Impact of migraine

My name's Alex Nesbitt, I'm a consultant neurologist working in London and for the past ten years or so I have been assessing and treating people who have both headache problems and also sleep problems in clinics at Guys Hospital.

Migraine and sleep are very closely related and they are linked on many different levels.

So the most obvious one is having too much or too little sleep can influence migraine attacks.

Sleep itself can modulate A migraine, so in some people sleep's the only thing that will terminate A migraine attack.

Your levels of sleepiness or alertness can fluctuate before a migraine attack, during a migraine attack, and after a migraine attack.

So there are a few common sleep disorders that are linked to migraine, the commonest of which is insomnia.

And we know from population studies that people who have migraine are about 60% more likely to also have insomnia, and that figure probably increases with more frequent migraine attacks.

So the more migraine you have, the more likely you are to have insomnia.

Then also restless leg syndrome, which can affect sleep in a variety of different ways, seems to be more common in people with migraine.

So if you have migraine, you also probably have about a 20% higher chance of having restless leg syndrome.

Sleep can impact migraine frequency in a number of ways, and I think it's best thought of as a threshold.

So if your sleep is disrupted, it's too short, too long, fragmented, then the threshold for developing A migraine attack is much lower.

So you might expect migraine frequency to increase with time, and conversely, if your sleep is regular, consolidated, and of higher quality, then that threshold for triggering or developing A migraine attack would be raised.

So again, over time, you'd expect the frequency of migraine to decrease.

So there is a question of whether or not sleep impacts migraine or if it's migraine having an impact on sleep.

But I think it's probably best thought about as what we call a bidirectional relationship or I suppose maybe a vicious cycle.

If you are able to break that cycle, then you can sometimes see an impact on the other.

So if you treat migraine, particularly if you're making sensible choices with how you prescribe medications to make sure that they don't impact sleep in any undue way, then you can see improvements over time and sleep.

And similarly, if you're treating sleep and you're using interventions that aren't going to worsen migraine, then you can over time see improvements in migraine.

But it's not always immediate, and it's not always straightforward.

I don't generally recommend tracking sleep for patients who have migraine and sleep problems, except having an understanding of how consistent their get up time is each day and also whether or not they're getting enough sleep.

So broadly 7 or 8 hours sleep.

I think tracking sleep can become important if you're undergoing sleep treatments, but obsessing over it can start to become counterproductive, and striving towards perfect sleep often has more problems than usefulness.

So we all know about the broad sleep hygiene measures that I always recommend for people who have migraine.

And generally speaking, that can be avoiding caffeine 6 hours before sleep onset, trying to avoid alcohol 4 hours before sleep onset, and avoiding heavy meals or exercise 3 hours before sleep.

And for those people who do smoke, then avoiding nicotine 2 hours before sleep.

Having the right sleep environment can also be quite helpful.

So we all know that having somewhere quiet and dark and ideally cooler, so around sort of 18° is the optimum temperature can help promote better sleep.

Another really important factor is to try and reserve your bedroom just for sleep and intimacy.

So not for other things.

So not really unwinding in the bedroom, not watching television in the bedroom, not doing other things so that your brain starts to associate it really with being the place that you go to sleep.

And then I think for people with migraine who are struggling with insomnia, it can be really helpful to try and create a buffer between ending your day and going to sleep.

And during that time having a warm bath or a shower can be important.

Writing down on paper, anything that's on your mind, so be it to do lists, worries, future plans, the sorts of things that might keep you awake at night.

Writing that down and having some kind of relaxation technique like breathing exercises, muscle relaxation built into that buffer can be really effective.

So for people with migraine, consistency is the most important thing.

So having a consistent schedule, getting up at the same time seven days a week is more important than trying to compensate for lack of sleep by having lions or naps.

Also, the other thing that helps with this consistency is trying to get some daylight exposure as soon as possible after getting up, even if it's a cloudy day.

So there is a good amount of support and information available about these topics.

So for people with migraine who are particularly struggling with their sleep, my message will be don't be afraid to reach out to your healthcare professionals to ask for help.