When Insomnia Inspires Migraines and Vice Versa

For those living with headache disorders – especially migraines – sleeping is often a go-to solution for finding relief. But sometimes, sleep can also provoke a migraine.

How are migraine and sleep disorders connected? And how can you find relief if you experience both?

When migraine leads to insomnia

Research has long linked migraine with insomnia. Insomnia complaints are frequently documented in people with migraine. As many as half of all migraineurs have difficulty falling asleep.^1,2

Migraine researcher, Dr. Jeanetta C. Rains, has written how recent research "has begun to unravel the magnitude and temporal patterns of sleep and migraine," pointing out that most migraineurs needing treatment have insomnia.³

Biological causes

Certain brain structures can dysfunction, contributing to both headache and sleeplessness. Also, some hormones, notably orexin, may fail to act in regulatory roles for both sleep and pain. These kinds of functional or neurochemical imbalances will link migraine to insomnia.⁴

A circadian link?

If most migraines take place between 4:00 and 9:00 AM, it seems odd they could lead to insomnia at night. However, some migraineurs report peak headache time in the afternoon or late in the evening. Napping can bring relief. Unfortunately, it can lead to disrupted circadian rhythms – when naps are too long or late in the day – foiling attempts to fall asleep at bedtime.^5-7

Headache drugs

Migraine medication can also cause insomnia:⁸

• Beta-blockers reduce secretion of the sleep hormone, melatonin, delaying our ability to fall asleep.
• Amitriptyline (an antidepressant) reduces total sleep time while increasing morning and daytime sleepiness.

When insomnia leads to migraine

Insomnia is defined as having trouble falling asleep or maintaining sleep.

Causes for insomnia include:⁹

• Stressful life events
• Day-to-day stresses
• Anxiety or depression
• Medication use
• Substance use (caffeine, nicotine, alcohol)
• Other medical conditions
• Shifts in daily schedule
• Poor sleep hygiene

Any changes in normal sleep – especially if they lead to chronic sleep loss – are going to affect the body, and that includes how we develop and manage migraines.

Daytime sleepiness

For instance, if we don't get enough sleep, we risk daytime sleepiness. However, napping can inadvertently disrupt our circadian rhythms. Circadian disruption has been shown to lead to problems with low pain threshold and the development of migraines.¹⁰

Sleep deprivation

Meanwhile, sleep deprivation is significantly linked to migraines. Case in point: Those who "sleep in" on weekends are said to experience "weekend migraine."⁸

The female factor

Women with insomnia have a more than threefold risk for developing migraine independent of symptoms like anxiety and depression.²

How to help yourself

If you have chronic insomnia

Your best move forward is to treat your sleeplessness. This may mean visiting a doctor specializing in insomnia. The gold standard for treating insomnia is cognitive behavioral therapy for insomnia (CBTi). Its basic form, cognitive behavioral therapy (CBT), is also used to treat migraine. Both therapies are non-medication approaches that focus on techniques that change both behaviors associated with sleep or headache and ideas about one's sleep or headache.⁸

Meanwhile, the use of suvorexant, a newer insomnia drug created as an alternative to benzodiazepines, has been found beneficial in treating migraine.¹¹

If you have migraine disorder

Treating your migraine under the supervision of a specialist can help you find relief. But getting good sleep may be part of the problem. Talk to your doctor about any sleeplessness you also face.

Sleep hygiene, by itself, is not going to cure poor sleep or migraine. However, good sleep hygiene has been shown to be very effective in helping migraineurs achieve more and better sleep.⁸

Basic rules for good sleep hygiene include:

• Planning for adequate sleep
• Excluding certain activities in bed (TV watching, reading, listening to music)
• Practicing relaxation techniques such as visualization
• Restricting the intake of foods and drinks to several hours before bedtime
• Avoiding naps

Also, talk to your doctor about insomnia as a possible side effect of your migraine medication. If this is the case, you may need a change to the timing or amount of your dose, or you may need to switch medications.

Can treating one treat the other?

In her review of migraine and insomnia, Dr. Rains suggests that recent revisions in definitions of sleep and headache disorders have made it easier for doctors to recognize and act on sleep-related headache.³

This means that someone experiencing migraine disorder or insomnia separately may be better able to manage one or both conditions with greater success.

Treating migraine through behavioral sleep regulation may result in lower migraine frequency, for instance. Meanwhile, CBT and CBTi are treatments found to be "complementary to standard headache practice."^1,3

Meanwhile, preventive migraine treatments may also be credited with improving the quality of sleep.¹²