They always seem to strike at the worst times; I knew it was coming the last time I was at Disneyland when I started seeing spots. Then came the intense pain behind my eyes followed by nausea.
Rather than spending my day pounding churros and riding Matterhorn, I was stuck in the hotel with a wet washcloth on my neck and a pillow over my head, desperately praying that sleep would bring some sweet relief.
Migraines: you either hate ‘em or you’ve never had one. So what are they anyway, and what can we do about them?
Headaches and migraines are often used synonymously, but there are some key differences between the two. Much like how a square is a rectangle but a rectangle is not always square, a migraine is a type of headache, but a headache is not always a migraine. There are many different types of headaches, including cluster, tension, and sinus headaches.
Generally, the pain that comes with common headaches is not as intense and is not associated with other symptoms. Migraines are severe and accompanied by other issues, such as pain behind one eye, seeing spots, sensitivity to light, loss of vision, and nausea.
There are two different categories of migraines, those with an aura (a classic migraine) and those without. An aura is “sensory disturbances” that happen about an hour before it hits.
These disturbances can include:
Some go through a prodrome phase, or “preheadache,” up to several days before the headache itself. During this period, some experience constipation, tiredness, neck stiffness, and depression, among other things.
The headache itself can last up to several days, and, as if that isn’t enough, a postdrome phase can bring tiredness, depression, and difficulty concentrating for a day or two afterwards.
Source: “The Timeline of a Migraine Attack”, American Migraine Foundation
That all sounds terrible, right? Once migraine sufferers can recognize the triggers that bring them on, they can learn to avoid them. Although we don’t know exactly why migraines happen, research shows that timing may be a large factor.
Dr. Alex Nesbitt, researcher in Clinical Neurology at the University of Surrey, explains it this way:
“The balance of sleep and wakefulness, and its correct timing, relies on a finely tuned system … referred to as homeostasis. If too much overloads this system in favour of one state (sleep or wakefulness) versus the other … the system will try and compensate to redress the balance.”
Jet lag, sleeping in on weekends, staying up late, or taking naps can throw off this balance, and your body will try to readjust. One theory is that migraines could possibly be your body’s way of attempting to get back to normal. (An example of this is someone getting significantly less sleep than normal may be forced to lie down and rest because of a severe headache.)
Lack of rest is the most common correlation to headaches, which is perhaps why insomnia is so common among migraine sufferers.
Globally, chronic migraines are the second largest contributor  to years lived with disability and are more prevalent than asthma, diabetes, and epilepsy combined. Despite this, migraines — and headaches in general — are one of the least funded diseases in the world. 
What research has been done shows a relationship between sleep disorders and severe headaches. A study in South Korea not only showed an increase of headaches year by year but also a positive correlation between disorders and migraines, especially insomnia (see chart below).
Source: “The Association between Migraine and Types of Sleep Disorder”, MDPI
For those with regular migraines, insomnia is the most frequently occurring disorder; in fact, most patients complaining of headaches also have insomnia. Additionally, many who suffer from both insomnia and migraines had some kind of past mild head injury.
We know that a lack of sleep is a common trigger for migraines, so it only makes sense that insomnia would be so prevalent for headache sufferers.
In a University of North Carolina, Chapel Hill study, researchers surveyed 147 migraine patients. For those who had more than 15 headache occurrences a month, insomnia was the most common complaint. Two-thirds of the participants had trouble falling asleep.
Those with both problems may constantly run into the issue of juggling rest in conjunction with their headaches; someone with a headache may want to nap in order to “sleep it off.” But the Journal of Clinical Sleep Medicine suggests that this could cause some problems when it comes to sleeping at night, potentially leading to chronic insomnia.
Just as insomnia gets in the way of good rest, sleep apnea makes the rest that you do get a lot less, well, restful. Sleep apnea is a disorder that disrupts your breathing at night, repeatedly starting and stopping. A study from the American Academy of Neurology found an underdiagnosis of apnea in those who experience migraines.
Many people that have apnea do not actually know it; it may not actually wake them up all the way, but it can be pretty serious and lowers the quality of rest. If you struggle with headaches, snore, and wake up feeling tired, you may have apnea, and you should have a chat with your doctor.
Most have experienced that feeling of just needing to move your leg—now, imagine having that urge all night long. Those with restless legs syndrome struggle with this exact thing, getting in the way of precious sleep.
Similar to apnea, those who have this disorder concurrently with migraines may be able to treat the latter by treating their sleep disorder. Headaches might actually be a symptom of the lack of good rest.
