Miya Pearson
Sleep and migraine have a complex and poorly understood relationship. People with migraines often report poor sleep before and during their attacks, and identify poor sleep as a migraine trigger. However, sleep is also reported to serve a therapeutic role in terminating a migraine attack.
The bidirectional relationship between sleep and migraine may be explained by a common underlying cause. For example, serotonin, which is involved in both sleep and migraine, may be released during a migraine attack, and could be responsible for lowering pain thresholds in people who experience frequent awakenings.
The hypothalamus, which is pivotal in the transition from non-rapid eye movement (NREM) sleep to rapid eye movement (REM) sleep, has been proposed as a central and early mediator in the pathophysiology of migraine.
In addition, the recently discovered glymphatic system, which is a central nervous system (CNS) clearing system that works primarily during sleep, may also explain the relationship between sleep and migraine.
| Characteristics | Values |
|---|---|
| Migraine and sleep | Bidirectional relationship |
| Migraine and sleep | Caused and relieved by sleep |
| Migraine attacks | More likely to occur between 4:00 and 9:00 am |
| Lack of sleep | Well-known trigger for migraine |
| Excessive sleep | Can keep you awake with a migraine on subsequent nights |
| Sleep and the migraine cycle | Vicious cycle |
| Sleep and the brain | Controlled by common regions |
| Sleep and the brain | Use similar chemical messengers |
| Lack of sleep and pain threshold | Lowered pain threshold |
| Sleep problems as migraine triggers | Obstructive sleep apnea, insomnia, restless legs syndrome, jaw clenching, narcolepsy, circadian rhythm disorders, shift work or jet lag, night terrors (in children) |
| Migraine and sleep schedule | Migraines occur at the same time every day, often in the morning |
| Migraine and sleep diary | Helpful to pinpoint patterns in migraine attacks and figure out if you have a sleep disorder |
| Sleep and migraine treatment | Treatments including medications, diet changes, and behavioural sleep therapy can help prevent migraines |
| Sleep improvement tips | Consistent sleep schedule, dark and quiet room, no caffeine, nicotine or alcohol, no screens before bed, relaxing activities, exercise (not before bed), spend time outside during the day |
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What You'll Learn
Migraines and sleep: a bidirectional relationship
The relationship between migraines and sleep is a complex one, with a bidirectional influence. Sleep can be both a cause and reliever of migraine attacks, and migraines can disrupt sleep. This relationship is not yet fully understood, but it is thought that the interplay between the parts of the brain that regulate sleep and the nerves that carry pain sensations to the brain may be a factor.
The Impact of Sleep on Migraines
Changes in sleep patterns, both insufficient and excessive sleep, have been identified as potential triggers for migraines. Sleep deprivation, oversleeping, and lack of a regular sleep schedule can increase the likelihood of a migraine attack. This may be due to the impact of sleep on our pain thresholds; a lack of sleep can make us more sensitive to pain, including migraine pain.
The Impact of Migraines on Sleep
Migraines can also disrupt sleep. They can wake people from sleep, and people often go to sleep to alleviate migraine pain. This can cause a vicious cycle, where migraine causes sleep disruption, which in turn exacerbates migraine symptoms.
A Complex Relationship
The relationship between migraines and sleep is further complicated by individual differences. Migraines most frequently occur between 6 a.m. and 12 p.m., with over half of migraines happening between 4 and 9 a.m. This suggests a link to our body's circadian rhythm and sleep-wake cycles.
Understanding the Relationship
While the exact nature of the relationship between migraines and sleep is not yet fully understood, it is clear that the two are closely connected. This understanding can help people with migraines manage their sleep and reduce the frequency and severity of migraine attacks. Maintaining a healthy sleep-wake cycle and practising good sleep hygiene may help to reduce the likelihood of migraine attacks.
The bidirectional relationship between migraines and sleep is a complex one, influenced by various factors, including our body's circadian rhythm, pain thresholds, and individual differences. Further research is needed to fully understand this relationship and develop more effective treatments for migraines and associated sleep disorders.
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Migraines and sleep: a common underlying etiology
The relationship between sleep and migraines has been a subject of interest for many years, with clinicians observing the association between the two and confirming it through epidemiological studies. While the nature of this relationship is not yet fully understood, recent progress has been made in uncovering the common anatomical structures and pathogenetic mechanisms that link sleep and migraines. This article will explore the bidirectional relationship between sleep and migraines, discuss the potential underlying etiology, and provide insights into possible treatment options.
The Bidirectional Relationship
Changes in sleep patterns, including insufficient or excessive sleep, have been identified as potential triggers for migraines. At the same time, migraine attacks can also disrupt normal sleep patterns. This bidirectional relationship suggests a complex interplay between sleep and migraines, with sleep disturbances making migraines worse and vice versa. The close connection between sleep and migraines may be attributed to the interaction between the parts of the brain that regulate sleep and the nerves that carry pain sensations to the brain. Additionally, chemicals in the brain, such as adenosine, orexin, and melatonin, may also play a role in both sleep issues and pain associated with migraines.
