The Connection Between Migraines & Sleep-Breathing Problems

Michelle Bachmann’s recent revelation that she suffers from migraines brings up an important point that most doctors and the lay public don’t appreciate: the importance of proper breathing at night. It’s commonly known that sleep deprivation can cause or aggravate migraines, but what’s usually assumed is that migraine sufferers are breathing well at night. If you’ve read my articles or listened to my teleseminars, I can make a convincing argument that migraine sufferers all have some variation of a sleep-breathing disorder, of which only a small fraction have obstructive sleep apnea.

Not Your Normal Migraines

The classic migraine headache is described as a one-sided, debilitating, pounding, intense headaches that’s associated with nausea, vomiting, light or sound sensitivity. Notice that classically, migraines get better with sleep. Recently, neurologists have expanded the definition of a migraine attack. Any time the nerves in any part of your body becomes oversensitive or overly excitable, then you’ll experience symptoms that are specific to that part of the body.

For example, if the nerve endings in your sinuses are suddenly extra sensitive, then you’ll feel pain, pressure, nasal congestion, and post-nasal drip. In fact, it’s been shown that the vast majority of chronic sinus headache and pain sufferers actually have a variation of a migraine, with normal CAT scans. Many people are placed on oral antibiotics empirically, when there’s no bacterial infection.

You can also have migraines in your stomach. This can present as nausea, vomiting, diarrhea, constipation, or bloating. It’s been suggested that children who suffer from chronic abdominal pain actually suffer from migraines.

If you have a migraine attack in your inner ears, you’ll feel dizzy, lightheaded, feel fullness, or have hearing loss or ringing. This is called vestibular variant of migraine.

Problems Due to Your Tongue?

One anatomic feature that I see all migraineurs have in common is the very small nature of their upper airways, especially in the space behind the tongue and in the nose. I talk about how most modern humans have smaller jaws and facial skeletons due to a radical change in our diets and lifestyles. This leads to dental crowding, which narrows the space behind your tongue, especially if you lay flat on your back. When you go into deep sleep, since your muscles will relax, you’ll stop breathing and wake up to turn over to your side or stomach. This is why most people with this type of anatomy can’t sleep on their backs.

You Are A What?

These breathing pauses usually aren’t long enough to be called apneas (at least 10 second pauses), and usually don’t lead to lowered oxygen levels. However, it does lead to more frequent arousals and sleep fragmentation. Essentially, you can’t stay in deep sleep. In most cases, you won’t even realize that you’re waking up. What you will feel is not feeling refreshed when you wake up in the morning, or feeling like you only slept for 2-3 hours.

In the early 1990s, a new type of sleep-breathing problem called upper airway resistance syndrome (UARS) was described. Young women and men who didn’t meet the official criteria for obstructive sleep apnea were recruited and underwent esophageal pressure monitoring. What they showed was gradually increasing negative inspiratory pressures leading to an arousal, but not severe or long enough to be called apneas or hypopneas. Officially, apneas require at least 10 second breathing pauses, whereas hypopneas require 30 to 50% drop in airflow, along with arousals or oxygen level drops. However, if you don’t reach the 10 second threshold for apneas or hypopneas, then they’re not scored at all. So in theory, you can stop breathing 20 to 30 times every hour and not officially have obstructive sleep apnea.

En garde

Not being able to get deep, refreshing sleep can lead to a physiologic state of stress, where your entire nervous system can become heightened and hypersensitive, even carrying over into the daytime. Poor sleep quality also cause muscle tension and tightening, which can predispose to headaches, TMJ, neck spasms or backaches. Even your senses can become overly sensitive, especially to weather changes, chemical, scents or odors. In this particular situation, even your creativity or intuition can be heightened.

Notice how many of the features of a migraine attack are very similar to suffering from a hangover: nausea, vomiting, brain fog, and sensitivity to bright lights and loud noises. This is your involuntary nervous system over-reacting to something that’s not normally bothersome.

