A woman lying face-down on a sofa with a book in one hand, having a migraine attack.
Asger Hee Stjernholm, MSc

How Is Migraine Connected to the Sleep-Wake Cycle?

For anyone suffering from migraines, it’s important to know that this health condition is connected to the sleep-wake cycle (or circadian rhythm). This is an internal clock that cycles between sleepiness and alertness at regular intervals. If your sleep-wake cycle is disturbed, this can influence migraines in a number of ways. For example, sleeping too much or too little can trigger migraines. Researchers have highlighted that, for 49.8% of the migraine sufferers they looked at, sleep disturbance was a trigger for a migraine attack.

Also, if you are already suffering from a migraine and then go to sleep without treating it, this can worsen the condition, leading to more unpleasant symptoms when you wake up. The relationship between migraines and the circadian rhythm is often a vicious cycle. Migraines can disturb the sleep-wake cycle, stopping you from getting the rest you truly need, which can make the symptoms more severe or increase the risk of further migraines.

In the following article, we will explore how migraines are connected to the sleep-wake cycle, how poor sleep can trigger migraines, why migraines start when we sleep, and finally offer some essential sleep tips for migraine patients. By adjusting your lifestyle slightly and getting into a routine of good quality sleep, you can manage your migraine symptoms and reduce your chances of subsequent attacks.

The connection between migraines and the sleep-wake cycle

There are all sorts of fascinating connections between migraines and our sleep-wake cycle. Just as migraines can impact our quality of sleep, the kind of sleep we have each night can also influence the onset and intensity of migraines. Here’s why.

Migraines and sleep quality

Migraines and the sleep-wake cycle are deeply interconnected. The Korean Headache Sleep Study, published in 2018, showed that migraine sufferers are much more likely to report poor sleep quality compared to people who suffer from headaches but not migraines or those who suffer from neither. Researchers from the study noted that migraine patients who had poor sleep quality experienced headaches more often than migraine sufferers whose sleep quality wasn’t badly affected.

Sleep quality isn’t the same as how many hours you sleep – it refers to how well you sleep. Some signs of good sleep quality would include falling asleep in 30 minutes or less, sleeping soundly throughout the night and not waking up more than once, and being able to fall back to sleep within 20 minutes if you do wake up once in the middle of the night.

Poor quality sleep – the kind which migraines can lead to – is characterised by trouble falling and staying asleep, feeling restless, and waking up early. Of course, poor sleep quality can affect how much you get to sleep. After all, if it takes you hours to fall asleep and you need to take up to an alarm, then you might not get enough sleep. When it comes to protecting your well-being and avoiding conditions like migraine, sleep quality and quantity both matter.

How sleeping poorly can worsen migraines

When your sleep quality is affected as a result of migraines, this can make the condition more difficult to deal with. This is because the quality of sleep we get can affect our experience of pain. For example, if you get a healthy amount of sleep (around seven to nine hours), then the better you will be able to emotionally and physically manage pain. In contrast, a study from the University of California, Berkeley, found that a lack of sleep (less than six hours) makes your experience of pain more intense. So, the less sleep you get, the more painful your migraines may be.

The team behind the University of California study discovered that sleep-deprived brains had higher activity in brain regions that detect pain signals. Brain scans also revealed less activity in regions responsible for natural pain relief. This research goes to show how crucial a good night’s rest is for dealing with migraine pain. If you are unable to sleep well, for whatever reason, then your migraine symptoms the next day could be quite unmanageable, getting in the way of your everyday activities.

Migraines can be extremely painful. There’s no doubt about it. This is often why doctors will prescribe certain kinds of pain medication for those suffering from regular migraine attacks. If you struggle with migraines yourself, then you know that the pain can last throughout the day and remain when you are trying to get to sleep. You may find that you can’t fall asleep as a result of the pain or you find it difficult to stay asleep. This experience of insomnia is an added challenge that many migraine sufferers have to deal with and it can present many issues, including – as we have seen – more painful migraine symptoms.

Tae-Jing Song, PhD, one of the investigators involved in the Korean Headache Sleep Study, said: “If patients are getting short sleep and they have migraines, [addressing their sleep quality] could be an alternative way to improve their migraines without medication.”

A study from the University of California, Berkeley, found that a lack of sleep (less than six hours) makes your experience of pain more intense.

How too much and too little sleep can trigger migraines

The rapid eye movement (REM) stage of sleep, a crucial aspect of the sleep-wake cycle, can help to explain why too much or too little sleep can trigger migraines.

