Pay attention to your sleeping habits and you'll lessen the odds and intensity of migraine headaches, say researchers.
The idea sounds almost too simple, and headache specialists have long advised their patients to heed what they term "good sleep hygiene." But a study by a University of North Carolina sleep specialist provides some scientific evidence that good sleep habits can reduce the number of headaches and their severity.
Migraine sufferers who cleaned up their act reduced their headache frequency by 29% and their headache intensity by 40% compared with those who didn't change their sleep habits, Anne Calhoun, MD, reported at the 48th Annual Scientific Meeting of the American Headache Society in Los Angeles.
"We've been talking about sleep being a problem in migraine for 125 years, but no one has looked at behavior modification to fix it," Calhoun tells WebMD. Calhoun is an associate professor of neurology at the University of North Carolina Medical School.
"People with migraine say it affects their sleep," Calhoun says, "but it may be the other way around. They're having chronic migraines because they are not sleeping well."
In her study, she assessed 43 women with transformed migraine. That's a headache pattern in which occasional or episodic headaches become chronic -- defined as at least half of the days of the month. All the women were told they would be learning how to improve lifestyle habits such as diet, exercise, and sleep.
Calhoun assigned 23 women to the behavior-modification group. These women were told to schedule eight hours of time in bed each night, not to read or watch television or listen to music in bed, and to limit their fluid intake beginning two hours before bedtime. They also were taught how to use visualization to fall asleep quickly and were instructed to move dinnertime to four hours before bed to ensure sounder sleep.
The other women were assigned to the control group. They were told to schedule dinner at a consistent time each night and were taught to use an acupressure point that actually had no relationship to headache, Calhoun says.
All the women recorded their headaches in diaries.
"We instructed them to stop overusing medications," Calhoun says. "About three-quarters of the 43 women were overusing medications."
While headache specialists point to medication overuse as a factor in headaches becoming more chronic, "we feel there may be other important factors involved in the transformation process," Calhoun says. "Sleep problems may be one of these methods by which episodic headaches become chronic."
The women stayed on preventive medication throughout the study but were not to overuse any medications. And when a headache struck, they were allowed to use acute medication.
Better Sleep Habits, Less Pain
The results of improved sleep were seen fairly quickly. "At the first follow-up visit at six weeks, 35% of the sleep habit-modification group reverted from chronic headaches to episodic," Calhoun says. No one in the control group reverted, however.
Then the women in the control group were switched over to the true behavior-modification group for the rest of the study -- another six weeks. At the end of the 12 weeks, 58% of the original behavior-modification group had seen their headaches drop from chronic to episodic and 43% of the women who were switched to the true behavior-modification group did, Calhoun says.
"It's a very difficult thing to get someone to revert," Calhoun explains.
She found that paying attention to sleep habits appears to be an all-or-nothing package to obtain improvement in headaches. "Of the people who fixed all their sleep habits, only one did not revert to episodic." If the women kept three or more bad sleep habits, they did not revert from chronic to episodic.
Back to Basics?
The study underscores the need to pay attention to lifestyle, says Stephen Silberstein, MD, president of the American Headache Society and professor of neurology at Thomas Jefferson University in Philadelphia.
"We've known for a long time that going to bed at the right time [and] getting up at the same time are things we have always taught our headache patients to do [to avoid headaches]," Silberstein tells WebMD. "I think it is a good study and it's important. What it really tells us is patients with migraine need regularity in their lives."