The Link Between Migraines and Sleep Issues

Migraine and sleep disorders/disturbances are complex conditions that are often intertwined in a vicious cycle of one triggering the other. Though scientists know the enormous impact of this, they aren't clear on how or why it occurs. The last two decades have seen a body of research exploring how migraine and sleep disorders influence each other and theories on their shared underlying mechanisms.

migraine sleep disorders
Illustration by Cindy Chung, Verywell

Migraines and Sleep Disturbances

It's well-established that sleep and migraine have an intricate relationship and that sleep disorders and migraine are frequently comorbid conditions. While lack of sleep is a trigger for many migraineurs, migraine patients use sleep as a treatment for migraine.

There's also a relationship between sleep quality and migraine frequency—the more migraines you have, the more sleep disturbances you're likely to have, such as:

  • Interrupted sleep
  • Snoring
  • Early morning awakening
  • Difficulty falling and staying asleep
  • Poor overall quality sleep
  • Reduced total sleep time

This can, of course, make the following more likely in migraineurs:

  • Excessive daytime sleepiness
  • Still feeling tired after awakening
  • Daytime fatigue

Having a sleep disorder is linked to more severe and more frequent migraines as well. And sleep disturbances are believed to contribute to the transformation from episodic migraine (fewer than 15 migraines per month) to chronic migraine (15 or more migraines per month) in certain people.

Specific Sleep Disorders and Migraine

Different sleep disorders have different diagnostic criteria, but all of the above are potential signs that you may have such a condition. The following are sleep disorders those with migraines may experience.

Insomnia

Insomnia is not just the most common sleep problem in migraineurs, it's the most common one in the general population as well. This condition occurs when you have difficulty falling and/or staying asleep, leaving you feeling tired. Your sleep may also be light and of poor quality, and you may wake up much earlier than you should.

People with migraine report increased insomnia symptoms in between their migraines including poor sleep quality, difficulty falling and staying asleep, feeling tired after awakening, waking up too early, feeling sleepy during the day, and getting less sleep than normal. Additionally, many migraineurs say they're awakened from deep sleep by a migraine.

Migraine is linked to a higher risk of insomnia and the majority of people with chronic migraine say they have insomnia almost every night. Insomnia is considered a risk factor for more frequent migraines as well. And having both migraine and insomnia puts you at a higher risk of depression and anxiety disorders.

Treating insomnia has been shown to have the potential to improve migraine, so talk to your doctor about treatment if you have insomnia symptoms.

Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is the most common type of sleep apnea. It occurs when you breathe too shallowly or stop breathing periodically while you sleep, often resulting in frequent awakening.

Head pain is often a symptom of sleep apnea, and snoring, which is also a symptom of sleep apnea, is a risk factor for chronic migraine. Studies of both children and adults have found that waking up with a migraine is associated with snoring, breathing problems, and sleep apnea.

It doesn't appear that OSA occurs any more frequently in migraineurs than it does in the general population, but even so, having OSA seems to contribute to more severe migraines. One theory for this is that migraineurs, already sensitive to pain, have a harder time coping with the head pain that results from reduced oxygen intake during the night.

A 2018 study used data from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study, which involved 11,699 people with episodic migraine and 111 with chronic migraine. The researchers found that compared to those with episodic migraine, more of the chronic migraineurs were at high risk for sleep apnea and more likely to report poor quality sleep.

OSA is underdiagnosed in the general population; thus it's underdiagnosed in migraineurs too.

Since treating OSA can potentially decrease the severity and frequency of your migraines, as well as reduce your risk for a host of other medical problems, talk to your doctor about having a sleep study if you have OSA symptoms.

Bruxism

Grinding your teeth while you sleep, called bruxism, is common when you have temporomandibular joint disorder (TMD), which also often occurs along with migraine. Bruxism has been associated with both episodic and chronic migraine, though it's unclear what the relationship is exactly.

One theory is that TMD and bruxism activate the trigeminal nerve, a cranial nerve thought to be involved in migraine. Another possibility is that migraineurs are more sensitive to the pain that TMD and bruxism can cause thanks to central sensitization, a condition associated with migraine that causes your central nervous system to become hypersensitive to certain stimuli.

Restless Legs Syndrome

Studies have found a higher risk of restless legs syndrome (RLS) in migraineurs, as well as an association between migraine and more severe symptoms of RLS, a condition that causes discomfort in your legs.

It's possible that this link exists because both conditions seem to involve a dysfunction of the system that releases dopamine, a neurotransmitter that plays a role in movement, memory, emotion, thinking, and motivation.

Other Potential Shared Mechanisms

The relationship between migraines and sleep disturbances is not well understood. Along with the possible mechanisms mentioned previously, there are several neurotransmitters and brain structures involved in sleep cycle regulation that may also be involved in the development of migraines.

Neurotransmitters

Like dopamine, serotonin is an important neurotransmitter that's linked to sleep, mood, appetite, and vasoconstriction. With regard to sleep, experts believe that serotonin contributes to wakefulness and hinders that deep sleep we all need known as rapid eye movement (REM) sleep.

In migraineurs, research has shown that serotonin levels are lower in between migraines, but during migraines, levels rise, possibly contributing to night awakenings.

Brain Structures

The brainstem may also play a role in the relationship between these two conditions. For one thing, it's thought that all serotonin is produced there. For another, studies have suggested that in migraineurs with insomnia, there may be a dysfunction in the brainstem that interferes with moving between sleep stages.

The hypothalamus is another potentially related brain structure since it's the primary regulator of sleep. Imaging studies have shown that the activity in the hypothalamus is changed in the hours before migraine pain occurs.

Glymphatic System

The glymphatic system, a recently discovered mechanism that essentially clears out the waste products of neural activity while you sleep, may be another explanation for the connection that migraine and sleep disturbances share. There haven't been any studies done on how the glymphatic system affects migraine, but the fact that sleep is often successfully used as a treatment for migraine could reflect the restorative effect the glymphatic system is thought to have.

It's also possible that the sleep disturbances often found in migraineurs may limit the waste the glymphatic system can dump, causing it to leave more behind than it should, which could contribute to migraines.

More studies need to be done to determine exactly what mechanisms migraine and sleep disturbances share and why. For now, it's at least known that treating coexisting sleep disorders can help decrease migraine frequency and severity.

Treatment

There are a variety of treatments for sleep disorders and migraine individually, but there's one in particular that may be a good option to help both conditions.

Cognitive-behavioral therapy for insomnia (CBTi) involves behavioral interventions that help you learn how to relax, get into better sleep habits, and reframe your thinking about sleep. So far, studies have shown it to be safe and quite effective, even in the long term.

For example, a 2016 study of CBTi in people with both insomnia and chronic migraine found that migraines were significantly reduced after three, 30-minute, biweekly sessions. The participants were sleeping better in comparison with the control subjects, too. Migraine and sleep both continued to improve afterward, unlike in the control group.

A Word From Verywell

If you have migraines or headaches and think you might also have a sleep disorder, see your doctor to get a diagnosis for both. You may need further testing, like a sleep study. It's also a great idea to keep both a headache diary and a sleep log for at least 24 hours before you go see your doctor, as these can be extremely helpful in the diagnosis process. Be sure to mention any sleep aids you may use, as well as alcohol, caffeine, and nicotine, which can contribute to wakefulness. Bring your headache diary and sleep log to your doctor's visit so you can correlate patterns together.

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