Sleep, Migraine and Improved Patient Outcomes

By Angeliki Vgontzas, MD

The value of educating patients on healthy sleep habits

Poor sleep habits and migraine continue to be linked as more advanced technology allows physicians to reveal a stronger connection. Most physicians can attest that migraine patients consistently present with poor sleep habits. But what isn’t exactly clear is if something is happening during the migraine attack that is interrupting sleep, or if poor sleep can trigger more attacks.

“This is a really exciting time for sleep and migraine research because, as imaging continues to advance and clinicians are able to hone in on portions of the brain, additional breakthroughs could occur,” says Angeliki Vgontzas, MD, a neurologist at Brigham Health.

Help Patients Create a Healthy Sleep Schedule

Regardless of the why, it is imperative to help patients improve their sleep hygiene as part of a broader migraine management plan. As a first step, clinicians should speak with patients about their lifestyle and identify unhealthy sleep patterns. Make an effort to understand the number of hours they sleep, if there are any disruptions during their sleep (animal in their bed, kid waking them up), what hours of the day they sleep, and if they have difficulty falling asleep.

“I generally have a patient run through a typical day—when headache symptoms come on, what happens throughout the day and night,” says Dr. Vgontzas. “It gives me a sense of their day-to-day life to envision what a patient is going through on the daily basis.”

From there Dr. Vgontzas is often able to identify patterns that may need to be altered. She will work alongside shift employees to try and rearrange night schedules to day shifts, or partner with sleep specialists if her patients have difficulty falling asleep at night. When necessary, there are questionnaires that screen for some of the more serious sleep disorders like sleep apnea or insomnia.

For patients that have long term issues with frequent headaches, many medications include a drowsy element to help induce a deeper sleep among patients.

Small Changes, Big Results

“It’s very rewarding to work on sleep hygiene with a patient,” says Dr. Vgontzas.

This is because with less serious cases, patients can start seeing major improvement in just a few months or less. Typically, individuals who have unhealthy sleep patterns who see the most benefit, meaning a reduction in migraine days. Even in patients with insomnia, have shown improvements with the right medications and sleep when working in partnership with sleep specialists.

So while clinicians wait for improved technology and more targeted research studies pertaining to migraine treatment and research, it remains extremely beneficial to doing a sleep assessment with patients—something that takes a short amount of time for physicians but can greatly alter the lives of their patients.