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When treating patients with chronic headache or migraine, assessing sleep quality can be critical, according to this specialist.
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.
Lastly, physicians can advise patients of the ideal sleep environment, which is dark, quiet, cool, and comfortable. Rains recommends avoiding having cell phones or TVs in one’s bedroom. “Reserve the bedroom for sleep and sex,” she says.
If patients with migraine already have good sleep hygiene it is worth investigating if there may be an underlying sleep disorder that is causing sleep problems such as insomnia, non-restorative sleep, or trouble falling asleep.
Other risk factors that might predispose headache patients to sleep disorders include obesity and facial features (eg, very thick necks and large tonsils) that can compromise the airway.
Rains says patients who report headache right after waking from sleep, or headaches that wakes them out of sleep, should be referred to a neurologist or possibly undergo a sleep study.
Sleep changes are among the behavioral strategies-such as regulating fluid intake and engaging in relaxation exercises-that are shown to have a positive impact on migraine, Rains says.
“Studies give us good preliminary evidence that behavioral sleep regulation can improve chronic headache, decrease the frequency and decrease the severity, which is pretty compelling.”