Sleep and a daily headache: breaking the loop.

Sleep and headache feed each other

In a Norwegian study that followed more than 15,000 headache-free adults for 11 years, those with insomnia at the start were 40% more likely to have developed headaches by the end. The link was strongest for chronic headache.⁵¹

There is little sleep research in NDPH specifically, but what exists points the same way. In 527 children and teenagers seen at a headache clinic, those with NDPH had more sleep disturbance than those with migraine. Across all the groups, worse sleep went with more disability, anxiety and low mood.⁵²

What helped in trials

The trials were done in chronic migraine, not NDPH, so take them as a reasonable bet rather than proof.

• Simple sleep rules. In a randomised trial of 43 women with chronic migraine, those taught a short set of sleep habits had fewer and milder headaches than those given dummy instructions. By the end, 48.5% had gone from chronic to episodic migraine.⁵³
• Cognitive behavioural therapy for insomnia (CBT-I). In a pilot trial of 31 adults with chronic migraine and insomnia, three short sessions of CBT-I cut headache frequency by 48.9% at follow-up, compared with 25% in the control group.⁵⁴ CBT-I is the recommended first treatment for insomnia in general, and it is available in person, online and through apps.

The sleep rules from the trial

These are the instructions given in the 2007 trial:⁵³

1. Go to bed and get up at the same time every day, allowing about eight hours in bed.
2. No television, reading or music in bed.
3. Use a visualisation exercise to fall asleep more quickly.
4. Eat your last meal at least four hours before bed, and drink little in the two hours before.
5. No naps during the day.

Give it a few weeks. A bad night will still happen; the goal is to stop one bad night from turning into a bad pattern.

When it might be something else

A headache that is there when you wake up, with loud snoring, pauses in breathing that someone else has noticed, or heavy daytime sleepiness, can come from obstructive sleep apnoea. In the international classification, this headache is present on waking and usually goes within four hours.¹ It is worth mentioning to your doctor, because a sleep study can diagnose it and treatment can help.

Melatonin

Melatonin has only been studied in migraine. One randomised trial found 3 mg at night worked better than placebo and about as well as amitriptyline, with fewer side effects;²² another found it no better than placebo.²³ It is generally well tolerated, but ask your doctor or pharmacist first, especially if you take other medicines.

Medicines and sleep

Some headache preventives cause drowsiness, others can keep you awake, and painkillers taken late at night can affect sleep too. If a medicine seems to be changing your sleep, tell your doctor — often the time you take it can be changed. Don’t stop it on your own.