Simple Steps to Take

So if you suffer from any of these migraine types, what can you do besides take prescription medications? Here are 5 basic steps for better sleep and less headaches:

1. Don’t eat anything within 3-4 hours of bedtime. Having juices in your stomach can promote reflex into your throat, causing more arousals and less efficient sleep.

2. Don’t drink any alcohol within 3-4 hours of bedtime. Alcohol relaxes your throat muscles, causing more frequent obstructions and arousals.

3. Keep your nose clear. If your nose is stuffy for whatever reason, do everything possible to keep it open. Having a stuffy nose creates a vacuum effect downstream in the throat which causes your tongue to fall back more often. Use nasal saline irrigation systems, nasal dilator strips, allergy medications, decongestants and even surgery if the former options don’t work that well.

4. Don’t sleep on your back. Back sleeping promotes tongue collapse due to gravity.

5. Do more yoga, tai chi, or deep breathing exercises to calm your nervous system. Take 4-5 slow deep breaths anytime you have 15 to 30 seconds, such as while standing in line, in-between major activities, on hold one the phone, or walking to another room. This helps to activate your parasympathetic nervous system, which helps to calm and relax your body. Acupuncture can also help.

Other Steps to Take

Once you’ve tried these conservative options, and you wish to take it to the next level, consider undergoing a thorough ear, nose and throat evaluation to see of you have any narrowing in your breathing passageways. In particular, your doctor should focus on your nasal septum and turbinates, your nostrils (to see if they collapse), tonsils, adenoids, lingual tonsils, soft palate and tongue base areas.

Many people with migraines will have either UARS or sleep apnea. Standard treatment options can help to alleviate migraines significantly. Dental appliances and specialized orthodontics are also an excellent option—these options are more important if you have any significant dental crowding, bite issues, or if you have a very small mouth. Dentists can also help with TMJ, which can overlap significantly with migraines and various other facial pain syndromes.

Botox can also be used for migraines, but just like using prescription migraine medications, are only covering up the causes, rather than treating it.

To a certain extent, OTC medications, and  natural herbs or supplement (like feverfew), while they do work to various degrees, doesn’t help everyone. But it’s worth trying, if you’re interested.

Avoiding migraine triggering foods: red wine, aged cheeses, chocolate, and MSG.

I don’t usually recommend surgery, but it can be a viable option if the more conservative options don’t help. There are a number of different options, depending on where the narrowing occurs in your breathing passageways.

Hope for Migraine Sufferers

One of the most gratifying experiences is to have patients tell me that their migraines (or even cluster headaches) went away after various forms of surgery. It even happens sometimes with some of the non-surgical, conservative options.

It’s a given in our culture that migraines must be treated with a pill, and I want to dispel that stereotype. I believe that trying to achieve the best possible sleep (by breathing better) is a better way of improving migraines. It’s important to combine the various conservative steps along with techniques to help you breathe better and sleep better. Rather than focusing on the migraine only, it’s more important to re-evaluate your entire life situation, and be willing to make the lifestyle changes that can not only improve your migraines, but also significantly improve your overall quality of life.

Please note: I reserve the right to delete comments that are offensive or off-topic.

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19 thoughts on “The Connection Between Migraines & Sleep-Breathing Problems

  1. I wake up every morning with a headache and most turn into migraines, also it is the headaches that wake me. I do not have sleep apnea, but I’m tired all the time, my nerves are really bad as my temper is also. I’m suffering hearing loss all the time. You have written everyting that pertains to my illness. I thank you for any ideas that would help me Diana

  2. I’ve been suffering from migraines for many years and the doctors can’t seem to find the right meds. I am on the botox treatment and that hasn’t helped either. I was told that this is my last resort and if that doesn’t work I was going to be sent to UCLA where I guess I can be experimented with, which I think is ridiculous! I will be doing dental and getting a check up with the ear, nose, throat Dr. before that happens. Thanks

