If you suffer from migraines, you may want to pay more attention to your sleep habits. That's the message from several studies which show that sleep problems, like insomnia, may actually trigger migraines.
Migraines and Sleep Problems
Migraines begin when hyperactive nerve cells send out impulses to blood vessels, causing them to constrict, then expand. This is accompanied by the release of brain chemicals and inflammatory substances that cause the pulsations to be painful.
In a study published in the journal Headache, researchers conducted a detailed sleep interview with 147 women with transformed migraines (where occasional or episodic headaches become chronic at least half of the days of the month). When asked whether they were refreshed or tired on waking, not one reported feeling refreshed, and more than 80% said they were tired when they woke. Complaints about sleep problems were prevalent.
In a second study on sleep habits and migraines, also published in Headache, researchers provided stronger evidence that good sleep habits reduce both the number and intensity of migraine headaches. In these findings, 43 women with transformed migraines received behavioral sleep instructions or placebo instructions in addition to usual medical care. The women recorded their migraine headaches in diaries. At the end of the study, the women who received behavioral sleep instructions reported a significant reduction in migraine headache frequency and intensity.
How Do Sleep Problems Cause Migraines?
Rapid eye movement (REM) sleep provokes migraines, says Vincent Fortanasce, MD, a Los Angeles-based neurologist, psychiatrist, and author of the Anti-Alzheimer's Prescription. Fortanasce tells WebMD that REM sleep provokes most powerful migraines that occur five to six hours after sleep begins.
Most of us go through about six sleep cycles with about four stages of sleep, plus rapid eye movement (REM) sleep. The deepest stages of sleep (stages 3 and 4) are necessary for the production of sufficient serotonin and dopamine, both neurotransmitters.
These neurotransmitters are the "feel good" chemical messengers in the brain, and both depend on adequate sleep; a decrease in serotonin and dopamine is associated with poor sleep or sleep problems.
One reason for waking with migraines is that REM sleep is most powerful just before awakening. Sleepproblems can then trigger migraines by causing instability of serotonin and a lowering of dopamine levels.
Antidepressants, specifically the selective serotonin reuptake inhibitors (SSRIs), may help stabilize serotonin membranes and block migraines. These medications are sometimes used as migraine treatment.
Do Your Sleep Habits Trigger Migraines?
How are your sleep habits? Do you have difficulty falling asleep? Do you toss and turn most of the night? Do you feel irritable, fatigued, and even depressed the next day after a rough night trying to sleep? Whether you suffer with migraines or not, non-restorative sleep and impairment of daytime function is a problem for millions of Americans.
Not only do sleep problems wreak havoc on mood and decision-making abilities, but poor sleep habits also result in feelings of malaise, poor concentration, and even accidental deaths, according to Ronald R. Fieve, MD, professor of clinical psychiatry at Columbia Presbyterian Medical Center, and author of Bipolar II.
When trying to isolate signs of sleep problems, Fieve gives the following eight statements to patients. If you check more than two of the statements below, call your doctor and seek help for your sleepproblem:
- I have a headache in the morning upon getting out of bed.
- I feel scattered aches and pains throughout my body upon arising.
- I feel fatigue or tiredness that does not go away even after several large cups of strongly caffeinated coffee.
- I feel in a low mood that does not lift even as I get on with daily activities.
- I have felt depressed enough to seek psychiatric help or to obtain antidepressant medications.
- I feel irritable, impatient, and moody.
- I have trouble learning new information or grasping new ideas.
- I often have an inability to maintain social harmony with family and friends.
Will Better Sleep Habits Stop Your Migraines?
While no one can guarantee that better sleep habits will result in fewer migraines, there are some practical ways to get in control of your sleep problems.
Start by keeping track of your sleep habits and migraine patterns each morning for four weeks. Using a small calendar or diary, write down how you slept each night and record if you had a migraine. After reviewing your sleep habits and migraine diary over four weeks, you may begin to notice a pattern of sleep problems triggering migraines. Even if you don't notice a pattern, continue to work on your sleep habits so you feel better and are able be more alert and productive at work and at home.
Sleep Problems With Migraines: Do You Need a Sleep Study?
While researchers are still trying to determine the connection between sleep habits and migraine, REM sleep abnormalities have been implicated in a variety of problems, including depression and posttraumatic stress disorder. Sleep problems are also common in those with fibromyalgia, which is characterized by its deep muscle pain, fatigue, anxiety, and depression. Coincidentally, migraines are common in those with fibromyalgia, with 50% to 75% of sufferers also reporting migraine headaches.
If your doctor suspects you might have sleep problems such as sleep apnea, restless legs syndrome, or other sleep problems, your doctor may recommend a sleep study or polysomnography. With a sleep study, sleep specialists evaluate your sleep habits at an overnight facility, administering ongoing tests, including an electroencephalogram (EEG), which monitors electrical activity of the brain, oxygen levels, airflow, and other physiological functions.
How You Can Manage Sleep Problems With Migraines
Drugs, stress, and excessive noise can affect daily body rhythms, mood, and sleep, Fieve tells WebMD. He encourages patients to evaluate their lifestyle habits and sleep hygiene to make sure their body is prepared for rest.
- Start by giving yourself a fighting chance for rest: Turn off the lights, the TV, and the laptop when you're getting ready for bed.
- Eliminate caffeine from your diet.
- Try exercising regularly in the morning or afternoon (but not near bedtime; it can actually wake you up).
- Eat dinner at least three hours before you get in bed. Some experts recommend a snack high in carbohydrates such as cereal and milk, or a bagel, which may induce sleep by boosting levels of serotonin.
Above all, talk to your doctor, the best health care professional to advise you on lifestyle habits and medication that can help you manage your migraines and end your sleep problems.