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Migraine is the most common neurological disorder, often affecting half of the head, is often pulsating and throbbing in nature, and can last from two to more than 72 hours. Migraine often leads to poor quality of life, disability and is commonly accompanied by other disorders, including depression and anxiety. (1, 2) It has been stated that there is a relationship between migraine and sleep disorders. (3)
The quality of sleep is associated with the quality of life. One-third of adults in the U.S. have insomnia or poor sleep quality. (3) Disturbed sleep is especially common in adults and children with migraine. Approximately 30% to 50% of migraine patients have disturbed sleep. Sleep disruption can cause migraines, and sufficient, restful sleep helps relieve migraine attacks. Chronic migraine patients often suffer from morning headaches caused by poor, disrupted sleep. (4, 5, 6)
Migraine patients have a greater incidence of poor sleep quality compared to persons without migraine. (4, 5, 6, 7) Recent, large, carefully-controlled studies have shown direct associations between insomnia and headache occurrence. (7, 8, 9) An epidemiological study suggested that migraine and tension-type headaches were significantly related to insomnia. (10) Sleep quality was reported as especially poor in patients with eight or more migraines per month and much better in healthy controls than in migraine patients. (6) Collectively, these studies suggest that there are strong associations between sleep and migraine.
A more detailed analysis of a large population of 2,695 people showed that 27% of them had insufficient sleep. Out of these, 45.5% of migraineurs had insufficient sleep, people with non-migraine headaches had 32.9% of insufficient sleep and people with no headaches had a 20.4% rate of insufficient sleep. Looking at these figures, one would suspect that headaches regardless of type, would be responsible for insufficient sleep. (11) In the present study when you add both the migraine sufferers with ordinary headache sufferers the total people with insufficient sleep becomes a staggering 78.4%, suggesting that headaches, regardless of type, play a major role in insufficient sleep.
Lack of sleep is the most commonly reported trigger of headache. (12) In other studies, more than 80% of migraine patients identify stress and sleep disorders as headache triggers. (13, 14, 15)
Similarly, “lack of sleep” by itself is considered a trigger in 45% to 74% of persons with migraines and 26% to 72% of persons with tension-type headache. (15) Sleep disturbance has been strongly identified as a headache trigger and one study reports that coping with ‘stressors’, i.e., ‘lack of sleep’ is a better strategy than avoiding the ‘stressors’ (15, 16). A large study of migraine and sleep disorders conducted by Kelman and Rains included 1,480 headache sufferers with 1,280 migraineurs and reported that “approximately half of patients reported at least occasional symptoms of insomnia, 38% reported sleeping less than 6 hours per night, and 50% of patients reported that sleep disturbance triggered their migraines. The severity and prevalence of sleep problems increase proportionally to headache frequency, such that the majority of chronic migraineurs (68-84%) suffer from insomnia on a near-daily basis. (15)
Chronotype is an individual’s circadian clock rhythm and how it synchronizes to the 24 h day. Some people are evening people often referred to as ‘owls’ while other people are morning people, called ‘larks’. Both the late evening and the early morning people are at higher risk for migraines in the general population. A study of 2,875 migraineurs and 200 healthy headache- free adults aged 18–74 years was conducted using the Munich Chronotype Questionnaire. The MCTQ measures a person’s subjective self-reported chronotype, either early, normal, or late. The study authors found “that migraineurs are less prone to be of a normal chronotype compared with healthy controls and that they are less flexible in adapting to changes in the sleep/wake cycle. Migraine attack onset peaks in the early morning and is related to early chronotype.” This is in alignment with other studies show that found most migraine onset does begin in the early morning. (17)
Three equal groups of chronic migraine sufferers were given either 3 mg. of melatonin, sodium valproate or a placebo in a clinical trial. The study compared the migraine attack severity, the attack frequency, and the attack duration of the three groups over 3 months using the Migraine Disability Assessment (MIDAS) score. The results showed that the melatonin group had an equal reduction in all migraine measurements when compared to the sodium valproate group. Only 2 persons in the melatonin group had significant side effects compared to 8 persons with significant side effects in the drug group. The study authors concluded that “The adjuvant treatment with melatonin was found to be superior to the placebo and had the same clinical efficacy as sodium valproate, but with higher tolerability. Melatonin may prove to be an efficient substitute for sodium valproate, as a chronic migraine prophylaxis. (18)
These study results are not surprising since melatonin is well-known for resetting the circadian rhythm in humans. The results are in alignment with the previous study that showed migraine patients “are less prone to be of a normal chronotype compared with healthy controls and that they are less flexible in adapting to changes in the sleep/wake cycle. (17)
In the great majority of headache and migraine cases, sleep disturbances and insomnia are the driving forces behind these pathologies and are intertwined as to cause and effect. This often occurs in a vicious cycle where the pain and discomfort from the migraine causes insomnia and the insomnia causes the migraine to intensify and last longer.
