Sleep quality and tension-type headache
Most people know from daily experience that sleep can directly impact our wellbeing. It also plays a role in headache occurrences. Because not only the duration of sleep is decisive, but also how well or poorly we sleep. Do you often wake up at night or can you not relax at all? Is your breathing uneven or accompanied by loud snoring? Many surrounding circumstances play a role when it comes to whether we wake up rested in the morning or whether we feel exhausted and crawl out of bed weary and contrite. If, on top of all of this, we also have a headache, we would rather disappear back into our bed.
Many people are affected
Tension-type headache occurs particularly frequently in the population. Perhaps this is the reason why this type of headache receives less attention from researchers in comparison to migraine. Evidently, many see it more as a daily accompaniment and less as an independent disorder. Nevertheless, there is always a risk that this headache will eventually become a regular occurrence. In medicine, this is called a chronic illness. According to estimates from specialists, this could pose a risk for around three per cent of the population. Though this percentage may sound low, this affects almost one million people in Germany alone. For those affected, persistent headaches are a significant hindrance to their working day and leisure time.
What are the reasons?
Many studies identify sleeping problems as one of the particularly powerful triggers for tension-type headache. They are often the reason for occasionally occurring headaches. However, if you are sleeping badly over a longer period, there is a risk that these occasionally occurring symptoms could develop into a chronic headache, which is difficult to manage and can ultimately pose a serious health problem.
The most common disorders
A whole range of different phenomena fall under the umbrella term “sleeping problems”. For example, they include snoring, grinding your teeth at night, or the temporary suspension of breathing during sleep, known as “sleep apnoea” in medical terms. Here, it is important to note that disrupted sleep and headaches influence each other in both directions. This means that both issues each affect the other. The problem is therefore that sleeping problems often occur in patients with tension-type headache and, on the other hand, people with headaches often complain about sleeping problems.
When breath stops during sleep
The topic of sleep and headaches is closely linked to nightly breathing interruptions. This involves a temporary absence of breathing activity during sleep. Between two and four per cent of the population are affected by this. For many patients, this respiratory disturbance causes a headache when they wake up in the morning. Scientifically, the connection now appears to be proven. Researchers also discovered that the morning headache would feel particularly severe the more often the breathing interruptions occurred in patients and the longer they lasted. Moreover, irregular breathing poses further health risks. The cardiovascular system is under strain, meaning that the development of heart diseases is more likely. The risk of heart attack also increases.
What provides relief?
One way to counter headaches when waking up is using a breathing mask, through which the patient receives breathable air under slightly increased pressure. For most affected people, this prevents respiratory standstills and improves sleep quality. Often, this also makes the morning headaches go away. However, many patients find wearing a breathing mask uncomfortable, meaning that this measure is usually the last resort for relieving the symptoms.
The groundwork of daily wellbeing
It cannot be overstated how important good sleep is for health and wellbeing. Presumably, this is because our organism goes through many processes while we sleep, enabling it to start the new day rested and strengthened. Only this way can we keep taking in and processing new sensations or be equipped for physical activity. After seven to eight hours of restful sleep and with a refreshed mind, these daily exertions are easily managed. And additionally, they ensure that we once again sink into a healthy sleep in the evenings. If you would like to find out how sleep rhythm and quality influence your own experience of headaches, you can document your sleeping habits. This can be done, for example, with help from a sleeping journal or with the Headache Hurts App , which also documents individual headache occurrences as well as sleep and other factors relevant to headaches. This way, users can find out what the connection between sleep and the occurrence of headaches is for them personally.
Alberti A, Mazzotta G, Gallinella E, Sarchielli P. Headache characteristics in obstructive sleep apnea syndrome and insomnia. Acta Neurol Scand. 2005 May;111(5):309-16.
Cho SJ, Song TJ, Chu MK. Sleep and Tension-Type Headache. Curr Neurol Neurosci Rep. 2019 May 30;19(7):44. doi: 10.1007/s11910-019-0953-8. Review.
Doufas AG, Tian L, Davies MF, Warby SC. Nocturnal intermittent hypoxia is independently associated with pain in subjects suffering from sleep-disordered breathing. Anesthesiology. 2013 Nov;119(5):1149-62. doi: 10.1097/ALN.0b013e3182a951fc.
Engstrøm M, Hagen K, Bjørk MH, Stovner LJ, Sand T. Sleep quality and arousal in migraine and tension-type headache: the headache-sleep study. Acta Neurol Scand Suppl. 2014;(198):47-54. doi: 10.1111/ane.12237.
Hagen K, Zwart JA, Vatten L, Stovner LJ, Bovim G. Prevalence of migraine and non-migrainous headache--head-HUNT, a large population-based study. Cephalalgia. 2000 Dec;20(10):900-6.
Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018 Jan;38(1):1-211. doi: 10.1177/0333102417738202.
Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, Mooser V, Preisig M, Malhotra A, Waeber G, Vollenweider P, Tafti M, Haba-Rubio J. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015 Apr;3(4):310-8. doi: 10.1016/S2213-2600(15)00043-0.
Hirotsu C, Haba-Rubio J, Andries D, Tobback N, Marques-Vidal P, Vollenweider P, Waeber G, Heinzer R. Effect of Three Hypopnea Scoring Criteria on OSA Prevalence and Associated Comorbidities in the General Population. J Clin Sleep Med. 2019 Feb 15;15(2):183-194. doi: 10.5664/jcsm.7612.
Kim J, Cho SJ, Kim WJ, Yang KI, Yun CH, Chu MK. Insomnia in tension-type headache: a population-based study. J Headache Pain. 2017 Sep 12;18(1):95. doi: 10.1186/s10194-017-0805-3.
Loh NK, Dinner DS, Foldvary N, Skobieranda F, Yew WW. Do patients with obstructive sleep apnea wake up with headaches? Arch Intern Med. 1999 Aug 9-23;159(15):1765-8.
Rains JC, Davis RE, Smitherman TA. Tension-type headache and sleep. Curr Neurol Neurosci Rep. 2015;15(2):520. doi: 10.1007/s11910-014-0520-2. Review.
Rundo JV. Obstructive sleep apnea basics. Cleve Clin J Med. 2019 Sep;86(9 Suppl 1):2-9. doi: 10.3949/ccjm.86.s1.02. Review.
Sancisi E, Cevoli S, Vignatelli L, Nicodemo M, Pierangeli G, Zanigni S, Grimaldi D, Cortelli P, Montagna P. Increased prevalence of sleep disorders in chronic headache: a case-control study. Headache. 2010 Oct;50(9):1464-72. doi: 10.1111/j.1526-4610.2010.01711.x. Review.
Scher AI, Lipton RB, Stewart WF. Habitual snoring as a risk factor for chronic daily headache. Neurology. 2003 Apr 22;60(8):1366-8.
Uhlig BL, Engstrøm M, Ødegård SS, Hagen KK, Sand T. Headache and insomnia in population-based epidemiological studies. Cephalalgia. 2014 Sep;34(10):745-51. doi: 10.1177/0333102414540058.
Verri AP, Proietti Cecchini A, Galli C, Granella F, Sandrini G, Nappi G. Psychiatric comorbidity in chronic daily headache. Cephalalgia. 1998 Feb;18 Suppl 21:45-9.
Winsvold BS, Hagen K, Aamodt AH, Stovner LJ, Holmen J, Zwart JA. Headache, migraine and cardiovascular risk factors: the HUNT study. Eur J Neurol. 2011 Mar;18(3):504-11. doi: 10.1111/j.1468-1331.2010.03199.x.