CPAP and Headache: for Better or for Worse?

Most people know CPAP (Continuous Positive Airway Pressure) as a treatment for sleep apnea. Essentially, a machine connect to a mask, which pumps air under pressure to the lungs, keeping the windpipe open while you’re asleep. The windpipe remains “unobstructed”, thus helping with obstructive sleep apnea.

But over the past few years, patients and researchers have become interested in another aspect of CPAP machines. That is, their relation to headaches.

There are three aspects to this question:

1. Could CPAP machines actually cause headaches, or at least make them worse?
2. Is sleep apnea related to headaches and migraine? In other words, could treating sleep apnea also fight headaches?
3. Could CPAP machines be a treatment for headaches, migraine, and even cluster headache?

Let’s start with #1. Yes, some people have noticed an increase in headache symptoms when they use the CPAP machine. This shouldn’t be surprising – any significant change can certainly trigger an attack in people with migraine disease.

However, there may be some good solutions (besides avoiding CPAP treatment). One would be “giving it time”, of course, but one business focused on sleep related medical equipment reports that there could be a simple solution:

Sinus systems extend behind your ears. When a CPAP is used and part of the sinus cavities are blocked, a situation is created where there is a pressure differential between the sinus cavities affected. These pressure differences can sometimes be felt as sinus headaches or just plain headaches, even though they are caused by sinus blockages. These can be treated using over the counter medications to open the sinus. CPAP heated humidifiers can also open and maintain sinus systems. If you do not use a heated humidifier, we strongly suggest using one. If this does not correct the problem, visit your ENT. [Why do I have a headache when I wake up?]

These are common recommendations from both companies with experience and doctors. Check if a pressure adjustment is needed, and consider a CPAP heated humidified (and make sure it’s working properly).

Also, you may have a reaction to the straps used for the mask. See if you can loosen them or try a different type of mask/strap.

While a temporary increase in headache symptoms may be common, it’s also common that headache symptoms decrease – or disappear – when a patient starts using a CPAP.

A few people from our community have shared their stories of unexpected success – see Sleep Apnea and Migraine – Comments from You!

It seems that sleep apnea (sleep apnoea) is a significant trigger for headache attacks, such as those from migraine. In 2013, for example, a study was released that showed significant improvement in migraine patients with sleep apnea who started using CPAP (CPAP Improves Migraine Burden in Patients With Sleep Apnea). Another study also found that patients with obstructive sleep apnea and migraine often improved significantly if they were committed to CPAP treatment.

Could CPAP work specifically as a treatment, even if patients aren’t diagnosed with sleep apnea? And which patients are most likely to benefit?

Much more study is needed, and some studies are beginning. For example, a CPAP study in Norway will be evaluating the use of CPAP for cluster headache treatment.

In the mean time, it’s very important for doctors to pay attention to the sleep patterns of headache patients. There are probably a high number of patients with headache symptoms who have undiagnosed obstructive sleep apnea. In fact, doctors could make a lot of headway just by asking a simple question – When you woke up this morning, did you feel refreshed?

For more on sleep apnea and migraine in particular, listen to this podcast.