Sleep issues like insomnia can affect migraine and other headache disorders. Learn what sleep techniques can help prevent migraine attacks and minimize headaches from lack of sleep.

It’s common for people with migraine to experience waking up with a headache and other migraine symptoms, often in the middle of the night. But why does this happen? One reason could be your sleeping habits. Medical providers have known for over a century that there is an association between poor sleep and the frequency and intensity of migraine attacks and other headache disorders. Insomnia is one type of sleep disorder that is common among individuals with chronic migraine.

Below, learn how insomnia and migraine are linked and find tips for promoting healthy sleep habits that can help you manage migraine.

What is insomnia?

Insomnia symptoms can include difficulty falling asleep or staying asleep, as well as early morning waking or waking up feeling tired and unrefreshed. Certain forms of insomnia called psychophysiologic insomnia involve an interplay between both physical and mental factors. In many cases, insomnia may stem from other medical problems that cause chronic pain, which make it difficult to sleep comfortably or disrupt normal sleeping patterns.

Research Insights on Migraine and Insomnia

Researchers at the University of North Carolina at Chapel Hill studied the association between insomnia and migraine by interviewing 147 adults with transformed migraine (TM). TM is a frequently used term for people who progress from having relatively few headache days early in their migraine journey to a higher frequency of headache days, with their symptoms “transforming” over time into chronic migraine. Chronic migraine is defined as having 15 or more headache days per month for more than three months, as well as eight or more days of either migraine pain symptoms or acute medication use for migraine.

The UNC survey found that of those who had more than 15 days of headache with migraine, insomnia was a common complaint, with two-thirds of respondents reporting having difficulty falling asleep. None of the participants reported feeling “refreshed” upon awakening, and four out of five regularly felt “tired” upon waking. By comparison, researchers found that approximately one in four individuals with infrequent migraine attacks felt “refreshed” upon waking and only about one in three awoke feeling “tired.”

When asked about their sleep habits, almost 80% of study participants said they watch TV or read in bed, 70% get up in the middle of the night to use the bathroom, approximately 60% regularly nap during the day and a little over 50% regularly use sleeping pills. Interestingly, less than one in ten used caffeine within eight hours of bedtime. Thr poor quality of sleep and suboptimal sleep habits reported by the study represent typical sleep issues for those with frequent, severe migraine needing specialty headache care.

Can treating insomnia positively affect migraine?

The UNC researchers attempted to see if making changes in sleep patterns could have an effect on migraine frequency and intensity. To do this, they randomly placed 43 women with chronic migraine into one of two groups. The first group received formal instructions on how to improve their sleep habits. The other received placebo instructions. They were asked to keep a diary of their headache symptoms.

The first group was given these instructions to improve their sleep quality:

  • Schedule consistent bedtime that allows eight hours of sleep in bed.
  • No TV, reading or music in bed.
  • Use visualization techniques to shorten time to sleep onset.
  • Move your last meal to at least four hours before bedtime and limit fluids within two hours of bedtime.
  • Stop naps.

Six weeks later, women who changed their sleep behavior reported a significant improvement in headache frequency and intensity. Dramatic improvement was seen in one of three, to the extent that they no longer met criteria for chronic migraine. None of the placebo group had such a dramatic change.

However, when researchers then gave the placebo group the same formal teaching on improving sleep habits and then followed them for an additional six weeks, they found that nearly 50% of all subjects who followed the instructions experienced headache improvement to the degree that they no longer met the criteria for chronic migraine.

Risk Factors for Sleep Disorders & Migraine

Since poor sleep can be associated with more frequent and severe migraine attacks or headache pain, it is only natural to ask what factors place people at risk for developing a sleep disorder. Changing behaviors as suggested in the sleep plans above address some of the factors that can disturb deep and uninterrupted sleep.

