Migraine and Sleep Relations
Migraines are severe headaches which are very disruptive to the lives of those who suffer from them. As if the headaches alone aren’t bad enough, migraine attacks can also impair sleep, which further intensifies the pain. Conversely, sleep disorders also commonly trigger migraines, so the influence is reciprocal. This blog addresses how to sleep with a migraine, and how to fall asleep with a headache. We’ll also explore sleep disorders to be aware of which can be tied to worsening your migraines including lack of sleep and even too much sleep.
What is a Migraine?
Migraines are electrical neurological events that extend beyond the scope of typical headaches, impacting daily life and often severely disrupting sleep patterns. In other words, migraine is “more than just a headache.” Understanding the multifaceted nature of migraines is essential for effective management. Various factors contribute to migraines, including genetic predisposition, hormonal fluctuations, food, and environmental triggers. Identifying and avoiding these triggers is critical in reducing the frequency and intensity of migraine episodes.
Migraine headaches manifest through a range of symptoms such as throbbing pain, sensitivity to light and sound, and even nausea +/- vomiting. These symptoms can vary greatly among individuals, making it crucial to recognize your specific patterns and triggers. Keeping a migraine diary can be beneficial for tracking the onset, duration, and potential triggers of your headaches. This data can offer valuable insights and help healthcare providers develop a tailored treatment plan.
How Does a Migraine Affect Sleep?
Sleep problems and migraines often exist in a cyclical relationship, each exacerbating the other. Poor sleep quality can trigger migraines, while the pain and discomfort of migraines can hinder restful sleep. This relationship underscores the importance of managing both sleep and migraine symptoms concurrently.
Migraines may also be linked to medical conditions and sleep disorders such as obstructive sleep apnea and insomnia. Addressing these underlying conditions can provide significant relief. For instance, treatments for obstructive sleep apnea, like continuous positive airway pressure (CPAP) therapy, have been shown to reduce the frequency and severity of migraines in some patients.
Understanding the stages of sleep, particularly the role of REM (rapid eye movement) sleep, can also shed light on the connection between sleep and migraines. Disruptions in REM sleep are often reported among migraine sufferers, leading to fragmented and less restorative sleep. Sleep deprivation is one of the most common migraine triggers. For some people, certain sleep stages can trigger their migraines and they may routinely wake with a miserable migraine from sleep. Waking headaches should always be discussed with your doctor though, before assuming it is simply a morning migraine attack. There are also some characteristic nocturnal headache disorders such as hypnic headaches and cluster headaches.
Hormonal changes are another common trigger, particularly for women. Fluctuations during menstrual cycles, pregnancy, and menopause can influence the onset and severity of migraines. Being aware of these patterns can help in anticipating and managing migraine episodes more effectively.
In summary, comprehending the various dimensions of migraines and their triggers is foundational to developing strategies for better management and improved sleep quality.
Evening Routines to Lessen Migraine Attacks
A consistent evening routine with good sleep hygiene can significantly impact how well you manage migraines. Sleep disruption, sudden changes in sleep schedules, and even oversleeping are common migraine triggers. Establishing a regular sleep schedule can help stabilize your body’s circadian rhythm and improve sleep quality. Aim to go to bed and wake up at the same time every day, even on weekends.
Creating a calm pre-sleep routine is equally essential. Engage in relaxation techniques such as meditation, deep breathing exercises, or gentle stretching to ease the transition into sleep. Reading a book or listening to calming music can also help your body and mind wind down.
Be mindful of electronic device usage in the hours leading up to sleep. It’s crucial to limit screen time before bed. The blue light emitted by electronic devices can interfere with melatonin production, making it harder to fall asleep. If you must use electronic devices, consider blue light filters or migraine glasses designed to reduce exposure.
Incorporate sensory-based therapies and calming elements into your evening routine. Consider using sensory-based therapies like pink noise or guided imagery, which have shown promise in improving sleep quality for chronic pain sufferers.