NATURAL ALTERNATIVES FOR SLEEP
Alternative headache and migraine therapies include psychological counseling, biofeedback, and physical therapy, which work by making lifestyle changes. Non-pharmacological treatments for the management of migraines and headaches has a growing field of science to support their use. Biofeedback techniques teach patients to control certain responses of their body to help reduce pain. For example, a patient can learn diaphragmatic breathing, heart rate, muscle tension and how to control temperature to enter a relaxed state, which may bring about better pain control.
Alternative treatments for insomnia and disordered sleep include background music, acupuncture, prayer, deep breathing, meditation, yoga and massage.
Non-pharmacological treatments include natural supplements for sleep which avoids the serious side effects of prescription drugs. Drug-related side effects include kidney damage, ulcers, dependence, addiction, tolerance development requiring higher doses, rebound insomnia, withdrawal symptoms and daytime grogginess. (19, 20, 21)
INGREDIENTS FOR SLEEP
Seven clinically proven ingredients (vitamins, minerals and herbs) that support healthy sleep in human clinical trials include; Hops extract, Valerian, Zizyphus Jujube seed extract, Glycine, Vitamin B-6 (Pyridoxine HCL), Magnesium and Melatonin. The Hops and Valerian root extracts i improve sleep quality, shorten time to fall asleep, and improve subjective measures of restfulness after waking. (24, 25, 26, 27, 28, 29) The Ziziphus jujube seed extract has also been clinically proven to be extremely beneficial to people with occasional sleeplessness. (30) Likewise, Glycine which has multiple health benefits also has been shown to improve sleep quality. (31, 32, 33) Vitamin B6 (Pyridoxine HCL) helps helps your body convert food energy into glucose, metabolize fats and proteins, and ensure proper function of your nervous system. With these various effects, there are ways in which your vitamin B-6 status may cause or contribute to your sleeping difficulties, or insomnia. Pyridoxine is considered adequate for neurotransmitter production to support sleep. Studies also show vitamin B6 is essential for promoting and maintaining a good mood. Migraineurs can be deficient in Magnesium, which helps restore sufficient Magnesium levels needed for sleep as well. People with migraines have circadian rhythm (the sleep-wake cycle) disruption and Melatonin supplementation can help restore this imbalance to provide more restful sleep, longer sleep time, and time to fall asleep. (34) These ingredients fill in nutritional deficiencies and address the issue of sleep-wake cycle disruptions to restore healthy sleep patterns.
To the Best of Health,
Curt Hendrix, M.S., C.C.N., C.N.S.
References:
1.Vos T, Barber RM, Bell B, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; 386:743–800.
2.Chu, HT, Liang, CS, Lee, JT, Yeh, TC, et al. Associations Between Depression/Anxiety and Headache Frequency in Migraineurs: A Cross-Sectional Study. Headache. 2018 Mar; 58 (3): 407-415.
3.Walsh, J, Coulouvrat, C,Hajak, G, et al. Nighttime Insomnia Symptoms and Perceived Health in the America Insomnia Survey (AIS). Sleep. 2011 Aug 1; 34 (8): 997–1011.
4. Lin YK, Lin GY, Lee JT, Lee MS, et al. Associations Between Sleep Quality and Migraine Frequency: A Cross-Sectional Case-Control Study. Medicine (Baltimore). 2016 Apr; 95 (17): e 3554.
5. Kelman L, Rains JC. Headache and sleep: examination of sleep patterns and complaints in a large clinical sample of migraineurs. Headache 2005; 45: 904–910.
6. Sahota P. Morning headaches in patients with sleep disorders. Sleep Med 2003; 4:377.
7. Seidel S, Hartl T, Weber M, et al. Quality of sleep, fatigue and daytime sleepiness in migraine, a controlled study. Cephalalgia 2009; 29: 662–669.
8. Rasmussen BK. Migraine and tension-type headache in a general population: precipitating factors, female hormones, sleep pattern and relation to lifestyle. Pain 1993; 53:65–72.
9. Odegard SS, Sand T, Engstrom M, et al. The long-term effect of insomnia on primary headaches: a prospective population-based cohort study (HUNT-2 and HUNT-3). Headache 2011; 51:570–580.
10. Odegard SS, Sand T, Engstrom M, et al. The impact of headache and chronic musculoskeletal complaints on the risk of insomnia: longitudinal data from the Nord-Trondelag health study. J Headache Pain 2013; 14:24.
11. Uhlig BL, Engstrom M, Odegard SS, et al. Headache and insomnia in population-based epidemiological studies. Cephalalgia 2014; 34:745–751.
12. Kim, J, Cho, S, Kim, W, et al. Insufficient sleep is prevalent among migraineurs: a population-based study. J Headache Pain. 2017; 18 (1): 50.
