What is the best position to sleep in when you have a headache?
According to Diana Shadbehr, DO, director of the Headache Clinic at Cedars-Sinai, the best position to sleep in if you have a headache is a position that both feels comfortable to you and aligns your neck and spine. For most people, this means sleeping on your back or side rather than on your stomach—which can overextend the neck and back or lead to hyperflexion of the neck, as you turn your head to the side to breathe. This can cause neck strain, which may just worsen a headache, according to pulmonologist and sleep-medicine specialist Raj Dasgupta, MD.
The best position to sleep in if you have a headache is a position that both feels comfortable to you and aligns your neck and spine.
Overall, Dr. Dasgupta also emphasizes that spinal alignment is key to finding a sleep position that can help you fall asleep when you have a headache (and won't exacerbate headache pain). "I know that when I'm in pain, I just want to curl up in a ball, but that's usually not the best position to be in," he says.
Aim for a back or side sleeping position with a pillow that conforms to the shape of your head and neck, so that both can remain in neutral alignment throughout the night. And remember: More isn't always more here; you might be tempted to stack pillows or use a super-thick pillow for what would seem like additional support, but both of these moves can overextend the neck in back or side sleeping positions.
Also, Dr. Shadbehr notes that it's important to consider any other health conditions that might affect your sleep when settling on the best sleep position for managing a headache. For example, if you have obstructive sleep apnea or struggle with snoring, you may find it harder to breathe while sleeping on your back, which would make a side-sleeping position more optimal—for both breathing and neck positioning—when you're suffering from a headache.
The link between sleep and headaches
Poor sleep can make headaches more severe and even increase the frequency of headaches that a person gets over time. But, the solution—aka getting more good-quality sleep—doesn't typically come easily. “While poor sleep can decrease the threshold for developing a headache and make people more prone to headaches, having a headache can also make it difficult to stay asleep and fall asleep,” says Dr. Shadbehr.
Indeed, that relationship between headache pain and sleep issues may be particularly pronounced for those with migraines. According to the American Migraine Foundation, people who suffer from migraines are between two and eight times more likely than the general public to experience insomnia. As for why? Research has found that the same neurotransmitters involved in the onset of a migraine could play a role in sleep patterns—and when they're off-kilter, it might trigger both migraine and sleep issues. That just makes it all the more important for folks who deal with migraines to take afternoon naps if they're losing nighttime sleep, says Dr. Dasgupta.
Certain other types of headaches can even arise during sleep, disturbing your sleep and worsening the cycle. These include hypnic headaches (chronic, dull headaches that surface after the age of 50) and cluster headaches, which tend to cause intense pain in or around one eye or on one side of the head. Both of these "can classically occur during sleep, and the pain and associated symptoms can awaken people out of sleep," says Dr. Shadbehr.
Similarly, other types of headaches that spring directly from nerve, muscle, or other issues in the neck or cervical spine, including cervicogenic headaches and the headaches typical of occipital neuralgia, can also be triggered or worsened by sleep positions or pillows that put put pressure on the back of the head, she adds.
Is it safe to sleep when you have a headache?
In general, it is totally safe to sleep with a headache even if it feels difficult or uncomfortable to do so.
That said, because a headache can, in rare circumstances, be a sign of a more serious health condition, it's important to consider the nature of the headache you're feeling and any other symptoms you might have before deciding to try dozing off.
If, for example, your headache comes on within 60 seconds, is extremely painful, and is accompanied by nausea or vomiting, it may be a thunderclap headache, signaling potential bleeding in the brain or another brain issue; in this case, it would not be safe to go to sleep, and you should seek emergency care.
Similarly, a sudden and severe headache that alters your vision and senses could be a sign of a stroke; and a headache accompanied by a fever, behavioral or mental changes, and a stiff neck could indicate meningitis, says Dr. Shadbehr. And in either scenario, you should bypass sleep in order to get care immediately.
General tips for sleeping with a headache
Besides choosing a sleep position that feels comfortable and will keep your spine and neck aligned, it's important to practice good sleep hygiene when you have a headache, in order to optimize your chances of getting good-quality sleep. For starters, Dr. Dasgupta and Dr. Shadbehr recommend sleeping in a room that's dark, quiet, well-ventilated, and somewhere between 60 and 68 degrees F.
Other tips? Try to do something relaxing, if you can, to take your mind off the headache, like listening to a meditation; take an over-the-counter medication (like ibuprofen), if your doctor has okayed it; apply an ice pack to your head (or use an ice-therapy cap, if you have one handy), limit screen time, and avoid alcohol consumption.
When to seek help from a doctor
If you regularly experience headaches that hinder your ability to get enough restful sleep, it would be wise to seek care from a doctor. "Letting poor sleep or headaches linger can create a cycle of chronic headaches and insomnia that can become more difficult to treat the longer it stays untreated," says Dr. Shadbehr. A primary-care doctor or neurologist can pinpoint the type of headaches you may be experiencing and come up with a treatment plan to lessen the severity and frequency of the attacks and make getting good sleep easier.
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