Aromatherapy with essential oils like lavender or chamomile can create a relaxing atmosphere conducive to sleep. Techniques such as pink noise or guided imagery have shown promise in improving sleep quality for those dealing with chronic pain. Light stretching or yoga can also help in unwinding before bed.
By integrating these practices into your evening routine, you can create a more restful environment that supports better sleep and helps to manage migraines more effectively.
Establishing a Sleep-Conducive Environment and Sleep Position During a Migraine
Creating a restful sleep environment is crucial for those dealing with migraines. Light and noise can significantly aggravate migraine symptoms, so ensure your bedroom is dark and quiet. Blackout curtains can be particularly effective in blocking out light. For noise reduction, consider earplugs, noise cancelling ear plugs, or a white noise machine to mask disruptive sounds.
Temperature control is another vital aspect. A cool room, typically between 60-67°F, can promote better sleep. Investing in a good-quality mattress and pillows that support your head and neck can make a substantial difference. Many migraine sufferers find that memory foam pillows offer the necessary support to alleviate pressure points.
What position should you sleep in with a migraine?
Be mindful of your posture while sleeping in general, whether there is an active migraine attack or not. Many migraine sufferers find relief by sleeping on their back or side with a supportive pillow to maintain proper alignment of the neck and spine. This can reduce pressure on the neck and alleviate symptoms. The ideal sleep position is to keep the head and neck parallel and aligned as straight as possible to the rest of the body. In other words, avoid sleeping with the head and neck significantly higher or lower than the chest. This lessens the muscular strain and occipital nerve irritation while sleeping overnight. With that said, some prefer to sleep with the head in a slightly elevated position to lessen pressure in the head. This if fine too, but try to slightly elevate the chest along with the head and neck in order to maintain that neutral position between the head, neck, and chest. Stomach sleeping should be avoided as this can cause neck strain and exacerbate the migraine.
Establishing a consistent bedtime routine, such as reading a book or listening to calming music, can signal to your body that it’s time to wind down. Keeping the bedroom clutter-free and reserved only for sleep can further help in associating the space with rest and relaxation. Aiming for 7-8 hours of sleep is optimal. If you do not get enough sleep, your brain cannot properly replenish neurotransmitters, which leads to all types of problems such as excessive daytime sleepiness, depression, and cognitive complaints.
These adjustments can collectively create an environment more conducive to sleep, helping to minimize the impact of migraines on your nightly rest.
Nutrition, Fluid Intake, and Exercise
The foods and drinks you consume can greatly affect both your sleep quality and migraine severity. It’s essential to steer clear of common migraine triggers like caffeine, alcohol, and foods high in tyramine close to bedtime. Caffeine can be particularly disruptive to sleep and may trigger or worsen migraines, so it’s best to limit intake throughout the day and avoid it altogether in the hours leading up to sleep.
Alcohol, while sometimes used as a nightcap, can disrupt sleep cycles and potentially trigger migraines, making it counterproductive for those looking to improve their sleep quality. Similarly, foods high in tyramine, such as aged cheeses, processed meats, and fermented foods, should be avoided as they can contribute to migraine onset.
Staying well-hydrated is crucial, as dehydration is a known migraine trigger. Aim to drink plenty of water throughout the day to maintain optimal hydration levels, but be cautious about fluid intake in the evening to minimize nighttime awakenings. Diuretics like caffeinated beverages and alcohol can exacerbate dehydration, so it’s wise to avoid them as bedtime approaches.
Consider incorporating magnesium-rich foods into your diet, such as leafy greens, nuts, seeds, and whole grains. Magnesium has been shown to help reduce the frequency of migraines in some individuals. Additionally, foods rich in omega-3 fatty acids, like fish and flaxseeds, can have anti-inflammatory effects that may be beneficial for migraine sufferers. Adding a daily bedtime supplement of magnesium glycinate 400-800 mg helps to prevent migraines, and is also used for sleep and anxiety by many patients.
Maintaining stable blood sugar levels can also play a role in managing migraines. Meal timing and avoiding long gaps between meals and opting for balanced snacks that include protein, healthy fats, and complex carbohydrates can help keep blood sugar levels steady and potentially prevent migraines.
