Sleep problems are one of the most frustrating symptoms of migraines. Migraines disrupt sleep, while lack of sleep triggers migraines. Like the proverbial chicken-and-egg, one might wonder: which came first, the sleep issues or the migraines?
For many of the over 36 million migraine sufferers in the U.S., they don’t care; they simply want to find relief.
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)
Nausea and stomach pain or upset
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.
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
According to the American Migraine Foundation, migraine sufferers are 2 to 8 times likelier to experience sleep problems. The worse the migraines, the worse the sleep problems.
The largest barriers to relief often involve insomnia and resulting sleep deprivation. It’s impossible to do anything when you’re in the midst of a migraine, including sleep. As a result, people with migraines can have a tougher time going to bed due to a late night migraine. 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, like jet lag, can also trigger migraines.
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 is noisy breathing during sleep. OSA is a more serious form of sleep-disordered breathing where the individual literally stops breathing momentarily during sleep, typically due to a blockage or narrowing of their airways. 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.
Nearly half of migraines are known as “awakening headache” since they occur between 4 and 9am in the morning. 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 will monitor your breathing, brain waves, and more while you sleep. In the days following your exam, a doctor certified in sleep medicine will analyze your results for signs of a 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 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 disrupted due to a problem like sleep apnea, their sleep cycle get interrupted as well, returning to light sleep earlier than would otherwise happen.
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 sometimes prescribed to treat migraines (as well as associated depression from insomnia).
Go to sleep 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.
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 can upset your stomach and make sleep more challenging.
Also avoid alcohol and caffeine later in the day. Both of these substances interfere with sleep. The one exception to this is if you suffer from hypnic headaches. Caffeine before bedtime is an effective treatment, and in the case of hypnic headache sufferers, does not keep them awake.
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 behavioral therapy for insomnia (CBT-I) is an extremely effective treatment that can take as few as 6 to 8 sessions. Your therapist will work with you to recognize the problematic thoughts you have around sleep so you can learn to manage them and react with healthier, sleep-promoting behaviors. CBT can also be helpful for addressing any fear you’ve developed of going to sleep and waking up with a migraine.
The American Migraine Foundation provides educational resources about migraines, a healthcare provider directory, and social media discussion groups and webinars.
The Migraine Research Foundation raises money to fund research into discovering a cure for migraines and developing treatment options. 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.