Migraine is associated with depression and anxiety, both of which come with insomnia.  Just plain migraine alone comes with light sleep, not deep sleep.  Poor sleep can set off more frequent migraine attacks.  So, sleeping well is a cardinal principal of treating migraine.

Read my article, “What is Migraine?’ on my website, www.doctormigraine.com

How can a person with Migraine learn to sleep well?

This is an article by Britt Talley Daniel MD, retired member of the American Academy of Neurology, the American Headache Society, migraine textbook author, and blogger.

Read my Mini Book on Migraine Here.

1.Exercise.  Persons with frequent headaches, such as chronic migraine, which is 15 headache days/month 8 of which have migraine features, tend to not exercise because exercise generally makes migraine worse.  On the other side of this, aerobic exercise can help both sleep and migraine.  So, migraine patients should exercise and if jogging provokes a headache, then swimming or walking on a treadmill in an air-conditioned gym may be tolerated.  Try to get some exercise.  I never see persons who do manual labor who don’t sleep well.

Read my article “Exercise and Migraine,” on my website, www.doctormigraine.com.

2.Set your sleep cycle.  Migraine patients should set their sleep/wake cycle and be consistent.  Jet lag is a real medical problem for persons who travel out of country, like airline pilots.  Many persons have 2 sleep cycles, one for the school or work week and another for the weekend.  This should be avoided.  Staying up late on Saturday night and oversleeping Sunday morning may result in a “week end, Sunday morning headache.”

Read my article, “Tips for Sleeping Well” on my website, www.doctormigraine.com.

3.Keep a migraine/sleep diary.  Keeping a migraine/ sleep log can be helpful for the patient and their doctor to study their patterns.  Many cell phones report sleep patterns anyway and there are migraine apps to track migraine, like iMigraine.

Read my article on “List of Migraine Cell Phone Apps” on my website, www.doctormigraine.com..

4.Take only short naps.  Analyzing sleep for migraine means that long naps should be avoided.  Many migraineurs wake up after a long, 2-hour nap with a headache.  It is true that all persons in all cultures get drowsy in the middle of their day, like the Mexican siesta, and the drowsiness may be hard to resist, yet many persons can dismiss the drowsy feeling with a short 10-15 minute nap set with an alarm clock.

5.Sleep environment. The bedroom should be cool, quiet, preferably dog and cat free, and dark.  Eye shades may help for bright rooms and ear plugs for house, road noise, or spousal snoring.  Dim the room lights earlier than when you finally go to sleep.

6.Preparation for sleep. The person with migraine should prepare for sleep 30-60 minutes before lights out with no exercise and no TV.  The blue light from the computer, iPad, or cell phone is stimulating.  Emptying the bladder just before sleep and avoiding drinking fluids before rest may cut down on trips out of bed to the toilet.

7. Learn CBT.  The American sleep council recently advised all doctors to avoid writing a prescription for insomnia before suggesting that their patient learn Cognitive Behavioral Therapy, CBT, either from a psychologist or YouTube.  Enter CBT and insomnia into the YouTube search engine and watch one of the many short movies written by specialists to help you sleep.  CBT is a skill that may be learned whereby one replaces hurtful, worrying sentences in the head with a calming sentence.  Instead of thinking what you should have done, congratulate yourself by noting how you tried.  Think, not I should be perfect, but my peace of mind is worth more than trying to be perfect.  Look at  YouTube.

8.Warm milk.  A low volume of a high calorie carbohydrate just before bedtime promotes sleep.  I'm talking about something like the proverbial "warm glass of milk."  This has been studied scientifically and shown to work.  You have to be careful here with the calories and cholesterol.

 9.General.  It's okay to get out of bed and go to another room for a while, if you can't fall asleep when you first try.  Then you may read , preferably something not too interesting , technical, or work related, for 10-15 minutes.  However, watching TV or doing housework are not good options.  They're too stimulating.

 10.Avoid Alcohol, Caffeine, and Nicotine.  Avoid alcohol or an evening “night cap.”  Alcohol is a short, 2-hour lasting drug, which may assist sleep at onset, but then it wears off, provoking awareness the rest of the night through a drug rebound action..