  3. My fiancee has migraines that make him delirious and seeing things. He gets them so bad that he is vomiting and can’t breath. He can’t open his eyes at all and when he does they are very glossy and his pupils are very small. I get very scared because nothing seems to help him. He can’t sit or lay down but stand against something solid and cold. Showers seem to help but once out the pain starts again. He says it fills like someone is punching and stabbing him at the same time. His whole face and upper body gets very red and it feels like he is running a fever. They last anywhere from 2-4 hours and when they calm he falls into a deep sleep. I’m very concerned and worried about him. Heat seems to trigger them but lately it seems like he is getting them more often. We are cutting back on his caffeine. He doesn’t smoke but dips. Can anyone help me please and Thank you.

  4. Any more when I get a headache I do not reach for the aspirin or ibuprofen. I do still reach for a cup of Gatorade (instant hydration) and water. But I have found something much better for headache!

    Any more when my nose starts to get stuffy I do not reach for the “allergy medications”. Yes, hydration still for this too but to handle the nose right away I have something much better.

    For those with migraine I have often wondered if a common reaction to stress may be a precipitating cause. Stress tends to send our blood to our core, away from the brain. As well, it tends to increase our use of air – which tends to move our blood carbon dioxide levels away from normal to less than normal. Carbon dioxide is a very effective vasodilator, a very effective help of blood circulation. If we start to want for it the brain in particular responds by shutting down the blood supply and going into a “starve Peter to keep Paul going” kind of mode. I do believe this has been the cause of several of my headaches!! I do know that using eucapnic breathing techniques (pulse oximeter guided) has consistently made my headaches go away in minutes.

    Just as I know that the same pulse oximeter guided eucapnic breathing techniques have helped me “un-stuff” my nose. It works every time. It is so nice to smell the flowers in the summer time!!!

    So I wonder if the same circulation helping techniques might be used to help migraines?

  5. Years ago I had sleep study done. Diagnosis was mild sleep apnea. They werent able to test for uars back then, but I suspect that too. You helped explain much about my symptoms. I have sinus headache, vertigo, bloating, and tinnitus all together. Never heard of stomach migraine before.  I have custom dental splint for clenching and taking hormones. Both have helped but vertigo bloating attacks are get worse. How do you know if the sleep I’d causing problems and not the other way around?

  6. Margie,

    One good way of treating UARS is to wear a dental appliance that pulls your lower jaw forward. I can’t say if you’d be a good candidate without examining you first, but it’s a good consideration. It’s different from ones that control clenching, and used commonly for snoring and mild obstructive sleep apnea. Talk to your dentist about it. Good luck.

  7. Yes I tried that device that pulls the jaw forward for week and it caused so much pain, I had to stop. Thank you for addressing my question.

  8. Yes I tried that device that pulls the jaw forward for week and it caused so much pain, I had to stop. Thank you for addressing my question.

  9. My 10 year old daughter had tonsils and adenoids removed when she was 4 due to sleep apnea. At 6 she started getting migraines after 2 years we finally were referred and now at 10 and various migraine medications later she still suffers with migraines (one sided pain) and vomiting.She snores loudly and a recent xray shows enlarged adenoids (despite them being removed 6 years ago) We are now waiting for another referral/sleep study with ENT. Really want to get her off medication (taking pills every day to prevent the migraines for the last 2 years at her age worries me) Had been thinking all along they may be linked to her sleeping/snoring – good article.Fingers crossed.

  10. Robert Fried in his ground breaking book Breathe Well Be Well says; ‘I have not seen a single migraine sufferer who did not show hyperventilation and the accompanying brainwave abnormalities. When a combination of breathing retraining and nutritional control reduced the incidence and severity of the migraine attacks, the brain waves always showed the corresponding change towards higher frequency, normal patterns.

