A recent study and review of previous studies came to an interesting conclusion. Maybe migraine headache pain isn’t causing as many sleep problems as we think. But that doesn’t mean migraine and sleep aren’t related.
The study, published earlier this year in the journal Brain Communications, reported on a study with mice to see just how much migraine pain interfered with sleep. And the surprising result was: not much.
Let’s put it this way. Looking at this research and other studies, migraine does seem to affect sleep in certain ways (for example, migraine may affect REM sleep). But we can be forgiven if our perception is an exaggerated connection – when you’re writhing in pain, you’re desperate to sleep – and sometimes sleep just won’t come.
However, for some patients, they do sleep more with migraine. This may be a physical result of migraine itself, or simply because they’re trying to sleep more, and looking for a dark, quiet room.
I would be interested in your comments below, to hear if you have found that migraine pain actually results in less sleep or more sleep overall.
But that’s not the end of the story. The researchers confirmed again that migraine is associated with sleep disorders, and that sleep problems may trigger migraine attacks. In fact, sleep disorders may play a part in migraine becoming chronic. The connection between sleep and migraine is real, but complex. As a simple example, a poor night of sleep may not mean a migraine attack the next day, but it may increase your risk the day after that.
Sleep schedule, along with diet, may be one of the most powerful indicators of future migraine attacks. Though we all get frustrated when we can’t “sleep away” a migraine attack, we should also pay attention to daily sleep patterns in order to prevent future attacks.
Last month a meta-study was published in the Journal of Oral & Facial Pain and Headache, focusing on the use of melatonin supplements for migraine. The results are pretty encouraging for a supplement that is generally considered safe in small doses.
The helpful thing about this new study is that it didn’t just evaluate if melatonin “helped”, but it got specific into the “how”. Researchers found the following benefits:
Less frequent migraine attacks
Shorter migraine attacks
Less severe migraine attacks
Less use of “painkillers”
Why exactly melatonin works so well is not entirely understood. Obviously, if melatonin helps you sleep, improved sleep will certainly help fight migraine. But there may be more to it than that.
Melatonin is also an antioxidant, which may provide a number of benefits. Headache researchers have especially honed in on the anti-inflammatory powers of melatonin. More recently, melatonin gained traction as part of the COVID-19 fighting toolbox (see for example this study).
Melatonin is, of course, produced naturally in your body. At a 2019 Migraine World Summit event, migraine expert Dr. Christine Lay provided some very helpful advice for migraine patients:
I think there are ways to promote your own melatonin. When we come home after a busy day, I encourage patients to keep their room dim. And so not to have every single light on in the house, every, you know, television going, but rather to keep the room fairly dim and to use lamp lighting, perhaps, rather than overhead lighting so our own natural melatonin will kick in. But for some patients supplements can be very effective. I think we have to be mindful as migraine patients that you’re not spending all of your money on the most expensive one but you’re not buying the cheapest one because we know these things are not really mandated. We don’t know about quality control, necessarily. So you want to make sure you’re buying a good product.
The other thing I think is important: there are sometimes what we call sublingual, or melt-in-your-mouth, melatonin. I tend to tell patients to avoid those because they usually have additives in them or they may have an artificial sweetener which could then provoke a migraine attack. So they need to stick, primarily, with tablets or pills. In terms of amounts, it’s quite variable. There’s a lot of research showing that melatonin can help patients with chronic migraine, even chronic migraine people who feel like they don’t have a sleep problem. There’s something positive about melatonin. It may actually have even an antiinflammatory benefit to some degree. So melatonin can be very effective. I usually have patients start at a lower dose, perhaps three milligrams, and then work slowly to build up depending on how they tolerate it. I don’t think patients, without discussing with their doctor, should go beyond 10 milligrams because you have to be mindful of how much you’re taking. And most experts will say you need a melatonin break. It’s something that’s naturally produced in our brains by the pineal gland, and so, if you’re continually supplementing the melatonin, your brain might get used to not making its own. So you do need to take periodic breaks every few weeks or couple of months.
Dr. Christine Lay
Dr. Lay also recommends foods with melatonin, such as walnuts. (Make yourself some Morning Glory Muffins. Seriously.)
For a highly-rated melatonin without a lot of the additives that Dr. Lay talks about, try Natrol Melatonin. It’s very inexpensive right now, and has even bigger savings with Subscribe & Save. Be sure to get this particular version – Natrol has various others, such as the fast dissolve version that has additives that you’ll want to avoid.
Do you have chronic migraine, and also trouble sleeping? This clinical trial may be for you!
Earlier this month, Bethany Martin, a migraine researcher at the University of Strathclyde in the UK, contacted me regarding a new clinical trial. This may be a great opportunity for you to further investigate your own migraine and sleep challenges, but it will also be a help to others.