Caffeine has a cerebral alertness quality. It is what we drink in the morning as coffee to wake us up. Although it is not successful, coffee is what they give to the drunk man to drive home from the party.

Nicotine causes cerebral alertness. Smoking is a terrible daily habit also, give it up and become smoke free.

 11.Medication. As a neurologist with a large headache practice I try to avoid medicating sleep unless I just have to and the patient has tried and failed the ideas above.  So what do I use then?  I mention that Melatonin is over the counter and that doses of 3-12 mg at bedtimes may be used.  Also, Benadryl is an old timey sedating antihistamine that is sold alone, as Unisom, or has been added to pain killers such as Tylenol PM which is acetaminophen and Benadryl and may help sleep occassiounally.

Trazadone is supposedly the number one medication prescribed by doctors for insomnia and Trazadone is the generic of Desyrel which is an older antidepressant.  I heard the following statement at a psychiatry lecture on sleep years ago-“Trazadone, lousy antidepressant.  Great sleeping pill.”

I next go to amitriptyline, which is the generic of Elavil, an older antidepressant active for depression at 75-150 mg with predictable side effects of a dry mouth, constipation, and early morning drowsiness.  Neurologists use amitriptyline in small doses, 10-20 mg at bedtime and here it is a mild migraine preventive drug and works well for sleep.

I try to stay away from Class 4 narcotics for sleep and all the drugs listed so far are Class 2 drugs and not addictive, but the FDA has approved Ambien, generic named zolpidem, which is a benzodiazepine drug like Xanax and may be dosed at 5-10 mg for sleep.

Check that none of the medications you are taking regularly can cause insomnia and eliminate the ones that do.

Related questions.

1.What about Obstructive Sleep Apnea (OSA)?  Persons with possible Obstructive Sleep Apnea, OSA, may be obese, with a thick neck, and small throat at the base of the tongue.  They may have hypersomnia and fall asleep easily but inappropriately while driving, during meetings, at church or lectures, or watching TV.  At night they may snore very loudly and also stop breathing (which is apnea), sometimes for over a minute or so.

This syndrome can be suspected clinically but can only be diagnosed by a sleep study.  Also, persons with OSA have higher rates of stroke, heart disease, and motor vehicle accidents than normal controls.  Many persons who “die in their sleep” have OSA, develop a malignant cardiac arrhythmia or nocturnal stroke and are found dead in the morning.

OSA is an important diagnosis to make.  OSA is a risk factor for migraine.  The spouses of persons with OSA have interrupted sleep and many spouses ultimately sleep separately until the one with OSA is treated.]

2. What about Restless leg syndrome? Restless leg syndrome is diagnosed clinically with complaints by patients of trouble falling or maintaining sleep.  The patient may have to get out of bed and walk or jiggle their legs under the covers.  Leg movement helps the burning, aching, tingling, pain which is usually between ankles and knees that keeps these patients awake, but which is temporarily helped by leg movement.  A sleep study here may be normal or may show jerking or kicking of the legs at night, a syndrome called Periodic Leg Movements.  While all wired up during the EEG part of the sleep study the patient may have myoclonic leg jerking. 

Some of these patients have low serum Ferritin levels and this test should be checked when the diagnosis is suspected.  Sleep may be improved by treating with Ferrous sulfate, iron tablets, 325 mg if the serum ferritin level is less than 50, along with other useful medications.

3.Seeing a sleep specialist.  Persons who don’t respond to the above sleep, medical analysis and treatment should be referred to a sleep specialist who will take a careful sleep history, analyze blood testing, and order a sleep study.  Most persons who go this far with trying to treat their sleep problem will find relief.

Proverbs 3:24 When you lie down, you will not be afraid. When you rest, your sleep will be peaceful.

Summary

Good Migraine control and good sleep go together. Work on sleeping well.

Check out my Big Book on Migraine Here.

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All the best.

Follow me at:  www.doctormigraine.com, Pinterest, Amazon books, Google podcasts, and YouTube.

Britt Talley Daniel MD