    Many people who have completed the breathing programme at my clinic in Auckland, New Zealand were able to control their migraine headaches. I have included feedback from two clients:

    ‘Having heard remarkable reports from my patients who did the Buteyko course, my son and I tried it out. I learned how to eliminate a migraine headache and my son’s asthma, made worse by cold and exercise was noticeably better just by doing the exercises.’ -Anne O’Reilly MBChB FRNZCGP

    ‘I have suffered from migraines for years and would get at least two to three a month. I discovered to my surprise that the migraine headaches must also have been a symptom of my breathing because I haven’t had a migraine since doing the course and now only get very occasional and mild headaches.’- Jannene Alexander

    For a list of Breathing Educators in North America:

  11. I noticed that you didn’t mention CPAP/APAP/BIPAP as options for these breathing problems. I was diagnosed with UARS last summer, and since I started using a CPAP, the number of migraines I get has dropped dramatically. I was getting migraines after every Karate workout for a while, and had to take liquid advil before to prevent them. Since I started using my CPAP every night, I have only had one migraine!

    For years, I had restless legs at bedtime and was taking mirapex for it. I also developed asthma in my early forties and suddenly gained 40 lbs around the same time. As a child I had respiratory problems at night and had my tonsils and adenoids removed. I have always been a restless sleeper and have a small mouth. I suspect I have had UARS most of my life, and it got worse as I got older. With treatment, my RLS as almost disappeared (still struggling to get off the dopamine agonist, though). I have very little leg movements in sleep now, and my deep sleep and REM sleep both doubled during my titration study. After 6 months, I am at the point where I rarely need my asthma inhaler. Big improvements! I still suffer from some anxiety though – it has other causes than UARS, I believe, but sleeping better does help with it. I know many people can’t adjust to using a CPAP device, and it’s a shame, because it is such an effective, non-invasive treatment for breathing problems in sleep. I love mine.

  12. Jennifer,

    Thanks for sharing your story. I do recommend any of the standard OSA treatment options for people with UARS. It can be somewhat challenging since most insurance companies don’t cover for UARS. I have had numerous reports, like you, of dramatic improvements in various symptoms after using CPAP, oral appliances, or even surgery. Unfortunately, for many people with UARS, CPAP can make things worse.

  13. I relate to Diana’s post from 2012. I’ve had a sleep study and while I definitely snore, not enough for sleep apnea. I also have a type of tinnitus in my left ear and wake up almost every morning with a headache that turns into a migraine. Was very sad when the sleep study neurologist had no opinion/thoughts on my snoring and migraines. I feel like once again my suspicions have not met up with medical science. To her there was no correlation what so ever. I can not obtain more than 9 abortive sumatriptan pills a month so I ration all the time. Those with mirgraines know that if you aren’t aggressive (and early) with the meds the “beast” takes over. You are incentivized to be neither when you know you might run out before the end of the month. I’ve been discouraged from using Asfrin. But flonase and nasal irrigation doesn’t seem to do anything at all.My doctor does say my upper airways are on the small size – but workable. Thanks for this site.

  14. thank you very use.. I suffered for past 12 years but i not know what is the reason.. Now i cleared proper oxygen is requied..

  15. I have had chronic daily migraine for 25 years but I am now much better thanks to oxygen treatment. I have an oxygen concentrator and have one hour each day of O2 at 10 litres per minute. While using the concentrator I concentrate on slowing my breathing rate. I still wake with pain each morning but it is around 10% of what it was before I started on oxygen.

  16. This is so interesting! I have been treating migraine for ten years with my “Migraineyoga” . And I see so much breathing problems in my clients. Maybe the most important in treating headaches with yoga is our breathing techniques?

  17. I think I have been wrongly diagnosed with fibromyalgia!
    Everything you list in this article is me!
    I do t snore but I have have every symptom mentioned.
    I have spent the last 9 years vomiting up to 30 times a day every day.
    I’ve had every test and medication going and nothing has helped.
    I get the occasional head migraine but mostly I get stomach migraine.
    Thankyou for this article!!!