A routine of regular exercise has been shown to improve the quality of sleep, improve the sleep-wake cycle, increase the time spent in those crucial stages of deep sleep, and decrease the frequency of migraine attacks.
Avoiding heavy meals in the hours leading up to bedtime should also be avoided. Instead, opt for a light snack if you’re hungry, such as a small serving of nuts or yogurt, which are less likely to disturb your sleep.
Finally, it’s worth noting that each person’s triggers can vary. Keeping a food diary can help identify specific foods or drinks that may be contributing to your migraines, enabling more personalized dietary adjustments.
How to Sleep with a Migraine; Alleviating Migraine Symptoms
When a migraine hits, there are several ways to ease symptoms and enhance sleep quality. Medications, both over-the-counter and prescription, can offer relief, but always follow your healthcare provider’s guidance. Prescription medications such as the triptans, gepants, ditans, or DHE are often needed to help abort the attack if OTCs don’t do the job. Some medications can have associated side effects of drowsiness for some patients, which can be used as an advantage to help induce sleep such as Rizatriptan, Sumatriptan, or Lasmiditan.
Diphenhydramine (Benadryl) is sometimes used by patients to help induce sleep during a migraine. In fact, diphenhydramine is a common ingredient in “migraine cocktail” IV infusions in the ER and headache centers because it helps to induce sleep (and sleep helps shut the migraine off for many people).
Beyond medications, alternative remedies and natural home remedies can be effective. Applying a cold compress to the forehead or neck can help reduce inflammation and numb pain. Migraine ice caps or migraine hats are also very popular. Essential oils like peppermint or lavender, used in aromatherapy, may also provide comfort.
Cognitive Behavioral Therapy (CBT) is another method that has shown promise in reducing migraine frequency and severity, as well as dealing with the migraine pain better. CBT focuses on changing negative thought patterns and behaviors, which can help manage the pain and stress associated with migraines. Mindfulness practices such as meditation, yoga, and deep breathing exercises can also improve pain intensity and overall quality of life for those with migraines.
Biofeedback is a technique that teaches you how to control physiological functions such as heart rate, muscle tension, and breathing. By learning to control these functions, you can often reduce the severity of migraine symptoms. Biofeedback has been shown to be particularly effective when combined with other treatments.
By exploring these strategies, you can find a combination of treatments that works best for you, helping to alleviate symptoms and improve sleep quality by helping to “turn down the volume” of your baseline overactive nervous system, making sleep easier.
When to Consult a Professional
While many strategies can be implemented at home, there are times when professional medical advice is necessary. If migraines persist despite trying various home remedies and lifestyle adjustments, it may be time to seek help. Persistent headaches, worsening symptoms, or new symptoms such as visual disturbances, numbness, imbalance, vertigo, weakness, or speech difficulties warrant immediate consultation with a healthcare provider. Your doctor can conduct a thorough evaluation to rule out underlying conditions such as obstructive sleep apnea or other sleep disorders that could be contributing to your high frequency episodic migraine or chronic migraine. Diagnostic tests and detailed medical history can help identify specific triggers and suitable treatment options.
A tailored treatment plan may include prescription medications, specialized therapies, or referrals to headache specialists or neurologists. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a validated treatment modality for insomnia in migraine patients and should be considered as a first-line therapy. This approach focuses on changing the thought patterns and behaviors that contribute to sleep issues, providing long-term relief.
Additionally, biofeedback and relaxation training can be effective complementary treatments, helping you manage stress and physical symptoms more effectively. Chronic migraines can also benefit from a multidisciplinary approach, involving pain management specialists, physical therapists, and even dietitians. This holistic strategy aims to address all aspects of your health and well-being, offering comprehensive support. Don’t hesitate to seek professional help if your migraines are impacting your quality of life. Early intervention and a well-coordinated treatment plan can significantly improve both your sleep quality and overall migraine burden on your life.
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