13. Kelman L. The triggers or precipitants of the acute migraine attack. Cephalalgia. 2007; 27: 394–402.
14. Spierings EL, Ranke AH, Honkoop PC. Precipitating and aggravating factors of migraine versus tension-type headache. Headache. 2001; 41:554–558. https://www.ncbi.nlm.nih.gov/pubmed/11437890
15. Houle, T, Butschek, R, Turner, D, et al. Stress and Sleep Duration Predict Headache Severity in Chronic Headache Sufferers. Pain. 2012 Dec; 153 (12): 2432–2440.
16.Kelman L, Rains JC. Headache and sleep: examination of sleep patterns and complaints in a large clinical sample of migraineurs. Headache. 2005; 45: 904–910. https://www.ncbi.nlm.nih.gov/pubmed/15985108
17. Hicks RA, Garcia ER. Level of stress and sleep duration. Percept Motor Skill. 1987; 64:44–46.
18. van Oosterhout, WPJ, van Someren, EJW, Schoonman, GG, et al. Chronotypes and circadian timing in migraine. Cephalagia. 2018 Apr; 38 (4): 617–625.
19. Ebrahimi-Monfared M, et al. Use of melatonin versus valproic acid in prophylaxis of migraine patients: A double-blind randomized clinical trial. Restor Neurol Neurosci. 2017.
20.Ingrasciotta, Y, Sultana,J, Giorgianni, F, et al. Association of Individual Non-Steroidal Anti-Inflammatory Drugs and Chronic Kidney Disease: A Population-Based Case Control Study. PLoS One. 2015; 10 (4): e0122899.
21. Castellsague, J, Riera-Guardia, J, Calingaert, J, et al. Individual NSAIDs and upper gastrointestinal complications: a systematic review and meta-analysis of observational studies (the SOS project). Drug Saf. 2012 Dec 1; 35 (12):1127-46.
22.Uzun, S, Kozumplik, O, Jakovljievic, M, et al. Side effects of treatment with benzodiazepines. Psychiatr Danub 2010 Mar; 22 (1): 90-3.
23. Tepper SJ. Debate: analgesic overuse is a cause, not consequence, of chronic daily headache. Analgesic overuse is a cause of chronic daily headache. Headache 2002; 42:543-547.
24.Dodick D, Freitag F. Evidence-based understanding of medication-overuse headache: clinical implications. Headache 2006; 46 Suppl 4: S202.
25.Ross SM. Sleep disorders: a single dose administration of valerian/hops fluid extract is found to be effective in improving sleep. Holist Nurs Pract. 2009 Jul-Aug; 23(4):253-6.
26. Dimpfel W, Suter A. Sleep improving effects of a single dose administration of a valerian/hops fluid extract – a double blind, randomized, placebo-controlled sleep-EEG study in a parallel design using electrohypnograms. Eur J Med Res. 2008 May 26; 13(5):200-4.
27. Koetter U, Schrader E, Käufeler R, Brattström A. A randomized, double blind, placebo-controlled, prospective clinical study to demonstrate clinical efficacy of a fixed valerian hops extract combination in patients suffering from non-organic sleep disorder. Phytother Res. 2007 Sep; 21(9):847-51.
28. Schellenberg R, Sauer S, Abourashed EA, Koetter U, Brattström A. The fixed combination of valerian and hops (Ze91019) acts via a central adenosine mechanism. Planta Med. 2004 Jul; 70 (7):594-7. https://www.ncbi.nlm.nih.gov/pubmed/15254851
29. Schmitz M, Jäckel M. Comparative study for assessing quality of life of patients with exogenous sleep disorders (temporary sleep onset and sleep interruption disorders) treated with a hops-valerian preparation and a benzodiazepine drug. Wien Med Wochenschr. 1998;148(13):291-8.
30. Müller-Limmroth W, Ehrenstein W. Experimental studies of the effects of Seda-Kneipp on the sleep of sleep disturbed subjects; implications for the treatment of different sleep disturbances. Med Klin. 1977 Jun 24; 72 (25):1119-25.
31. Xiaojia, N, Shergis, J, Guo, X, et al. Updated clinical evidence of Chinese herbal medicine for insomnia: a systematic review and meta-analysis of randomized controlled trials. Sleep Medicine. Dec. 2015. Vol. 16, (12): 1462-1481.
32.Soja, PJ. Glycine-Mediated Postsynaptic Inhibition is Responsible for REM Sleep Atonia. Sleep. 2008 Nov; 31(11):1483-6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2579976/
33. Inagawa K, Hiraoka T, Kohda T, Yamadera W, Takahashi M. Subjective effects of glycine ingestion before bedtime on sleep quality. Sleep Biol Rhythms. 2006; 4:75–77.
34. Yamadera W, Inagawa K, Chiba S, Bannai M, Takahashi M, Nakayama K. Glycine ingestion improves subjective sleep quality in human volunteers, correlating with polysomnographic changes. Sleep Biol Rhythms. 2007; 5: 126–131.
35.Brzezinski, A, Vangel, MG, Wurtman, RJ. Effects of exogenous melatonin on sleep: a meta-analysis. Sleep Med Rev. 2005 Feb; 9 (1): 41-50.