migraine and narcolepsy. But the some research suggests that migraine is more likely to occur in people with narcolepsy and people with hypersomnia, a condition that’s characterized by excessive daytime sleepiness that is present even right after waking, or after long stretches of sleep.

If you experience migraine, it’s important to talk with your doctor about screening for sleep disorders—and not only insomnia and sleep apnea. Make sure you and your physician are covering all the bases, and attentive to the risks and symptoms associated with restless leg syndrome, narcolepsy, and hypersomnia.  

Nightmares

It’s a little-studied area of sleep research that deserves more attention: the intersection between migraine and nightmares, as well as other parasomnias, which are unwanted and disruptive behaviors that occur during sleep. Nightmares can trigger migraine, increase the frequency of nighttime migraine attacks, and also worsen anxiety and low mood in people with migraine.

Some of the drugs used to treat migraine—specifically tricyclic anti-depressants and beta blockers—have been linked to nightmares.

Migraine is also associated with a higher rates of sleepwalking, particularly in children and in people who experience migraine with aura.

Another parasomnia that occurs in connection with migraine is sleep bruxism—grinding and clenching teeth while we sleep. Bruxism is a cause of TMJ (temporomandibular joint dysfunction), which is commonly found in people with migraine. Some research suggests that migraine may be triggered by sleep bruxism and TMJ.

If you have migraine and experience nightmares or disturbing dreams, or other parasomnias such as sleepwalking or bruxism, don’t assume these conditions are unrelated. Discuss all your disruptive nighttime behaviors with your doctor. These parasomnias are not only disrupting your nightly rest—they may also be making your migraines worse, and more frequent. If you’re taking medication for migraine and experiencing nightmares, you and your doctor may consider alternate therapies for your headaches.

Migraine and sleep problems share neurobiological roots

Clearly, there are deep connections between migraine and disrupted sleep—in sleeping poorly before, during, and after a migraine, and in the strong overlap between migraine and sleep disorders.

 What’s behind this deep connection?  Research indicates that the frequent co-occurrence of migraine and sleep problems may be attributed to underlying, brain-based biological factors that contribute to both conditions. Some of the same key structures, neurotransmitters, and pathways in the brain that regulate sleep are also responsible for processing and modulating pain and contribute to the development of migraine.

It’s a tremendously complex neurobiological network that contributes to the onset of sleep problems and the development of migraine, which includes:

The brainstem, cortex, and hypothalamus. The hypothalamus is critical to the shared biological roots of migraine and sleep. The hypothalamus is a central hub for the processing of sensation, including pain. The suprachiasmatic nucleus, or SCN, the brain’s central circadian timekeeper, is located in the hypothalamus.

Neurotransmitters including serotonin, dopamine, orexin, GABA and adenosine.  Each of these neurotransmitters and their pathways in the brain play an important role in regulating sleep and wakefulness throughout the 24-hour day. And each has been shown to have potential effects on the development of migraine and the symptoms that accompany migraine, from pain to nausea and light sensitivity.

What can alter activity among these neurobiological networks, making us vulnerable to disordered sleep and potentially triggering migraine? There are a range of factors, including:

  • Genetic predisposition 
  • Stress
  • Mood disorders such as depression and anxiety
  • Environmental factors, including excessive and poorly timed light exposure
  • Over-consumption and poorly timed consumption of stimulants, including coffee, alcohol, nicotine
  • Illness and disease
  • Insufficient and poor-quality sleep, and irregular sleep schedules

There is a lot more for scientists to learn about the intersection of sleep problems and migraine in the brain and central nervous system. What we already know is this: the fundamentals of sleep hygiene can protect sleep and healthy brain function, which may reduce risks for developing migraine and the frequency and severity of attacks when they occur.

Low melatonin may be a factor in migraine

You likely know melatonin as a sleep hormone. Melatonin helps to initiate sleep, and it regulates circadian rhythms, which control our daily, 24-hour circadian sleep-wake cycles. You may not know that melatonin has analgesic (aka pain-relieving) capabilities, and it plays a critical role in the complex signaling of pain pathways in the brain and central nervous system. A growing body of research shows that low melatonin, and the delayed release of nighttime melatonin, are associated with headache pain and specifically linked to migraine.

One important way to protect melatonin levels, and the timing of nighttime melatonin production, is to manage your exposure to artificial light in the evening hours. Melatonin production is triggered by darkness, and it’s most aggressively suppressed by blue wavelength light, which is found in high concentrations in our digital devices and the LED lights that we use in our homes. Here’s what to know about managing light exposure to protect melatonin, and how blue-light blocking glasses can help.

Sleep can end a migraine attack

For many people, sleep is the best remedy for ending a migraine. Scientists aren’t yet sure why, but a recently discovered system in the brain that is most active during sleep may be involved. The brain’s glymphatic system is responsible for flushing accumulated waste and toxins from the brain. And this newly identified waste-flushing system kicks into high-gear during sleep. According to research, the glymphatic system operates at 10% capacity during wakefulness—and it removes twice the amount of potentially damaging proteins from the brain during sleep.

Some scientists are now questioning whether the glymphatic activity that occurs in the brain during sleep is a factor in sleep’s ability to bring migraine to an end.

There’s also research that indicates inhibition of the glymphatic system is connected to the development of migraine—so the influence of this sleeping brain activity may run in both directions, helping to terminate some migraines when it’s functioning optimally, and contributing to the onset of migraine when it is impaired.

We don’t yet know what role the glymphatic system plays in migraine. We do know that the glymphatic system is a critical one for maintaining the healthy structure and function of the brain, and its impairment may be a key factor in the development of neurodegenerative diseases such as Alzheimer’s. Prioritizing a consistent routine of abundant and high-quality sleep helps enable this brain-protecting system to function.

Here are some helpful resources that support people living with migraine, and patients wondering whether they have migraine:

The Coalition for Headache and Migraine Patients (CHAMP)

The American Migraine Foundation

These organizations can support you in identifying symptoms, learning more about treatment options, finding a migraine specialist, talking with your physician, navigating insurance claims associated with migraine, and connecting with communities of people living with migraine.

Sweet Dreams,

Michael J. Breus, PhD, DABSM

The Sleep Doctor™

www.thesleepdoctor.com

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Michael Breus, Ph.D - The Sleep Doctor is a Diplomate of the American Board of Sleep Medicine and a Fellow of The American Academy of Sleep Medicine and one of only 168 psychologists to pass the Sleep Medical Specialty Board without going to medical school. Dr. Breus is a sought after lecturer and his knowledge is shared daily in major national media worldwide including Today, Dr. Oz, Oprah, and for fourteen years as the sleep expert on WebMD. Dr. Breus is the bestselling author of The Power of When, The Sleep Doctor’s Diet Plan and Good Night!

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