Working in a sleep clinic you’ll often hear people say that sleep problems trigger their migraines, but is this actually true? And if so, what aspects of sleep are the culprits?

Researchers at Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center have looked into this. And their findings make for interesting reading.

The Mystery of Migraines and Sleep

Despite people pointing to sleep disturbances as a trigger for migraines the exact link between sleep and migraines has remained somewhat of a mystery.
Dr. Suzanne Bertisch, the lead author of the study, explains that she became interested in this topic because migraine patients are often referred to sleep clinics for help with insomnia.

“Anyone treating these patients wants to be able to counsel them on what to do to decrease their risk of a migraine, but the literature is unclear on what kind of sleep interventions may be helpful.”

This highlights a real gap in our knowledge and the need for more research in this area.

With this gap in mind, the research team decided to conduct a large study using objective measures of sleep to get a better idea of what’s going on.

So what did they find?

Well, it turns out, their work generally backs up what migraine sufferers have been saying all along: that sleep disturbances can indeed trigger migraines.

But here's the interesting twist:

They found that it's not about how long you sleep, but how well you sleep.

The study, published in the journal Neurology, revealed that sleep fragmentation—that's when you're in bed but not actually sleeping—is linked to migraines.

But here's what’s even more surprising: this link isn't immediate.

The team observed that sleep fragmentation was associated with migraines not the next day, but the day after that.

This is a crucial finding because it suggests that the impact of disrupted sleep on migraines might not be as straightforward as we once thought.

It's not just about a bad night's sleep leading to a headache the next day. It seems there's a delayed effect at play here.

The Study: A Closer Look

So, how did they conduct this study? Well, the team recruited 98 adults who experienced episodic migraines. These participants had at least two headaches a month but fewer than 15 headache days.

For six weeks, these individuals kept electronic diaries, twice a day, where they recorded details about their":

• sleep;

• headaches, and

• health habits.

They also wore a wrist actigraph to bed, which is a device that objectively measures sleep patterns.

This combination of subjective diary entries and objective actigraphy data gave the researchers a comprehensive view of the participants' sleep. The team also made sure to account for other potential migraine triggers, such as caffeine and alcohol intake, physical activity, and stress.

Over the six-week study period, the participants reported a total of 870 headaches.

The researchers found that:

• short sleep duration (less than 6.5 hours) was not associated with migraines;

• self-reported poor sleep quality was not associated with migraines;

• sleep fragmentation, as measured by both the diaries and the actigraphs, was linked to a higher chance of having a migraine, not the day immediately following the fragmented night, but the day after that.

Dr. Bertisch explains,

Sleep is multidimensional, and when we look at certain aspects such as sleep, we found that low sleep efficiency, which is the amount of time you’re awake in bed when you’re trying to sleep, was associated with migraines not on the day immediately following, but on the day after that.

So a key takeaway then: it's not necessarily about the quantity of sleep but the quality of sleep, specifically how much time you spend tossing and turning in bed, that is linked to future migraines.

Limitations and Future Research

Now, it's important to note that the authors acknowledge some limitations to their study. For one, actigraphs don't directly measure sleep or sleep quality. They provide an estimate based on movement.

Also, the participants in this study had episodic migraines and relatively low levels of sleep disturbance. This means that the results might not apply to people with more severe sleep problems, such as those with insomnia or chronic migraines.

This is an important point because it highlights the need for more research in different populations to see if these findings hold true.

What Does This Mean For You?

So, what does all this mean for you? Well, it suggests that if you're prone to migraines, focusing on improving your sleep quality, particularly reducing sleep fragmentation, might be beneficial.

And it's not about getting enough hours of sleep, it’s more about ensuring that those hours are spent in consolidated, uninterrupted sleep.

The good news is that improved sleep quality is a key focus and outcome of CBT for insomnia.

Key Findings

Let’s recap:

• Sleep Fragmentation: The study found a significant link between sleep fragmentation (time spent in bed but not asleep) and migraines. This was observed using both diary entries and actigraphy measurements.

• Delayed Effect: The link between sleep fragmentation and migraines was not immediate. Migraines were more likely to occur the day after the sleep disturbance, not the next day.

• Not About Sleep Duration: The study did not find a connection between short sleep duration (less than 6.5 hours) and an increased risk of migraines.

• Not About Self-Reported Sleep Quality: Similarly, self-reported poor sleep quality was not linked to a higher risk of migraines.

• Objective Measures: The use of actigraphy provided objective data on sleep patterns, which is a strength of the study.

• Multidimensional Sleep: The study highlights that sleep is not a simple, one-dimensional concept. Different aspects of sleep, such as duration, quality, and fragmentation, can have different effects.

• Need for Further Research: The authors emphasize that the study participants had relatively low levels of sleep disturbance, so the results may not apply to people with more severe sleep problems.

Practical Takeaways

• Focus on Sleep Quality: If you experience migraines, it may be beneficial to focus on improving your sleep quality, particularly reducing sleep fragmentation.

• Address Sleep Issues: If you suspect you have a sleep disorder, such as insomnia, it's important to seek help from a healthcare professional.

• Track Your Sleep: Keeping a sleep diary and using a sleep tracker can help you identify patterns in your sleep and any potential triggers for your migraines.

• Consider Other Triggers: Remember that migraines can have multiple triggers, so it's important to consider other factors, such as stress, diet, and caffeine intake.

References

Bertisch, S. M., et al. (2019). Nightly sleep disturbance linked to daily migraine risk. Neurology, 93(24), e2251-e2261.