When patients come in complaining of frequent or chronic headache, physicians should begin by assessing the quality of the person’s sleep, according to Jeanetta Rains, PhD, clinical director of The Center for Sleep Evaluation at Elliot Hospital, in Manchester, New Hampshire.
“Headache is one of the most common symptoms seen in primary care. Sleep disturbances are one of the most common triggers of migraine and chronic headache,” Rains says.
Any form of sleep disturbance that disrupts “sleep homeostasis” can potentially cause migraine, she says. This includes sleeping too little, oversleeping, disturbed sleep, schedule shift changes, and underlying conditions such as sleep apnea or restless legs syndrome.
In fact, sleep apnea and migraine tend to coexist, she explains. Sometimes the sleep apnea itself can even cause the headache, as it affects oxygen levels at night. “And we know that low oxygen levels at night can cause a headache the next day,” Rains says.
The sleep-apnea-induced migraine disorder often goes away after treating the breathing problem, but not always. On occasion, she says, “It can become a more complex headache condition or it can interact with a pre-existing migraine.”
Physicians with patients who have migraine should determine the nature of their patients’ sleep hygiene, which Rains calls, “the most effective self-management tool to improve our own general health, and our risk for headache.”
Good sleep hygiene means adopting a set of regular behaviors such as creating a predictable sleep schedule—going to bed at the same time every night and getting up at the same time every morning.
“The average adult needs at least 7 to 8 hours of sleep. Modern people often sacrifice sleep because it’s somewhat more flexible than work schedules,” Rains says.
Other aspects of good sleep hygiene that physicians can assess and recommend include winding down for bed with non-stimulating behaviors – such as reducing screen time and turning off the TV—and avoiding caffeine and alcohol. Patients should “practice calming down, clearing the mind, and getting in the state that’s conducive to sleep,” she says.