The Role of Sleep in Migraine Prevention and Treatment
Research has shown that improving sleep quality may reduce migraine headaches. Animal studies suggest that spending less time in the rapid eye movement (REM) sleep stage can increase sensitivity to pain. When humans experience sleep disturbances, they tend to spend less time in the REM sleep stage, which may explain why disrupted sleep can lead to more intense headache pain. Therefore, maintaining a well-balanced sleep-wake cycle and practising good sleep hygiene may help reduce the likelihood of triggering a migraine attack. This includes establishing a consistent sleep schedule, understanding one's sleep needs, spending time outdoors during the day, creating a restful sleeping environment, and incorporating stress management and relaxation techniques.
The Impact of Migraines on Sleep
Migraines can significantly impact an individual's sleep quality and duration. People with migraines often experience insomnia, daytime sleepiness, sleep apnea, and parasomnia. These sleep disturbances can further affect concentration, mood, and the ability to carry out daily tasks, adding another layer of difficulty to living with migraines. The pathophysiology of migraines is still not fully understood, but it is believed to involve a dysfunction in the dopaminergic system and the trigeminovascular system, which includes the brain, brain vessels, and trigeminal nerve.
A Common Underlying Etiology
While the relationship between sleep and migraines is complex, there is growing evidence to suggest a common underlying etiology. Both sleep and migraines are regulated by similar regions in the brain and utilize similar chemical brain messengers. Additionally, the recently discovered glymphatic system, which is primarily active during sleep and responsible for clearing waste products from the brain, may play a role in the pathophysiology of migraines. Disruptions in this waste removal system could contribute to the build-up of toxic substances and potentially trigger migraine attacks. Furthermore, the hypothalamus, a key structure in the regulation of sleep and wakefulness, has also been implicated in the pathophysiology of migraines.
In conclusion, the relationship between sleep and migraines is complex and bidirectional, with sleep disturbances triggering migraines and migraines disrupting sleep patterns. However, there is also evidence to suggest a common underlying etiology, with shared anatomical structures, biochemical mediators, and waste removal systems implicated in both conditions. Further research is needed to fully understand this relationship and develop more effective treatment options for migraines and associated sleep disturbances.
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Sleep disorders and their relationship with migraines
Sleep disorders and migraines have a bidirectional relationship, with sleep disturbances triggering migraines, and migraines negatively impacting sleep. People with migraines are more likely to suffer from sleep disorders than the general population. The most common sleep problems for people with migraines include insomnia, sleep apnea, and teeth grinding.
Sleep Disorders and Migraines
People with migraines are between two and eight times more likely to experience sleep disorders than the general public. Insomnia is the most common sleep problem, with people with chronic migraines reporting almost twice the rates of insomnia as those with less frequent headaches. Insomnia includes difficulty falling or staying asleep, early morning awakenings, and non-refreshing sleep. It impairs daytime functions, resulting in fatigue, poor attention and concentration, and loss of motivation.
Sleep Loss and Migraines
Sleep loss and oversleeping are common migraine triggers. Research has established a solid relationship between sleeping problems and migraines. Sleep deprivation has also been shown to increase the severity and frequency of migraines. When you don't get enough sleep, your pain threshold gets lower, making you more sensitive to pain, including migraine attacks.
Sleep and Migraine Treatment
Understanding the relationship between sleep and migraines is important for developing effective treatment plans. Medical history and psychological factors should be considered when treating migraines, as anxiety and depression are common comorbidities. Maintaining a healthy sleep schedule and practising good sleep hygiene can help reduce migraines. This includes sticking to a consistent sleep schedule, avoiding substances like caffeine, nicotine, and alcohol, and winding down before bed.
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Pathophysiology and potential mechanisms
The relationship between sleep and migraine is complex and not fully understood. However, there are some bidirectional relationships among these varied interactions. A more comprehensive approach may be to view migraine and sleep problems as manifestations of a common underlying pathophysiology.
The relationship between sleep and migraine has been interpreted as a series of bidirectional interactions. For example, a nocturnal migraine may disrupt one's sleep, or sleep may be used to abort a migraine attack.
There is increasing neuroscientific evidence to support such a proposition, with new discoveries on anatomic localisation (the importance of common subcortical structures in both sleep and migraine, such as the hypothalamus), roles of common mediating signalling molecules (neurotransmitters, neuropeptides, and hormones), and the discovery of a new CNS waste removal system, the glymphatic system.
Whether insomnia is part of the migraine prodrome or actually incites a migraine attack is a complicated and interesting question. Frequent nighttime awakenings, but not objectively decreased total sleep time, precede sleep-related migraine attacks.