Another type of sleep disorder associated with migraines is circadian rhythm disorders that disrupt a person’s innate clock. A circadian rhythm is essentially how our bodies know what time of day it is and whether we should be awake or sleeping. It’s what tells us something is up when we turn the clocks forward for Daylight Savings Time and when we travel across time zones.
When a person’s circadian rhythm is thrown off, rest can come and go at odd times of the day and night, making a good night’s rest seem impossible. This can definitely cause some issues with migraines, especially for night shift workers or regular travelers.
If lack of rest is the problem, then shouldn’t you sleep as much as possible? Well, not exactly. We mentioned earlier that sleep deprivation is the most common cause of a migraine; however, too much rest can also put your system out of whack.
When it comes down to it, the quality of rest that you get is much more important than the quantity. Studies show that cluster headaches mainly occur during a night’s rest, so trying to sleep off a headache may not necessarily be the best solution. Getting to the root of the problem is the best way to decrease the frequency of migraines, which is why those with disorders have seen improvement by treating their disorder with the help of their doctor.
So what should you do when a migraine inevitably comes along to ruin your day? Starting with healthy bedtime habits can make a huge difference.
The study from the University of North Carolina, Chapel Hill surveyed migraine sufferers to examine what kind of patterns occurred. Almost 80 percent of participants watch television or read in bed, 70 percent woke up in the night to go to the bathroom, 60 percent napped during the day, and over 50 percent used sleeping pills regularly. Researchers put these habits to the test to see if changing things reduced the frequency and intensity of headaches.
Two groups of women were given instructions to follow for six weeks; one group was given placebo instructions, and the other group instilled new pre-bedtime habits. After six weeks, the women with altered bedtime behavior noted that their headaches significantly improved in severity and frequency. Some improved so much that they no longer had chronic migraines.
So here are a few tips and tricks to try out, along with advice from your doctor, of course.
Ever notice that you start getting tired at the same time every night? This is totally normal; in fact, it is actually the perfect queue to listen to. When your bedtime waivers, your body may struggle to predict when it is time to go to bed, which can lead to problems falling asleep and staying asleep.
Going to bed at the same time every night gives your body a change to self-regulate its biological clock and expect when sleep is coming each night — yes, even on the weekends. Try to plan your bedtime so that you can regularly get 8 hours of rest.
Having a predictable routine before bed can help trigger a sleepy response. Light a candle, take a hot bath or shower, listen to a podcast, or meditate for a few minutes before getting into bed. Some calming activities can tell your brain it’s time for rest.
Eating big or fatty meals late at night can make it difficult to fall asleep. To keep those midnight bathroom runs at bay, avoid drinking too many fluids before bed. Caffeine can stimulate your brain for hours after consumption, and although alcohol may bring on initial tiredness, it can prevent you from getting deep rest.
Although sleep can seem like a short term solution for headaches, long term, it may lead to some bigger problems like insomnia. Too much daytime rest can get in the way of your nighttime sleep, especially if napping has become a regular thing for you. If you really need a nap, however, try to limit them between 10 and 20 minutes, and do not nap after 3 PM.
Commonly, sleep deprivation is a cause of headaches. Even if you think you are getting the right amount of sleep every night, you could actually be struggling with the quality of rest. Talk to your doctor about the possibility of a disorder; many people do not even know that they have one.
Even if you do not have a disorder, consider making sleep a priority each night in order to regulate your body’s natural system and keep those headaches in check.
Certain medications can cause sleeping problems, and side effects often include insomnia. Some can even make you too drowsy. Both of these issues can be the source of migraines, so be sure to ask your doctor about this possibility.
Along with the tips and tricks above, be sure to check with your doctor for more personalized suggestions. Since your doc has your full medical history, he or she will be able to help diagnose possible disorders, prescribe medications, and discuss other treatment options.
For some, the best treatment is behavioral therapy — 30 to 60 percent of patients have fewer headaches than before when using CBT to cope. This treatment can include stress management, understanding and avoiding certain migraine triggers and altering physical habits (such as eating, exercising, and sleep).
A common misconception about CBT is that it is used instead of medication, but therapy can easily be used alongside medication or other physical treatments. A psychologist can work with your medical doctor to find the best way to treat your situation.
The connection between sleep and migraines is undeniable, and it can actually be a much more delicate balance than you think. For me, I get migraines when I get less sleep than usual, so I try to give myself about eight hours to rest each night.
For you, it may be different; try adopting better bedtime habits in conjunction with advice from your doctor.
Let’s face it — migraines suck. But you do not have to suffer forever.
 Global Health Metrics, The Lancet
 Public Funding for Headaches, Cephalagia