70: Sleep and headaches

Factors like stress, exposure to environmental triggers, prolonged screen time, hormonal changes, caffeine withdrawal, and dehydration can all increase the likelihood of headaches during the day.  Even sleep deprivation can be associated with headaches!

Nighttime headaches are less common than daytime headaches but can be just as distressing.  Here are some types of headaches that can occur at night:

- Tension headaches are very common. They are often characterized by a dull, aching pain that wraps around the head (usually described as a tight band or pressure sensation).  Muscle tenderness is often a feature.  Causes include stress, muscle tension in the head, neck, or shoulders, poor posture, bruxism (teeth grinding or clenching), eyestrain, fatigue, dehydration, and anxiety.  Treatment is over-the-counter pain relievers, such as acetaminophen or NSAIDs.  Applying heat or cold packs to the affected areas may help relieve muscle tension. In chronic or severe cases, prescription medications like muscle relaxants or tricyclic antidepressants may be indicated.  Lifestyle modifications are useful for prevention and include stress reduction techniques, regular exercise, proper posture, a bite splint, adequate hydration, and getting enough healthy sleep. 

- Hypnic headaches ONLY begin during sleep and wake a person up.  They occur at least 10 days per month and last between 15 minutes to several hours after waking. Hypnic headaches are rare but most often seen in people aged 50 and older. The pain is usually on both sides of the head, which is one feature that distinguishes hypnic headaches from cluster headaches.  Hynpic headaches are usually mild to moderate, rarely severe.  Caffeine at bedtime is the most used treatment and does not seem to affect sleep significantly for people who have hypnic headaches.  

- Migraines usually start during the day, but some people may wake up with a migraine headache.  Migraines are usually a repeated pattern of symptoms specific to an individual with recurring episodes of moderate to severe headaches. The causes of migraines are not fully understood, but a person can identify triggers, including stress, hormonal changes, certain foods or drinks, sleep disturbances, sensory stimuli (bright lights, loud noises), weather changes, and physical exertion.  Migraine headaches are commonly described as pulsating or throbbing and are typically localized to one side of the head.  A person may experience sensitivity to light, sound, or smells, nausea, vomiting, and visual disturbances (such as auras or blurry vision). Fatigue, dizziness, or difficulty concentrating are common either before or after the headache phase.  Treatment focuses on alleviating symptoms and preventing future attacks. Over-the-counter pain relievers (such as NSAIDs) can effectively treat mild migraines. Prescription medication is used for more severe migraines.  Stress reduction, regular and sufficient sleep patterns, maintaining hydration, and identifying and avoiding triggers can also help manage migraines. In some cases, complementary approaches like acupuncture or biofeedback therapy may be considered.

- Cluster headaches occur daily over weeks to months.  The cause of cluster headaches is unknown, but because of the daily reoccurrence, the circadian clock may play a role.  The headache onset often occurs after being asleep for an hour or two and tends to occur at the same time for an individual.  The pain comes on and leaves abruptly and is usually located on one side of the head.  The pain of cluster headaches is severe and can last from 15 minutes to several hours.  People tend to be very restless during the episodes.  Treatments focus on reducing the intensity and duration of the attack and also preventing future episodes.

Preventing nighttime headaches can involve a combination of lifestyle adjustments, establishing healthy sleep habits, and addressing underlying causes or triggers. Sleep apnea, insomnia, and sleep loss of any cause are often associated with headaches.  Nocturnal high blood pressure, low blood sugar (in people with diabetes), medication withdrawal, and alcohol are also associated with nighttime headaches.  Headaches are unique to each individual, and what works for one person may not work for another. It may take time and experimentation to find the best strategies and approaches to manage and prevent nighttime headaches.

1. Maintain a consistent sleep schedule. Establish a regular sleep routine by going to bed and waking up at consistent times. This helps regulate your body's internal clock and promotes a healthier sleep-wake cycle.
2. Create a sleep-friendly environment. Make sure your sleep environment is comfortable, quiet, and conducive to restful sleep. Consider factors such as room temperature, lighting, noise levels, and the comfort of your mattress and pillows.
3. Practice good sleep hygiene.  Adopt healthy sleep habits, such as avoiding caffeine and stimulating activities close to bedtime, limiting exposure to screens, and creating a relaxing pre-sleep routine to signal your body that it's time to wind down.
4. Manage stress.  Stress can contribute to headaches, including nighttime headaches. Stress management is an active process and can include relaxation exercises, deep breathing, meditation, or engaging in activities that help you unwind.  Explore progressive muscle relaxation, guided imagery, or biofeedback therapy. These techniques can help promote relaxation and reduce headache frequency.
5. Identify and avoid triggers. Keep a headache log to track potential triggers, such as certain foods, beverages, or environmental factors. Note the timing, duration, location, and severity (scale of 1-10) of your headache.  If you notice specific triggers, try to avoid or minimize exposure to them, especially closer to bedtime.
6. Address sleep disorders. If you suspect a sleep disorder, such as sleep apnea, consult with a healthcare professional for proper evaluation and treatment options. Treating the underlying sleep condition may alleviate associated headaches.
7. Stay hydrated. Dehydration can contribute to headaches, so make sure to drink enough water throughout the day. However, avoid excessive fluid intake close to bedtime to prevent sleep disruptions.
8. Maintain a healthy lifestyle.  Taking care of your body includes regular exercise, a balanced diet with mostly unprocessed or minimally processed foods, and managing any chronic health conditions.  

Headaches that affect your sleep or daily life need attention.  If headaches persist despite making lifestyle changes, see a doctor.  It is helpful to bring your headache log describing your symptoms, potential triggers, pain scale, and timing.  Testing may be indicated and treatment will focus on pain relief and prevention.  

Sleeping with a headache is generally not dangerous. In fact, for many people sleep can provide relief from headaches.  However, if a headache is accompanied by other concerning symptoms or a recent history of physical trauma, a person should get medical attention before going to sleep.