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‘I’m a Neurologist and Here’s What You Should Know About Migraine and Sleep’

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Photo: Stocksy/ Sergey Filimonov
Migraine headaches and sleep have a “chicken or egg” relationship in neurological science. Do migraines keep people from getting adequate sleep, or does poor sleep trigger migraine headaches? Unfortunately, the answer isn’t simple, and unlike the chicken and the egg, the intertwined relationship between migraine and sleep impacts many people’s lives.

There are four distinct migraine phases—prodrome, aura, headache, postdrome—and sleep is a factor during most of them. Some people report fatigue during the prodrome phase, which occurs before the migraine headache even starts. They might also find that sleep is the best course of action during the headache phase, says MaryAnn Mays, MD, a neurologist with the Cleveland Clinic. “People often say, ‘I want to sleep off my migraine,’” she says, adding that fatigue can also hit when the headache is over.

Still, some people experience sleep as a migraine trigger. In a 2016 study published in PLoS One, 55.1 percent of respondents said sleep deprivation was a migraine trigger. And a recent study in Neurology finds that adults and children who experience migraines also get less rapid eye movement (REM) sleep than those who don’t.

REM sleep is the fourth stage of sleep, and it typically starts 90 minutes after you doze off. According to the Neurology study, REM sleep is when you do most of your dreaming, and it’s also crucial for learning and memory. Children in the study who had migraines got less sleep overall. And research has found strong connections between migraines and sleep disorders like insomnia, sleep apnea, and teeth grinding, according to the American Migraine Foundation.

“There’s definitely a shared path of physiology [between migraine and] some sleep disorders,” Dr. Mays says. The hypothalamus, a peanut-shaped structure inside our brains, contains clusters of thousands of cells that receive information about how much light is around at any given time and play a role in your circadian rhythm, according to the National Institute of Neurological Disorders and Stroke. Your brain stem communicates with the hypothalamus to control transitions between sleeping and waking up.

Scientists believe that the hypothalamus may also be an early mediator of migraine, Dr. Mays says. “And a lot of the neurotransmitters, like dopamine and serotonin, are common in both sleep and migraine,” she says. Although the relationship isn’t totally understood, it’s clear that many migraine patients may benefit from managing their sleep.

“If people either awaken because of their headache...or they have a chronic daily headache, those are usually indicators that a sleep disorder may be underlying,” Aruna Rao, MD, an assistant professor of neurology at Johns Hopkins medical school tells Well+Good. Typically, migraines that happen between 4:00 am and 9:00 am are associated with REM sleep. Sleep disorder migraines may also occur early in the morning when waking up or after someone has spent an unusually long time sleeping.

Then again, trouble falling or staying asleep and even snoring while you sleep can be risk factors for developing chronic migraine headaches, Dr. Mays says. “We also see people with migraines report increased nightmares. They may also have restless leg syndrome, are more likely to be sleepwalkers, and are more likely to grind their teeth at night,” she says.

So how should you manage migraine and sleep issues

Unfortunately, it’s not possible to isolate treatment to focus on just migraine headaches or sleep. “If you don’t fix one problem, I can’t fix the other problem,” Dr. Mays says. So it’s best to address your sleep issues and migraines simultaneously. That may look like taking medication, but it may also involve several behavioral changes.

For instance, it might be time to brush up on your sleep hygiene. If you want to sleep like a baby, you’ll have to establish a bedtime routine that ideally involves putting down anything with a screen and finding a way to relax, sleep doctor Carleara Weiss, PhD, previously told Well+Good. She suggests yoga, meditation, or reading a (paper) book. You can also make other adjustments to get better sleep, like controlling the temperature and the amount of light in your room (we suggest getting a really good sleep mask).

Of course, many sleep disorders can’t be managed by a good sleep routine alone. Obstructive sleep apnea, for instance, is associated with early-morning headaches (both migraines and tension headaches, Dr. Mays says). Sleep apnea treatment requires working with a doctor to open your airways at night, usually through a CPAP machine. Other sleep disorders may similarly need medical intervention, as will managing chronic migraines.

The best course of action involves being honest with your doctor about when you get migraine headaches, how they feel, and what you’re feasibly able to do to treat them. “It's important to look at the whole person,” Dr. Mays says. If someone comes to her for migraine treatment but doesn’t mention being a shift worker or an overworked parent who gets four hours of sleep on average,  a traditional migraine treatment might not be very effective. Because sleep and migraine are so intertwined, indeed a chicken-and-the-egg phenomenon, it's difficult to manage one without managing the other.

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