Thread by @beth_morton

This week’s #MigraineChatAMA invited Qs about the relationship between sleep disorders and #migraine.

Nothing shared is medical advice. Please talk to an HCP before making changes to your migraine treatment. Errors are mine. #MigraineChat /1

What is the relationship between sleep and #migraine? “[T]he exact nature and direction of the association remains enigmatic; migraine may be the result of sleep disruption, but also sleep disruption may trigger migraine,... [cont.]
#MigraineChatAMA /2

"...or migraine and sleep disruption may be symptoms of an unrelated medical condition, or they might be two intrinsically related phenomena with shared pathophysiological mechanisms.”
…alofheadacheandpain.biomedcentral.com/articles/10.11… #MigraineChatAMA /3

Regarding common, underlying mechanisms: new evidence suggests that sleep & migraine share important, common brain structures (e.g., the hypothalamus) & common “signaling” neurotransmitters, neuropeptides, and hormones. #MigraineChatAMA /4

What sleep-related conditions are comorbid w/migraine? Insomnia, snoring & sleep apnea, restless leg syndrome, narcolepsy, sleep-wake disorders, parasomnia, sleep walking, teeth grinding, all occur at ⬆️rates in ppl w/#migraine compared to those without. #MigraineChatAMA /5

Source for last few tweets: …adachejournal.onlinelibrary.wiley.com/doi/abs/10.111… [abstract only] #MigraineChatAMA /6

What about nightmares & #migraine? There aren’t a lot of studies on this, but the few exist seem to suggest ppl w/migraine report greater dream “behavior” (evidence of dreaming during REM sleep) & nightmares. mdpi.com/2076-328X/11/9… (see also tweet # 6 source) #MigraineChatAMA /7

We need more research to clarify the relationship: i.e., whether bad dreams are a sort of prodrome (attack is already starting) or bad dreams are related to sleep disruptions and that ends up being the migraine trigger. #MigraineChatAMA /8

Why do we wake up w/a migraine attack? “[I]t’s believed headaches when you wake up are related to changes in the activity of the hypothalamus. This brain region regulates pain perception as well as your natural sleep-wake cycle....” Source ⬇️
#MigraineChatAMA /9

Source for tweet # 9:
verywellhealth.com/headache-at-ni… #MigraineChatAMA /10

Waking up *in the morning* w/a migraine attack? It could be triggered by a few things:
-Dehydration
-Blood sugar changes
-Alcohol (hangover)
-Medication withdrawal (medication overuse)
-Caffeine withdrawal
-Teeth grinding, clenching
-Sleep pattern* (Cont.)
#MigraineChatAMA /11

Sleep patterns include: too much or too little sleep, inconsistent bedtime or wake times, snoring, sleep apnea, sleep disruptions, insomnia, poor sleep quality. verywellhealth.com/obstructive-sl… #MigraineChatAMA /12

If the attack wakes you in the middle of the night or is worse first thing in the morning (but improves after you wake up), talk to a headache specialist about other headache disorders (three examples follow). #MigraineChatAMA /13

Hypnic headache - key feature is that it only develops during sleep and wakes you up. It also tends to affect both sides of the head and be shorter in duration than a migraine. medicalnewstoday.com/articles/hypni… #MigraineChatAMA /14

Cluster headache - typically severe pain centered around one eye that commonly starts at night, peaks quickly and lasts < 3 hrs. Occurs in clusters and is often accompanied by eyelid droop, tearing, runny or stuffy nose.
ncbi.nlm.nih.gov/pmc/articles/P… #MigraineChatAMA /15

Idiopathic intracranial hypertension - may wake you up or be worse after lying down (improves if upright), can be accompanied by blurred vision, pulsatile tinnitus.
merckmanuals.com/home/brain,-sp… #MigraineChatAMA /16

How to prevent waking up w/a migraine? How to get a good night’s sleep? This depends on the possible trigger(s). I recommend reviewing the list of possible triggers in tweets # 11 & 12, trying to track which might be the likely culprit(s).... #MigraineChatAMA /17

and working w/a headache specialist to determine what treatments or tests are needed: adding a preventive migraine treatment or treating comorbidities (like CPAP for apnea)... (cont) #MigraineChatAMA /18

Non-pharma treatments can include devices (e.g., mouth guards), sleep-focused CBT (CBT-I), changing diet or meal times, practicing good sleep hygiene (when possible). #MigraineChatAMA /19

More on treatment options: verywellhealth.com/obstructive-sl…
#MigraineChatAMA /20

Many will recommend CBT-I (insomnia), relaxation techniques, or good sleep hygiene. While all these can help, those in the #MigraineChat community often note that sticking to the practices are not always easy when mid-day attacks or fatigue, etc., ramp up. #MigraineChatAMA /21

How to treat a morning migraine? Aside from the above preventive options, consider your acute options. Morning attacks are some of the toughest to tackle because you have lost the chance to “treat early.” #MigraineChatAMA /22

For morning attacks, any of your acute treatments can be used but often non-oral/non-tablet acute treatments will work best for attacks in progress: e.g., IM sumatriptan or ketorolac, intranasal DHE or triptans, orally-disintegrating gepants or triptans, etc. #MigraineChatAMA /23

Why is sleep sometimes restorative, but other times makes migraine attacks worse? This question plagues me, but bear with me as I try to explain in a few tweets.
-We have a glymphatic systems that clears waste, primarily as we sleep. (Cont.) #MigraineChatAMA /24

More...
-Migraine may disrupt the glymphatic system, preventing proper function, possibly creating an accumulation of waste, & contributing to migraine (a vicious cycle).
-Cortical spreading depression in mice was related to impaired glymphatic flow. (Cont.) #MigraineChatAMA /25

More…
-This might be worse in people with chronic migraine due to chronic sleep disruptions.
…adachejournal.onlinelibrary.wiley.com/doi/abs/10.111… #MigraineChatAMA /26

Some additional resources:
On sleep hygiene: sleepfoundation.org/sleep-hygiene
On CBT-I: sleepfoundation.org/insomnia/treat… #MigraineChatAMA /27

Please do not use thread readers to unroll these #MigraineChatAMA threads or directly repost this without attribution. Collecting this info takes a lot of research. I don't want others to post/profit off my work. #MigraineChatAMA /28

Find these threads helpful? The tip option in my profile is live or support #MigraineChat these other ways ⬇️

https://twitter.com/beth_morton/status/1550208122194731008?s=20&t=ba0ZxZZflauTeAUc7xRk3g

#MigraineChatAMA /29

As usual, feel free to add any resources that might be helpful, ask for clarification, etc.

#MigraineChatAMA /30

Last note, I try to use open access (reputable) sources in my threads. However, one really good one in this thread is paywalled. So, a reminder of ways to access academic papers.

#MigraineChatAMA /31

https://twitter.com/LNivisonSmith/status/1577772262689624064?s=20&t=oUHr-6bNeOVmJeoEP2rgtQ

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