Headaches and sleep quality have a vast and complex relationship. That’s why The Insomnia and Sleep Institute of Arizona is home to quadruple board-certified neurologist Dr. Vimala Sravanthi Vajjala, a neurologist who focuses on headaches, facial pain, and epilepsy as these conditions relate to sleep. Her board certifications include Neurology, Epilepsy, Headache Medicine, and Clinical Neurophysiology. Dr. Vajjala completed her residency in Neurology at Rutgers University, followed by a fellowship in Clinical Neurophysiology/Epilepsy at Barrow Neurological Institute as well as a fellowship in Headache and Facial Pain at the University of Arizona. She is one just only 750 board-certified headache specialists in the country who is board-certified in Headache Medicine by the United Council of Neurological Subspecialties, and an even smaller number of board-certified headache specialists who actually completed formal fellowship training in headache and facial pain.
If you struggle with headaches, including migraines, seeing a sleep expert like Dr. Vajjala, who specializes in the association between this type of pain and sleep can be the first step on your journey towards management of your condition. But what exactly are headaches, and how is sleep a factor?
There are many types of headaches, but migraines are perhaps the most well-known. Headaches are classified into either “primary” or “secondary” headaches depending on the underlying cause. Primary headache disorders typically include migraines, trigeminal autonomic cephalalgias, and tension-type headaches. Secondary headaches are caused by another condition that triggers them, activating pain-sensitive structures in the head or neck. Secondary headaches are not very common, but can be serious and even life-threatening. They can be caused by many different conditions, including tumors or masses in the brain, hemorrhagic stroke, or inflammation of blood vessels.
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The American Migraine Foundation reports that those living with migraine headaches are 2–8 times more likely to also struggle with sleep disorders. Around half of migraine sufferers experience their first attack by the age of 12. Women are three times more likely to get migraines than men, though anyone can suffer from them. People with chronic migraines (classified as having 15+ “migraine days” per month) also have twice the rates of insomnia compared to those with fewer or no migraines.
Migraine headaches are defined as having recurring moderate or severe head pain that lasts anywhere from 4 – 72 hours. These types of headaches are often described as throbbing and usually affect only one side of the head. Light and sound sensitivity are normally reported by migraine sufferers, and nausea and vomiting can present alongside the pain. Unlike some other types of pain, physical activity can worsen migraine pain.
There are many activities that can trigger migraines, and everyone is unique. However, common triggers include alcohol—with red wine being particularly troublesome for many patients.
A change in sleep or lack of sleep can bring on a migraine attack. Additionally, skipping meals, menstrual cycles, stress, poor posture, and certain foods like aged cheeses and processed meats are all typically reported as migraine triggers. Avoiding your triggers is a key part of migraine management, but should be part of your treatment plan, not the whole of it.
A correct migraine diagnosis is also essential, as this type of headache can often be confused with other types of headaches or facial pain. For instance, migraines are often misdiagnosed as sinus headaches, but a sinus headache must be accompanied by an active infection. Migraines might also be misdiagnosed as a tension headache, although migraines limit or stop the person’s ability to function while tension-type headaches do not. Just like with sleep disorders, such as insomnia or sleep apnea, getting the right diagnosis for a headache is the first step in informing treatment.
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Treatments of Headaches and Migraines
There are multiple treatments for migraines and headaches—there is no primary treatment. The two categories of medications available for migraines are abortive therapy and preventative (or prophylactic) therapy. Abortive therapy is available on an as-needed basis to lessen the effects of the attack. These medications might be migraine specific or nonspecific and can include both over the counter (OTC) medications like Tylenol, Advil, Aleve, or Excedrin migraine, or may be a prescription. Prescription migraine medications are most often “triptans,” but there is also a new class of migraine prescription medications that target the Calcitonin-Gene Related Peptide (CGRP) protein. The specific abortive medication that may work best for you will be determined on your needs and how the migraine presents.
Preventative therapy medications work by decreasing the headache burden and are typically recommended for those with disabling headache attacks and/or a severe headache burden. If you have 6+ headaches per month or migraines that are severely debilitating (even if they are not “frequent”), preventative therapy medications may be for you. Daily preventative medications such as beta-blockers, anti-seizure medications, and antidepressants are commonly recommended or prescribed. Combination therapies may also be recommended if a single medication does not provide adequate relief.
Such therapies can include botulinum toxin injections, such as Botox and Xeomin, though these injections are not a first-line therapy and must be tried for 6 – 9 months on average to see improvement. Botulinum toxin therapy for headaches and migraines requires a very different approach than botulinum toxin injections for aesthetic purposes, and a great way to learn more about botulinum toxin for headaches is during botulinum toxin clinics at The Insomnia and Sleep Institute. This FDA-approved injection is a type of preventative therapy for migraine headaches that requires injections in several sites every three months. Those who experience relief with botulinum toxin for migraines, often in combination with other therapies, usually start to see results after 2–3 cycles (6–9 months). When botulinum toxin is effective, it will require ongoing maintenance to continue to prevent and lessen migraine headaches.
Medications and botulinum toxin for migraines and headaches are the most common treatments, but other complementary and alternative therapies are also available. For instance, transcranial magnetic stimulation (TMS) is a non-invasive option increasing in popularity in recent years. Acupuncture, lifestyle changes, behavioral therapies, and supplements have also been helpful for many patients—particularly those who want to avoid medication overuse. To learn more about therapies available for migraines, headaches, and facial pain, get in touch with The Insomnia and Sleep Institute of Arizona today where you will have access to leading experts in the field, including Dr. Vimala Sravanthi Vajjala.