The five stages of sleep

There are five stages of sleep: two stages of light sleep, two stages of deep sleep, and then one stage of REM sleep. If you’re healthy and have normal sleep patterns, then you will go through this cycle four or five times during the night. The REM stage of sleep is concentrated in the second half of the night and it’s where we spend most of our sleep cycle. If you don’t get enough sleep, then you don’t get enough REM sleep. When you sleep less than 6 hours a night, you will spend more time in the first half of sleep, experiencing less REM sleep overall.

A lack of REM sleep can trigger migraines

REM sleep plays a critical role in painful conditions, including migraines. For instance, researchers from Missouri State University have demonstrated that not getting enough REM sleep can lead to higher levels of specific proteins that trigger the headaches and chronic pain associated with migraines. This is one way that migraines can start when you are asleep and resting. If you’re not spending enough time in the REM stage of sleep, this may lead to migraine symptoms whilst asleep, which continue upon waking.

David Dodick, the American Headache Society (AHS) President, also stresses that sleeping too much can trigger migraine headaches. He said: “That’s why ‘Saturday morning’ migraines are so common. If someone with migraines who gets up during the week at 6 a.m. sleeps in on Saturday, this can cause a migraine.”

Oversleeping can also increase your migraine risk

Oversleeping can trigger migraine attacks because it disrupts the sleep-wake cycle. And this may lead to migraine headaches for various reasons. One way it may do so is through changes in the level of neurotransmitters in the brain. During REM sleep, neurotransmitters like dopamine and serotonin are released. If oversleeping interrupts the normal functioning of these neurotransmitters, then it could result in headaches. Elizabeth McDevitt of the Sleep and Cognition Lab at UC Riverside states:

“The mechanism behind this isn’t understood that well, and one hypothesis is that fluctuations in neurotransmitters during sleep may be a trigger for headaches. Another possibility is that when people sleep later in the morning, they may be sleeping past their normal breakfast or coffee time, and the headaches may be related to caffeine withdrawals, low blood sugar, or dehydration.”

This is how migraines can sometimes start during sleep. If you oversleep and experience withdrawals from caffeine, low blood sugar, or dehydration, your migraine symptoms could begin during the end of your sleep. This is why you might wake up with a pounding headache, as well as other migraine symptoms, such as nausea and hypersensitivity to light and sound.

Sleep tips for people with migraine

If you feel that you’re trapped in a cycle of not sleeping well and having migraine attacks, don’t fret. By practising called good sleep hygiene, which is a set of strategies designed to keep your sleep-wake cycle even, you can gain control over your migraine symptoms. When you have a balanced sleep-wake cycle, you will be able to make existing migraines less intense, as well as reduce the frequency of your migraine attacks.

How to practise good sleep hygiene

Here are some lifestyle habits that you may find helpful in dealing with your condition:

  • Try to go to bed and wake up at around the same time every day
  • Understand what you need for restful sleep. This includes noticing when it’s the right time to go to sleep and how much sleep you personally need. Remember, a healthy amount of sleep exists in a range, so can differ between individuals.
  • Spend time outside when it’s light. Your brain recognises the natural light as a cue to stay alert. This helps to maintain the body’s correct sleep-wake cycle.
  • Make sure that your bedroom encourages restful sleep. At nighttime, your room should be sufficiently dark and quiet, as well as room temperature (if it’s too cold or too hot, this may make it difficult to fall asleep). Your bed should also be comfortable. And it’s important to keep any devices away from your bed, as the blue light from your laptop or smartphone tells your brain that it’s daytime and makes you feel alert. For this reason, using devices close to bedtime can make it a real challenge to fall asleep.
  • Don’t exercise close to your usual bedtime (around three hours before you want to be asleep). While exercising can promote restful sleep, this changes if you exercise late at night. Doing so will keep your heart rate elevated, leading your body to stay alert.
  • Avoid using certain substances that have a stimulating effect late at night. This would include caffeine and nicotine.
  • Avoid drinking alcohol before going to sleep, as this disrupts your normal sleep patterns
  • Avoid certain foods that keep you awake, such as sugar and spicy food
  • Look after your mental health. Issues such as stress, anxiety, and depression can keep you up at night and result in poor sleep. If you’re dealing with emotional difficulties, make sure to seek out effective treatment, such as therapy and counselling, medication, or alternative strategies such as meditation. By reducing your stress levels and learning to cope with mental health problems, you may start to notice improved sleep and fewer migraine attacks or symptoms.

One of the most effective ways to treat migraine is through rest. By making the above recommendations a part of your routine, you will give yourself the best chances of controlling or reducing migraine symptoms and preventing any further attacks. As a migraine patient, your headaches may be so severe and constant that you may be losing hope, especially if medication isn’t offering you the relief you need. However, many migraine patients find that when they try to take better care of themselves, they notice massive improvements in their condition and, in turn, their overall quality of life.

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