Serotonin (5-HT), which has diverse roles in many human behaviours including sleep, mood (depression and anxiety), appetite, sexual function, and pain, may be playing a joint function in this process. With respect to sleep, serotonin appears to promote wakefulness and inhibit REM sleep. With respect to migraine, the evidence suggests that individuals with migraine exist in a low serotonin state interictally, with mobilisation of 5HT from intracellular stores early in a migraine attack.
The subsequent targets of signals from the dorsal raphe nucleus are diverse, involving both cortical and subcortical regions (including the amygdala, hypothalamus, locus coeruleus, and pontine reticular formation). One of these targets, the hypothalamus, has been proposed as a central and early player in the pathophysiology of a migraine attack.
In addition to serotonin, dopamine has been implicated as having involvement during the premonitory phase of migraine during which yawning, drowsiness, mood changes, irritability, and hyperactivity are reported. Dopamine is also important in sleep-arousal pathways, primarily promoting arousal via hypothalamic input into the periaqueductal grey dopaminergic neurons.
One common yet unexplained observation is that sleep can often terminate a migraine attack. In another common clinical observation, this restorative impact of sleep seems to not be as effective in those with chronic migraine. This raises the still unanswered question as to why humans require sleep, and the commonly held notion that sleep, particularly in the deepest stages, allows for the consolidation and restoration of the brain's daytime activity.
A newly discovered CNS waste clearing system, the glymphatic system, has provided one possible explanation. The glymphatic system is primarily active during sleep with its primary purpose of interstitial waste removal (such as beta-amyloid) via a perivascular system. Though the role of the glymphatic system during sleep in migraine has not been studied, the proposed restorative role that the glymphatic system plays in CNS during sleep may explain the often therapeutic role of sleep in migraine attacks.
The complex relationships between sleep and migraine point to a common shared pathophysiology. Although this topic has received significantly more attention over the last 2 decades, there are still many knowledge gaps.
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How to improve sleep to avoid migraines
Sleep and migraine have a bidirectional relationship. Changes in sleep patterns, both insufficient and excessive sleep, have been identified as potential migraine triggers. Sleep can also be very helpful during a migraine attack, and may even help stop it. Here are some tips to improve your sleep and avoid migraines:
- Maintain a consistent sleep schedule: Try to go to bed and get up at the same time each day. This is important for maintaining a well-balanced sleep-wake cycle, which may make triggering a migraine attack less likely.
- Understand your sleep needs: This includes both the timing of sleep (when it feels right for you to go to bed) and the duration of sleep (most adults need about 6 to 8 hours a night).
- Get natural light during the day: Try to spend some time outdoors or in natural light during the daytime. This provides an important cue to your brain about the timing of your body clock.
- Optimise your bedroom environment: Make your sleeping environment as restful as possible. This includes sufficient darkness and quiet, comfortable bedding, and few devices (particularly those with lights) around the bed.
- Avoid stimulants: Avoid caffeine, nicotine, and alcohol before bed. Caffeine and nicotine are stimulants that can interfere with your sleep, while alcohol reduces overall sleep quality.
- Exercise regularly: Exercise is beneficial, but preferably earlier in the day rather than before bed.
- Practise stress management and relaxation techniques: These can help improve your sleep and reduce migraine symptoms.
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Frequently asked questions
Sleep and migraines are closely linked. Sleep can be both a cause and reliever of migraine attacks. Changes in sleep patterns, both insufficient and excessive sleep, have been identified as potential migraine triggers. However, the nature of this relationship is still not fully understood.
If your sleep schedule is triggering migraines, you may notice that you always get headaches at the same time every day, most often in the morning. You may also wake up with a migraine or feel it coming on shortly after you get out of bed. Keeping a migraine diary can help you and your doctor pinpoint whether patterns in your sleep make you more likely to get migraines.
Anything that keeps you from getting 7 to 8 hours of uninterrupted sleep each night could be a migraine trigger. These sleep problems include:
- Obstructive sleep apnea (interrupted breathing during sleep)
- Insomnia (trouble falling or staying asleep)
- Restless legs syndrome ("pins and needles" feeling in legs, especially at night)
- Jaw clenching during sleep
- Narcolepsy (too much daytime sleepiness)
- Circadian rhythm or "body clock" disorders
- Less than 6 hours of sleep a night or more than 8.5 hours
- Shift work or jet lag
- Night terrors (in children)
Try to get 7 to 8 hours of uninterrupted sleep every night at a consistent time. This is key to preventing migraine headaches. To improve your sleep, try these tips:
- Go to bed and wake up at the same time every day.
- Get 7 to 8 hours of sleep.
- Make the room you sleep in dark and quiet.
- Avoid caffeine, nicotine, and alcohol.
- Avoid watching TV, using the computer, or texting on your cellphone in bed just before you go to sleep.
- Do relaxing activities at bedtime.
- Exercise regularly, but not right before bed.
- Spend some time outside in natural light during the day.
