For the one in six of us — myself included — who has ever experienced a migraine, we know the signs all too well: the throbbing, pulsing pain on one side of the head, sensitivity to light or sound, nausea, and vomiting. “I call it the great time robber. You can’t predict it, and it takes away from almost everything,” says Dr. Merle Diamond, a neurologist and director of the Diamond Headache Clinic in Chicago.
Migraines often have a range of triggers — certain foods or medications, weather changes, dehydration, hormones, and jet lag — and sometimes seemingly none at all. Among the most commonly cited triggers are sleep problems like insomnia or sleep apnea. Even if sleep problems themselves don’t cause a migraine, these often debilitating headaches can lead to problems such as difficulty falling or staying asleep, daytime sleepiness, and oversleeping.
“Your brain, your body, and your mind are all revved up because migraines make you feel more stress, and that jacks up your fight-or-flight system,” says Jade Wu, Ph.D., a psychologist, Sleep.com sleep advisor, and board-certified behavioral sleep medicine specialist.
Since sleep problems and migraines share deep, complex biological roots, it also means that improving sleep habits may also have a beneficial effect on migraine frequency, severity, and duration. In turn, reducing migraines may also improve our sleep. It’s a win-win scenario, Wu says.
What happens when you get a migraine
Migraine and sleep are linked in our everyday lives because they are linked in our underlying biology, explains Dr. Sandhya Kumar, a neurologist at Wake Forest Baptist Health in Winston-Salem, North Carolina, who specializes in headache and sleep disorders. Although no one knows exactly what causes migraines, the most commonly accepted hypothesis is the trigemino-vascular theory.
The trigeminal nerve sends signals from your face to your brain, helping you bite, chew, and swallow, as well as sense cold and heat. It’s also the neuron most closely linked with the tangle of blood vessels in the brain. Researchers suspect that those susceptible to migraines have a brain that is hypersensitive to both internal and external changes; there is also increased risk of trigeminal neuralgia for those who experience migraines.
These changes can spark the activation of trigeminal and other neurons, which, in turn, switch on pain-generating neurons surrounding blood vessels. The blood vessels enlarge, which leads to the production of even more pain-generating chemicals. This phase is then followed by what neurologists call cortical depression, or waves of altered electrical activity that spread throughout the brain. This, too, causes pain, but through a more indirect and convoluted method. Scientists also believe this might be responsible for the aura experienced by many migraine sufferers.
Like sleep, migraines involve a complex dance of neurotransmitters, including well-known ones like serotonin and N-methyl-D-aspartate (NMDA), as well as other chemicals, such as neurokinin A, substance P, and calcitonin.
“It’s a complex network, and you see a lot of interaction between the parts of the brain involved in sleep and the parts involved in migraine,” Kumar says.
Know your triggers…
Searching the Internet for “migraine triggers” provides an endless list of factors that may (or may not) be linked to migraines. What’s important, says Diamond, is to understand what factors might precipitate your migraines.
Two of the most common migraine triggers are stress and sleep deprivation. Kumar says that’s because both phenomena make our brains even more sensitive to small shifts within our body or the world around us. For someone already prone to migraines, that can transform a minor annoyance into a full-blown migraine episode.
Kumar also encourages her patients to address sleep issues because they have the biggest bang for the buck in terms of benefitting overall well-being. Even if better sleep doesn’t affect how often or how severe your headaches are, being better rested will help you cope with the migraines that remain more effectively, says Kumar.
…but don’t obsess.
It sounds a bit counterintuitive, Wu says, but some of her patients get so focused on avoiding every little thing that might trigger a migraine that they often begin avoiding many of the activities that make life enjoyable. What’s more, the stress and constant vigilance required to avoid everything that might cause a migraine can lead to difficulties sleeping, something that can paradoxically increase migraine susceptibility. Essentially, it’s always a trade-off, she says.
“I don’t want to put too much pressure on sleep as a solution,” Wu says, “because you get more desperate for sleep. And sleep is one of those things where the harder you work at it, the more it runs away from you.”
Instead of focusing on eliminating all triggers, Wu recommends that people with migraines prioritize addressing what she calls the low-hanging fruit: triggers that are easy to eliminate and that have the strongest links to your own, personal pattern of headaches.
Wu also stresses that you should not underestimate the power of reducing triggers if you can’t eliminate them entirely. For example, she says, everyone has a terrible night’s sleep from time to time. The aftereffects might not always be pleasant, but they’re rarely catastrophic. Even if you can’t eliminate all bad sleep nights, reducing them by half is still beneficial.
Should you sleep it off?
If your migraines are relatively infrequent (less than one per week), then taking your rescue medications before an hour-long nap isn’t a bad way to handle your headaches, Diamond says.
As someone whose migraines are triggered by the toxic combo of work stress and lousy sleep, I have found that getting a little extra shuteye is often just what I need to reset my brain. Plus, the nap gives my prescription medications time to start kicking in, and I can wake up ready to tackle my to-do list. Having this freedom and flexibility to manage my migraines is one of the major reasons I have remained a freelancer.
However, if you have more frequent migraines during daytime hours, than a nap-as-a-coping-skill is less effective, Diamond says. That’s because regular sleep sessions while the sun is out confuses our biological clocks. Our bodies start to get confused about when we should be sleeping and when we should be awake. While some studies have found a link between working the night shift and migraines — probably because of the circadian mismatch that occurs when you work at night — others have been inconclusive.
As Diamond points out, regular daytime migraine naps might make your problem worse over the long term because they put a headache-sized wrinkle in the progression of your normal body clock.
“Your days and nights get switched around,” Diamond says.
Consistency is key
Kumar says that, because the brains and bodies of those prone to migraines are especially sensitive to even small changes in the environment, maintaining a regular schedule for meals, physical exercise, bedtime, and waking is especially important. The exact hour when you perform these activities is less important than keeping the timing steady, says Kumar, because it helps train your brain to expect certain things at certain times.
It also helps reduce inflammation, she says, which is another important trigger for migraines and other chronic conditions.
Learn the difference between pain and suffering
Migraines can be debilitating, even causing excruciating physical pain. New generations of prescription medications have made a huge difference in the quality of people’s lives, but nothing currently on the market has the power to eliminate all migraines, forever and ever. When a migraine strikes, it’s easy to get trapped in the headache’s misery. You ask yourself, “Why me? What did I do to deserve this? When will this end? Why can’t I stop my headaches?”
This line of thinking is certainly understandable, Wu says. But not only does berating yourself for having migraines not help them go away, it only makes you suffer more during your migraine. It’s especially easy to get caught in this line of thinking at night, when trying to fall asleep, Wu says, and it can help keep our brains stimulated and awake instead of drifting off.
Rather than zeroing in on your misery and beating yourself up for having migraines, Wu encourages people to approach their headaches with curiosity and compassion. She cites the Buddhist truism that pain is inevitable, but suffering is optional. Someone with a history of migraines is likely to have a similar headache in the future. That’s pain. Blaming yourself for your headache and losing sleep as a result? That’s suffering.
“Trying to control sleep isn’t going to help,” Wu says. “You want to set yourself up well for sleep but also accept that if it doesn’t always come to you, that’s okay. That’s life.”
