Sleep and Headaches: New Insights from Research

Sleep and migraine: what does the science say?

A group of Italian researchers recently dug deep into the relationship between migraine and sleep. In a major review of existing studies, they spotted several factors that raise the risk of migraine attacks. Across all ages, one major cause emerged: poor sleep. In the reviewed studies, as many as two-thirds of people with migraines said that a bout of insomnia could spark an attack. Around 10 to 15 percent even lived with chronic insomnia – a heavy, long-term burden.

Poor sleep quality is closely associated with breathing issues at night. Frequent breathing interruptions can cause restless sleep and jolt people awake several times a night. Oxygen levels in the blood fluctuate dramatically, sometimes staying low for long stretches. All of this means that the nervous system does not get the rest it needs after a busy day. The next morning, people wake up drained and foggy, and far more likely to face a migraine attack. Daytime sleepiness and trouble focusing add to the problem. The relationship between sleep and migraines can become a vicious cycle where the migraine causes sleep disruption. This in turn worsens the migraine and the associated sleep issues.

The double burden of poor sleep and migraine attacks significantly interferes with quality of life. One Japanese study underlined just how heavy this burden can be. Using the well-established “MIDAS” questionnaire – designed to measure disability caused by migraines – the researchers showed that poor sleep makes migraine-associated disability worse. The worse the sleep disturbances, the higher the MIDAS disability score in migraine sufferers.

Sleep is also a trigger for tension-type headaches

When it comes to migraines, scientists have known for decades that certain triggers can set off attacks. A large body of evidence supports this.

For a long time, less research was devoted to the role of specific triggers in causing tension-type headaches. That has now changed. Based on recent new evidence, we now know that tension-type headaches do have specific triggers. Poor sleep is one of them, alongside stress. (Find a separate article on the connection between tension-type headaches and sleep quality here).

A study by researchers based in Kaunas, Lithuania, compared sleep problems in people with migraine and those with tension-type headache. Surprisingly, the tension-type group actually reported more sleep disturbances – in some cases, full-blown insomnia. Breathing interruptions during sleep were approximately equally common in both groups, as were high scores on the Excessive Daytime Sleepiness (EDS) scale. Three out of four people with tension-type headache, and more than half of migraine patients, said poor sleep was a headache trigger. The authors recommend a strategy combining pain relief, improving mental health, and a specific focus on combating insomnia.

How does poor sleep lead to headaches?

A Spanish research group set out to investigate the physical mechanisms behind the association between headaches and sleep. Their main question was this: what lowers the threshold at which we start to actually feel pain? One idea is that sleep regulation and headache are controlled by the same parts of the brain, which could mean that disorders in these two areas have common roots.

Interesting new findings suggest possible links to anxiety and depression. There are indications that these mental health conditions can also heighten sensitivity to pain throughout the body. Whether the causes of mental health disorders and changes in pain perception influence each other – with one making the other worse – is still under investigation.

Two natural messengers deserve special attention here: serotonin and melatonin. These brain chemicals have long been known to play a role in sleep, the body’s day-night rhythm, mood regulation, anxiety, reward processing, and sensory perception. It makes sense, then, that serotonin and melatonin show up in such a wide range of conditions – especially where body and mind overlap – and very likely in the development of headaches, too.

Prevention: what can you do yourself?

The sheer number of studies on sleep and headache shows just how crucial good, restorative, uninterrupted sleep is for head health. This applies most of all to migraine, but it matters for tension-type headaches too. A regular daily routine is key. Any change in your usual sleep rhythm registers as a disturbance, forcing the body to adjust – and in the worst case, triggering a headache attack. For people with migraine in particular, sticking to the same sleep-wake times – even on weekends – is one of the most effective headache prevention strategies (find out more here). A sleep diary can help you spot any deficits and show where you need to make adjustments (tools like the Prevent Headache app are ideal for this).

Here’s another reason why healthy sleep is so important: over the past decade, many studies have shown that the brain runs nightly cleaning processes while we are in deep sleep. Disposal of the waste materials that build up in the brain during the day mainly takes place at night. Among them are substances whose buildup has been linked with dementia. So good, restorative sleep is vital for our overall health – as well as being one of the most powerful tools we have to prevent headaches.