Chronic Headache and Sleep Disorders: How are They Related?

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Studies have shown that people who suffer from chronic headaches may be experiencing sleep disturbances which trigger the headaches. This is quite apparent, especially for those who have daily morning headaches, which is often an indicator of sleep disorder. In addition, people who suffer from primary headache, or headache not associated with any medical condition, may suffer disturbed sleep patterns. Because of this association, it is recommended that to diagnose and treat chronic headaches, screening for the possibility of concomitant sleep disorders must be done.

What is Chronic Headache?

According to the American Headache Society, headaches that occur for 15 or more days a month and last for four or more hours per day may be classified as chronic daily headaches. Close to 5% of the general population is affected, and along with these individuals, family members may be burdened with the problem. It presents a medical challenge, as most other causes of chronic pain do, and it may be debilitating to the individual.

When all other possible medical conditions such as the presence of brain tumor or other disease-causing headaches are eliminated, then other causes should be sought which can bring about primary headaches. For headaches that occur during sleep or present themselves as daily morning headaches, it is prudent to screen or examine the patient’s history for sleep disturbances.

Quality of Sleep: Sleep Assessment

The quality of how one sleeps may be affected by many factors such as a person’s behavior and habits concerning sleep, as well as environmental factors. The presence of a television or computer in the room, brightness of lights, food intake and activities before bedtime may adversely affect sleepiness.

The patient’s history of sleep can be assessed with different clinical tools such as a sleep diary which records the details of what happens before, during and after one sleeps according to the patient’s recall. Excessive daytime sleepiness, restfulness and duration of sleep, habitual snoring and feeling of tiredness may be described.

There are findings to support the claim that sleep disorders may be related to breathing problems during sleep (Medscape), Sleep apnea or the sudden loss of ventilatory effort during sleep sometimes occur in children, especially infants, and even in adults. Obstructive sleep apnea or altered breathing due to upper airway obstruction, such as during habitual snoring, may cause frequent feelings of tiredness after sleep, leading to daytime sleepiness. 

Obesity is often associated with these nocturnal breathing problems, and if chronic headaches are experienced, the possibility of sleeping disturbance should be investigated. These are strong indications that the daily headaches experienced by these people are closely related to sleep disturbances.

Another common complaint of patients who suffer from daily headaches is insomnia. Insomnia is often a distressing symptom where one may have difficulty in falling asleep, problems with staying asleep for a sufficient duration, or waking up too early, that one feels like he never slept at all. Insomnia may be due to stress, chronic pain and depression, but often times also present in individuals who are hyper vigilant.

Chronic disturbance of one’s sleep cycle can lead to frequent headaches. Many people are involved in jobs that frequently alternate between daytime and nighttime shifts, such as healthcare workers, call center operators, and other public service-related jobs. Mothers are often disturbed during sleep by a crying child. These people may experience chronic headache that are sometimes unrelieved by over-the-counter pain relievers.

How to Get Rid of Headaches Related to Sleep Disorder

Consultation with a family doctor or primary physician is important to rule out medical causes of chronic headaches and sleep disorders. If there seems to be no organic or major psychiatric problems which require medications, then other forms of therapy may be tried:

  • To improve sleeplessness brought about by environmental stress, one may enhance relaxation before bedtime by having the right ambiance: a good sleeping mattress, dim lights or even a dark room, comfortable room temperature, appropriate sleep attire, etc. to set the mood for sleep.
  • Avoidance of excessive daytime sleep, excessive exercise just before bedtime or a heavy meal may help to relax the body and prepare for sleep.
  • Avoid too much alcohol and coffee intake during the day, or just around bedtime. Cigarette smoking, eating chocolates and other stimulants that can increase wakefulness are likewise discouraged.
  • It is advisable that the bedroom, particularly the bed, be used only for sleep and probably sex, and not for other activities related to work or other potentially stressful activities.
  • If one is overweight or obese, a healthy lifestyle to improve breathing patterns is highly recommended. Problems with nasal or mouth obstructions that can result in snoring and difficulty in breathing should be medically treated. Body positioning during sleep may help improve or lessen one’s tendency to snore.
  • Learning behavioral techniques for daytime relaxation and coping with stress towards the night may be challenging to many people whose lifestyles demand a reversal of daytime and nocturnal activities. Some may have to sleep during the day or extend one’s sleep into the morning to catch a restful sleep. Headaches associated with these erratic sleep patterns may be difficult to manage without an individual’s cooperation for progressive relaxation techniques combined with pharmacologic intervention.
  • Medications for treating chronic headaches, chronic pain, depression and insomnia should always be taken under a physician’s supervision.

Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice.

References:

  1. www.AmericanHeadacheSociety.org, “Chronic Daily Headache and Chronic Migraine” (pdf)
  2. Medscape.com, “Review and Clinical Implications for Headache: Clinical Implications”