Gain insight into sleep-related headache pain and how to build healthy sleep habits.
Adults and children with headache often also experience sleep disorders. One of the most common sleep disturbances is insomnia. Sleep and headache are often part of a bad cycle. Sleep can relieve pain and migraine symptoms. But those symptoms can also disturb sleep and contribute to ongoing headache pain.
To find out more about the relationship between sleep, headache and pain, we talked with Dr. Emily Law, associate professor of anesthesiology and pain medicine, and pediatric psychologist at University of Washington in Seattle, Washington.
How are sleep disorders related to headache and pain?
Insomnia is defined as trouble falling asleep, trouble sleeping through the night, or waking up too early and not being able to fall back asleep at least three nights a week for more than three months. It can impact 50 to 75% of people with chronic pain and headache diseases, especially migraine.
Why is this? Many people use sleep to relieve their headache pain. While they may wake up feeling better, over time, using sleep in this way can contribute to insomnia and other sleep difficulties. “If they develop a habit where they’re spending excessive amounts of time in bed, spending a lot of time sleeping during the day, then the body starts to lose the association between using the bed for sleep versus using the bed for being awake,” says Dr. Law.
Sleep disorders and headache diseases also commonly co-occur with psychiatric disorders like anxiety and depression. Addressing anxiety and mood problems can be an important step in improving sleep and headache pain. “Oftentimes there’s some part of all three of those—the anxiety, depression, sleep problem and headaches—that are playing on one another,” says Dr. Law.
It’s a bit of a chicken-and-egg scenario: Is it the headache pain that’s causing the sleep disturbance, or is it the sleep disturbance that’s causing the pain? According to research, poor sleep more often predicts onset of headache the next day, or more sensitivity to pain the next day, than the opposite. Studies have also shown children who have poor sleep over a decade are at greater risk to develop an episodic or chronic headache problem in young and middle adulthood.
In her own research lab while studying youth and insomnia, Dr. Law has found that even when pain symptoms improve over a year-long period, the sleep disturbance does not. This means that while pain may initially spark sleep issues, insomnia can be a learned behavior and can continue even when the pain improves.
How can you tell if you have sleep-related headache pain?
Using a sleep and headache diary can help you and your doctor identify links between sleep and headache. When speaking with your doctor, it’s important to consider various aspects of your sleep.
To start, describe what type of bedtime or middle-of-the-night issues you experience. Do you have trouble falling or staying asleep? Do you have excessive daytime sleepiness or frequent night wakings?
Then share your sleep schedule and habits. Do you go to bed and wake up at the same time every day? Does your timing change on the weekends? Do you have a consistent bedtime routine?
Lastly, bring attention to any clues of a medical condition that may affect your sleep. For example, do you or someone else notice you snoring or gasping for air while sleeping?
The answers to these questions will help inform your doctor. They can point to a potential behavioral sleep disorder like insomnia or a sleep disorder like obstructive sleep apnea.
How can sleep habits prevent pain?
Dr. Law shares five tips for good sleep hygiene, which can help people prevent and cope with migraine and headache pain.
- Keep a regular bedtime and wake time. Try not to deviate more than 60 to 90 minutes from your regular time.
- Make your bed a sleep-only zone. Avoid using electronic devices or napping in your bed during the day.
- Store your electronics outside of the bedroom. Designate a recharging space for your phone, tablet and other devices in another room. That way you aren’t tempted to check them if you wake at night.
- Maintain a bedtime routine. Actions like changing into pajamas and brushing your teeth tell your body to get ready for sleep.
- Make time to wind down. Spend 20 to 30 minutes before bed doing something relaxing off-screen. This can include reading, listening to music, stretching or having a cup of tea or a light snack. Doing this will set yourself up for a restful night.
Other lifestyle habits, such as limiting caffeine, can also be helpful for quality sleep. “If you have a poor night’s sleep, you’re often going to go for caffeine to help you stay awake during the day,” says Dr. Law. “But we know that overuse of caffeine can lead to headache, and if you’re using caffeine too late in the day, that can lead to poor sleep.” She recommends limiting caffeine use to twice a week.
How can behavioral therapy be used to treat sleep-related headache pain?
Cognitive behavioral therapy can help with pain management. This type of medication-free intervention includes self-regulation strategies, like relaxation. It also identifies ways for people with chronic pain to participate in daily activities, even on days when they don’t feel well. “We work on identifying thoughts and feelings about pain and headache symptoms that might be getting in the way of activity participation,” says Dr. Law. “We work on making plans for gentle return to activities that are important. We also spend a lot of time talking about lifestyle factors, including sleep, in that intervention.”
Cognitive behavioral therapy is also the first-line sleep treatment for adults who have insomnia. It focuses on helping the body learn to fall asleep quickly in bed at night, implementing healthy sleep habits and minimizing the amount of time awake in bed, both during the day and night.
If you experience chronic headache and/or chronic insomnia, Dr. Law recommends talking to your primary care provider about accessing multidisciplinary care as a first step. These types of treatments are typically available in academic medical centers, such as hospitals that are associated with universities, or specialty clinics, like multidisciplinary pain medicine clinics, headache clinics or even sleep clinics. Multidisciplinary clinics lean on specialists from different knowledge areas to assist a patient.
How can a multidisciplinary approach be helpful for treatment?
In Dr. Law’s multidisciplinary headache clinic at Seattle Children’s Hospital, every new patient is evaluated by a neurologist and a pediatric psychologist. Together, the team can assess anxiety, depression, headache disorders and sleep problems, and consider a combination of medication management and psychotherapy options. “I think an interdisciplinary approach like that can help to sort out these issues for our most complex patients in terms of where to start for treatment,” says Dr. Law. “I really spend time talking with patients and their families about what they see as the most impactful issue for them and where they want to start.”
Prioritizing treatments is a strategy Dr. Law often uses, based on the full picture of a patient’s diagnostic assessment, mental health, family functioning, physical functioning and sleep habits. “If the patient is feeling that their insomnia is the most impairing issue, [I might] consider offering sleep intervention as [the] first treatment for that family and then see how much benefit they get from that, in terms of not only improving their sleep, but also reducing headache and helping them get back to daily life,” says Dr. Law. “Instead of offering the whole shebang at once, we might start with something small and then build from there.”
The resulting benefit isn’t always just physical. As Dr. Law says, “When we’re able to offer them additional interventions—both targeting their headache, but also targeting other issues that they’re struggling with—I think it brings a lot of hope to families that they’re not actually at the end of the road, and that our team is going to be there, partnered with them, walking with them until we get them where they want to be.”
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