Defining the Sleep Related Headache Disorders
By definition sleep related headaches are those that occur during sleep or upon awakening from sleep The pain may affect one side or both sides of the head and is described as being unilateral or bilateral respectively The headache types vary in severity and duration and often have unique associated symptoms
It is possible to separate the headaches into different categories factoring in their association with sleep Most sleep related headache conditions also occur during the daytime including migraine cluster and chronic paroxysmal hemicrania headaches
In contrast hypnic headaches occur exclusively during sleep
There are many headaches that are not related to sleep These include
Tension headaches often bilateral with a band like tightness associated with muscle pain
Sinus headaches due to inflammation of the sinuses due to allergies or infection
Facial headaches from infection often tooth or ear infections
Toxic headache part of a systemic illness associated with a fever
Benign intracranial hypertension due to increased pressure within the skull
Intracranial hypotension due to decreased pressure within the skull often after a lumbar puncture or due to a tear in the dura surrounding the brain and spinal cord
Vasculitis inflammation of the blood vessels supplying the brain
Head trauma
Alcohol intoxication or due to withdrawal and hangover
Giant cell arteritis older than age 50 with tenderness at the temple and associated with the risk of vision loss
Many of these other headaches may have obvious causes or associated symptoms In some cases further testing may be required to determine the headache type
What Causes Sleep Related Headaches
For those headaches that occur with sleep the underlying causes are similar but some may be associated with specific sleep disorders There is a lot of anatomy that is important to both sleep and headaches For example the brainstem and hypothalamus have roles in both states Some of the chemistry of the brain overlaps between these conditions as well including the role of adenosine melatonin and orexin
The precise triggers of headaches vary based on the underlying headache type It is known that alcohol can provoke both cluster and chronic paroxysmal hemicrania headaches It is estimated that 17 of people who go to a headache clinic have nighttime or early morning headaches half of these people had an identifiable sleep disorder
Many headaches are benign and generally decrease in frequency with age There may be spontaneous resolution of the headaches that lasts for months or even years Pregnancy seems to have a variable effect with some improving and others experiencing a worsening of their headache frequency and intensity
The Common Sleep Related Headache Disorders
There are four headaches that commonly occur in association with sleep The first two listed here are described in detail elsewhere These four sleep related headaches include
Migraine headaches
Cluster headaches
Chronic paroxysmal hemicrania
This headache closely resembles cluster headaches It is characterized by severe pain that may be unilateral and localized to the eye or temple There may be other changes affecting the face Though the headaches are short in duration lasting 2 to 30 minutes they may occur more frequently often with more than five episodes happening per day These headaches are strongly associated with REM sleep Fortunately they respond well to a medication called indomethacin
Hypnic headaches
This uncommon headache may cause the affected person to wake from sleep It lasts at least 15 minutes and occurs at least 15 times per month It usually begins at middle age or beyond the average of onset is about 50 years old ranging from 40 to 82 years It is less severe compared to cluster headaches often bilateral and associated with nausea or aversion to light or noise The headaches may occur one to three times per night and many report them occurring at the same time They are also associated with REM sleep and rarely N3 sleep These headaches also respond well to medications including lithium and indomethacin as well as to caffeineConsidering Other Causes of Headaches in Sleep
It can be important to consult with a neurologist if you have frequent recurrent headaches There are other potential causes of headache that must be considered Many headaches result from sleep disorders Others may due to other medical or psychiatric problems When thinking comprehensively about causes of headaches your doctor will consider these potential contributors
Bruxism often associated with neck back of the head temporo mandibular joint or tooth pain
Snoring and sleep apnea diagnosed with a sleep study and often improved with CPAP therapy
Exploding head syndrome occurs with sleep transitions and associated with hearing an explosion in the head which is unaccompanied by pain
Hypertension increases pressure within the skull
Brain tumors increases pressure within the skull and worsened by lying down
Pseudotumor cerebri increases pressure and is associated with vision changes and obesity
Arteriovenous malformations abnormal connections of blood vessels within the brain lead to pressure abnormalities
Cerebral venous thrombosis clot in the veins serving the brain
Trauma
Depression
Rebound headaches due to overuse of pain medications often occurring in the morning
In reviewing such a list the most worrisome potential cause for most people is a brain tumor In the proper context of other symptoms and signs further testing may be appropriate No matter what the cause of increased pressure within the skull ranging from tumor to blood clot the symptoms may be similar There may be a headache that occurs in the morning or starts soon after lying down It improves after the affected person is up for 30 to 60 minutes Headaches due to increased pressure may be worsened by bending sneezing or exertion that further increase the intracranial pressure These conditions are associated with other neurological abnormalities and symptoms such as nausea vomiting swelling in the eye and focal deficits such as weakness or seizures
The Consequences of Sleep Headaches and Further Evaluation
Headaches can be seriously disruptive to sleep This may contribute to insomnia and prolong time spent lying awake at night Depending on the headache subtype and the underlying causes other complications may also occur
If you experience frequent and recurrent headaches that are disruptive to your sleep and life start by speaking with your doctor It may be necessary to consider evaluation by a general neurologist headache specialist or even by a sleep specialist After a careful history and examination further testing may be indicated such as neuroimaging computed tomography or magnetic resonance imaging head scans or angiography may be performed to rule out structural vascular or infectious disease processes that may cause headaches
In order to maximize your sleep visit your local sleep clinic If you live in Alaska click on the link below to connect with one of our professional board certified sleep specialists Alaska Sleep Clinic 907 357 6700
About the Author David Hoang works as a copywriter for Write Any Papers He used to be a web designer but he decided to change his career In this case David has an opportunity to tell others how to create a perfect website design
