Sleep apnea and migraine
What is sleep apnea?
Sleep apnea means that the breathing stops during sleep, either because the airway gets blocked or because the drive to breathe from the brain stops. Eventually, the low oxygen triggers a gasp for air and the person starts breathing again.
What types of headaches can be caused by sleep apnea?
Typically, headaches caused by sleep apnea are called «morning headaches». They are present on awakening and tend to improve over a few hours. They can look like tension headaches or migraines. In one study, 20% of people diagnosed with sleep apnea had morning headaches.
Is there a link between migraine and sleep apnea?
People with chronic migraine are more at risk for sleep apnea. Sleep disorders increase the risk of chronic headaches. There are many histories of migraine that deteriorated in the setting of sleep apnea improving with CPAP treatment. We do not know yet exactly how many people with chronic migraine have sleep apnea.
Why would apnea cause headaches?
Obviously, we breathe for a reason. When we stop breathing, the oxygen in our blood decreases and the carbonic gas increases. This triggers different reactions in the body, like hypertension. All these metabolic changes during the night are thought to trigger the morning headaches.
The apneas (there are usually multiple episodes each night) disrupt the quality of the sleep and lead to daytime sleepiness, somnolence and fatigue. This may have a significant impact on migraine.
What are symptoms that could suggest that I have sleep apnea?
- Habitual snoring
- Witnessed apnea
- Waking gasping or choking
- Headache upon waking
- Hypersomnia (or Insomnia)
- Night sweats
What are risks factors for sleep apnea?
We think of the person with sleep apnea as an obese older snoring man, and it’s not wrong, but many other factors are to consider, and even younger slim females can have sleep apnea.
- Overweight to obese
- Wide neck (male > 17˝ and female > 16˝)
- Women more than men, after menopause almost equal
- Older age
- Family history (especially multiple family members)
- Small chin or jaw (micrognathia)
- Mouth/throat anatomy: large tongue, tonsils
- Neuromuscular disorders
- Substances (eg, tobacco, alcohol, sedatives, opiates, muscle relaxants)
What tests are available for sleep apnea?
- Polysomnography: overnight monitoring attended by technologist in a sleep lab
- Portable cardiorespiratory monitoring home sleep apnea test (HSAT) at home
The key result of testing is usually the Apnea Hypopnea Index (AHI). 5-15 is mild, 15-30 is moderate and >30 is severe.
What are treatment options?
- Conservative measures: positional therapy to avoid supine sleep, smoking cessation, non-surgical weight loss
- Avoidance of alcohol, muscle relaxants, anxiolytics, opiates, sedatives, and hypnotics)
- Positive airway pressure (continuous or CPAP, bilevel PAP)
- Oral appliances (mandibular advancement devices, tongue retaining devices)
- Surgery of the upper airway
- Hypoglossal nerve stimulation
- Bariatric surgery for weight loss
- Nocturnal oxygen (case-by-case basis)
The CPAP mask is not always easy to tolerate. The pressure can even trigger migraines. Discuss other option with a Sleep Medicine specialist.
The coverage of testing and treatments varies a lot. Considering the health consequences of untreated sleep apnea, it would be an advantage to our society to see this covered by public insurance.
In summary, if your migraines have worsened, if you snore, if you have morning headaches…it might be a good idea to discuss sleep apnea testing with your physician.
1. Buse DC, Rains JC, Pavlovic JM, Fanning KM, Reed ML, Manack Adams A, et al. Sleep Disorders Among People With Migraine: Results From the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study. Headache. 2019;59(1):32-45.
2. Ferini-Strambi L, Galbiati A, Combi R. Sleep disorder-related headaches. Neurol Sci. 2019;40(Suppl 1):107-13.
3. Rains JC. Sleep and Migraine: Assessment and Treatment of Comorbid Sleep Disorders. Headache. 2018;58(7):1074-91.