Headaches

Mike wakes up every morning with a dull headache. It goes away after 2 hours. His wife told him that he snores and he makes breathing sounds like he is choking. Mike talked to his primary care doctor who suspected sleep apnea. Mike had a sleep study which showed severe sleep apnea where he stopped breathing 50 times an hour and his oxygen dropped to the lower 80% (normal is above 90%). Mike was treated with CPAP mask and machine. He started sleeping better and feeling better. He joined the gym to lose weight. After 2 weeks of using the CPAP, his morning headaches were gone.

Morning headache is common in people with sleep apnea or those who don’t sleep well or sleep enough because of insomnia. Sleep apnea can drop amount of oxygen that gets to the brain and elevates  carbon dioxide (CO2)- both are mechanisms believe to contribute to headaches in sleep apnea. Headaches typically resolve or diminish with treatment of the sleep apnea.

Margaret suffers from migraines about twice to three times a week. During the attack, she feels nauseous and she may vomit or get lightheaded. These headaches are debilitating. Margaret doesn’t sleep well at night.  She only gets 5 hours of sleep at best. She suffers from insomnia because there is stress in her life (work related, family illness).  She sought treatment for her headaches from a neurologist who was also a sleep specialist. The neurologist treated the migraine with medications. He also focused on her sleep habits, sleep quality, stress levels and coping mechanisms. Over time, her headache frequency and severity improved (now once or twice a month). She gets a restful 6 to 7 hours of sleep every night. She started exercising and eating healthy and paid attention to her stress level especially in the evenings.

Margaret is among many women who suffer from migraines due to a number of reasons including hormonal changes, weather changes, specific foods (red wine, chocolates, aged cheeses as example). However, poor sleep quality and not sleeping enough is a huge problem that contributes to migraines. It needs to be discussed with your physician treating the headaches.

There is a high prevalence of non-restorative sleep and poor sleep habits among women with migraine. This is according to an interesting study from the University of North Carolina (NC) which was published in the April 2006 issue of Headache.  The same author took it a step further and found that behavioral intervention that led to improved sleep in a group of women with chronic migraine was associated with improvement in headache frequency. Not only that, but the headaches reverted from chronic (defined as at least half of the days of the month) to episodic. This second study was published in the 2007 September issue of Headache.

The behavioral intervention they used in the NC study included the following: Get 8 hours of sleep a night, avoid stimulating activities such as watching TV in bed, avoid liquids within 2 hours of bedtime and visualization techniques to help them sleep before bedtime.

Other types of headaches that are related to sleep are called “cluster headaches” and “hypnic headache”. Cluster headaches often occur during state REM sleep and they are very painful. They occur in clusters during weather changes such as fall season. Hypnic headaches are rare but they tend to be diffuse and occur at night.

Management of sleep problems in an individual with headaches

  • First, you need to talk to your doctor to make sure that your headache is not due to a serious problem such as a tumor.
  • Review your sleep habits: Are you getting enough hours? An average person needs 8 hours of sleep. Is your sleep quality disrupted? If so, why? Is it snoring or maybe your sleeping partner is snoring. Watch your sleep habits before bedtime. Avoid stimulating activities.
  • If you snore or stop breathing, ask your doctor to evaluate you for sleep apnea.
  • Review what you eat during the day. Food that potentially trigger migraines include red wine, aged cheeses such as Parmesan or Cheddar, salami, MSG containing food, caffeine, chocolate and peanut butter. Try to find your triggers. One of my patients found that every time she eats ice cream she gets a migraine. That is her trigger.
  • Bottom line: if you suffer from headaches, be proactive about your sleep (quality and quantity). Talk to a sleep specialist if you need help.