Here’s the official summary:
Do you experience chronic migraines and sleep problems? We are currently recruiting participants for a research study testing two digital sleep treatments. The MISSION Study research team are looking for individuals aged 16 and over that experience chronic migraines and sleep problems. Participating in this research would include completing questionnaires, sleep & headache diaries throughout and wearing an activity tracking device. A screening process is necessary to ensure eligibility to participate. For more information or to take part, contact Bethany Martin at hass-research-missionstudy@strath.ac.uk or call +44 (0)7519 589266
Feel free to share this information with anyone else who may be interested.
Research from the past few years had led to a sudden influx of new pills and injections for migraine, with many more under investigation. But there could be an interesting connection between some of these treatments – your body’s regulation of sleep patterns.
Anyone with migraine will immediately know the connection if we say the words “sleep” and “light”. Sleep is a classic “abortive treatment” for migraine. Changes in sleep schedule are a classic trigger. For many, light patterns and flashes may trigger an attack – and once an attack starts, bright light is the last thing you want!
All this is related to your body’s “clock”. Except that it’s not really that simple. Although you could say that there’s a “master clock” in the hypothalamus, there are also many individual clocks. Some are trying to “sync” with their environment (light plays a big role in this). Others seem to have a mind of their own.
We usually think of the 24 hour clocks, but there are also yearly (circannual) cycles. Cluster headache patients are especially aware of certain rhythms that help explain the “clusters” of these terrible headaches.
Not only are we just beginning to understand how the body regulates all these things, we are really just starting to study these rhythms in migraine patients (and we have a lot to learn about cluster as well). So we have a very long way to go!
But Dr. Philip Holland of King’s College London is a lead researcher who is noticing an interesting connection between the body’s clocks and recent research into migraine treatments.
If you’ve been watching the news, you know that drugs acting on CGRP (calcitonin gene-related peptide – a peptide which occurs naturally in the body and is linked to the migraine chain-reaction) are all the rage. You may also know that there are many upcoming treatments targeting PACAP (pituitary adenylate cyclase-activating polypeptide) are being researched.
So – more drugs and injections. But one thing that CGRP and PACAP have in common is that they’re related to sleep regulation. PACAP works with light to help the function of the hypothalamus clock.
What if sleep patterns could tell us which drugs would work the best? Or what if, instead of developing new drugs, we could find natural ways using light and sleep schedules to minimize or eliminate migraine and cluster headache?
Of course, as we know, these behaviours are already being studied and used to fight headache. What’s new is that we’re starting to see how sleep/wake schedules work in the chemistry of the body. But emerging research is perhaps pointing to the fact that we need to pay more attention to light (think especially of how we use screens, or how working “by the clock” instead of “by the sun” effects us) and our sleep patterns.
Most of us know that poor sleep can trigger migraine attacks, or make migraine symptoms worse or more frequent.
What we may not realize, however, is that there are many, many reasons why we may not be sleeping well.
So today we’re going to look briefly at a few of those reasons – and think about some basic information that we can give to a doctor or specialist to start looking for causes and treatments.
A few [surprisingly common] reasons why people don’t sleep well:
Depression: A case where one can make the other worse, and vice versa.
Sleep apnea (sleep apnoea): …of various types.
Hot flashes
Your pet: It’s moving around, getting up onto your bed… ? It’s a common problem!
Migraine: Of course, had to mention that one. Another case where one can make the other worse.
Caffeine
Some antidepressants: And other common medications too!
Worrying about not sleeping: Yup
Sleeping pills: Yes, not using sleeping pills properly can lead to major problems.
…and those are only a few examples. As you can see, some are serious in themselves, some not. Some are obvious, some are not. Some are easy to fix, some are not. But it helps to open up your mind and think about all the possibilities, instead of just assuming it’s one or two of the more commonly mentioned things.
It’s critical that we think about sleep when we’re trying to get good treatment for migraine, and other headache conditions as well. So where do we start?
Easy Sleep Evaluation
It helps to evaluate your own sleep, and then bring the information to your doctor. This doesn’t mean using an app with complicated charts, although that might be useful. And actually, you want to avoid obsessing too much about your sleep on a daily basis, which can easily make things worse.
Harvard Medical School has published a very useful “sleep diary” to fill out. There are simple questions for before bed, and after you wake up. They recommend using this diary every day for a week before talking to your doctor or specialist.
Before bed:
Medications during the day
Caffeinated beverages during the day
Alcohol during the day; list amount and time
Exercise during the day
Sleepiness during the day
Naps during the day
Food consumed within three hours of bedtime
Activities within two hours of bedtime
In the morning:
Bedtime last night
Approximate time it took to fall asleep
Approximate number of awakenings during the night
Reasons for awakening, if known
Time of awakening for the day
Level of energy and alertness after waking up in the morning (feeling refreshed?)
If you sleep with someone else in the room, also ask them what they’ve noticed about your sleep.