Other potential risk factors for insomnia include:

  • Stressful life events, such as the death of a loved one, divorce or the loss of a job.
  • Day-to-day life stresses, such as concerns about school, work, family and finances.
  • Depression, anxiety and other mental health disorders that can lead to fragmented sleep patterns, trouble sleeping or sleeping too much.
  • Prescription and over-the-counter medications that cause grogginess or contain caffeine and other stimulants that can prevent a good night’s sleep.
  • Consuming caffeine, nicotine or alcohol—especially before bed.
  • Medical conditions associated with chronic pain, breathing difficulties or frequent urination. (Medical conditions that have been linked with insomnia include arthritis, gastroesophageal reflux disease (GERD), cancer, lung diseases, congestive heart failure, overactive thyroid, obstructive sleep apnea and Parkinson’s disease.)
  • Change in environment or work schedule, such as jet lag from changing time zones, working nights or shift work.
  • Heartburn from eating too much or too late in the evening.
  • Poor sleep habits, including irregular sleep times or stimulating activities before bed such as reading, watching TV or studying/working.
  • Hormonal shifts experienced during one’s menstrual cycle and during menopause, which can lead to trouble sleeping. Lack of estrogen is thought to play a role.

Additionally, as sleeping patterns change with age, insomnia often becomes more common, especially after age 60. It is estimated that nearly half of elderly individuals suffer from sleep problems.

Sleep Techniques for Insomnia Treatment

Different sleeping tips and lifestyle modifications—particularly changes to your daytime and bedtime routine—can help treat insomnia. For example, keeping a consistent sleep schedule helps you maintain your body’s natural circadian rhythm. Another healthy sleep habit includes getting out of bed when you’re not sleeping, even if just for a few minutes in the middle of the night before going back to bed to attempt to fall back to sleep. In the mornings, allow yourself to sleep as much as you need to feel rested, and then get out of bed.

Other tips for better sleep include:

  • Make your bedroom conducive to sleep. Close the door or run a fan to create a soft background noise to shut out other noise. Adjust the temperature so that it’s comfortable, and keep the bedroom dark. Don’t keep a TV or computer in the bedroom.
  • Use your bed and bedroom only for sleeping. Don’t eat, read, work or watch TV in bed.
  • Find ways to wind down before bed, like taking a warm bath, reading, listening to soft music or doing these relaxation techniques for migraine prevention.
  • If you are unable to fall asleep after 15 minutes, get out of bed and try one of the above linked suggestions for relaxation. Try to wait until you become drowsy before getting back in bed and attempting to sleep.
  • Avoid napping. If you cannot avoid a nap, limit it to no more than 30 minutes, and don’t nap after 3 p.m.
  • Exercise and stay active. Do at least 30 minutes of vigorous exercise daily, five to six hours before bedtime.
  • Check your medications to see if they have possible side effects which may be contributing to sleep problems.
  • Avoid or limit caffeine, nicotine and alcohol.
  • Avoid large meals or beverages before bed.
  • Work with your healthcare provider to treat ongoing pain to minimize the chances of it keeping you up at night.
  • Set your alarm so you know when it’s time to get up in the morning, but otherwise hide clocks from view. This lessens the chances of looking at the clock while you’re trying to fall asleep (or fall back asleep) and creating anxiety.

Setting Goals to Improve Quality of Sleep

Use the above list to review your current sleeping habits. Consider crossing out or putting an “X” beside the habits you currently keep as part of your sleep schedule and daily routine. Circle those you consider an opportunity to work on and put a star in front of one priority you believe you can accomplish in the coming weeks. When you succeed at that goal, pinpoint another opportunity and so on until all are marked with an “X.”

If you experience insomnia or other issues sleeping, consider talking to your healthcare provider or seeing a sleep specialist to learn more about addressing sleep issues while living with migraine.

The American Migraine Foundation is committed to improving the lives of those living with this debilitating disease. For more of the latest news and information on migraine, visit the AMF Resource Library. For help finding a healthcare provider, check out our Find a Doctor tool. Together, we are as relentless as migraine.