From the Research
There is a significant association between migraine headaches and obstructive sleep apnea (OSA), with OSA increasing the risk of developing migraine by 1.85-fold, as shown in a recent large population-based cohort study 1.
Key Findings
- The relationship between OSA and migraine appears to be bidirectional, with sleep apnea potentially triggering or worsening migraine attacks through mechanisms such as intermittent hypoxia, sleep fragmentation, and fluctuations in intracranial pressure during apneic episodes.
- Treating OSA with continuous positive airway pressure (CPAP) therapy can reduce migraine frequency and severity, as evidenced by studies showing improvement in headaches with CPAP treatment 2, 3.
- A causal association between OSA and migraine with aura has been suggested by a bidirectional Mendelian randomization study, indicating a potential causal effect of OSA on migraine 4.
Clinical Implications
- Patients with frequent morning headaches or migraines that don't respond well to standard treatments should be evaluated for possible sleep apnea.
- Maintaining good sleep hygiene and consistent sleep schedules is important for both conditions.
- Weight loss, positional therapy (avoiding sleeping on the back), and treatment of nasal congestion can also help manage OSA and potentially reduce migraine burden.
Management
- A typical CPAP regimen involves nightly use with pressure settings individually calibrated (usually between 5-20 cmH2O).
- Behavioral sleep modification and pharmacologic treatment may be considered for patients with insomnia or other sleep complaints.
- Assessment for depression and anxiety may be warranted when insomnia or hypersomnia is present, as psychiatric symptoms can affect the choice of sedating versus alerting versus neutral pharmacologic agents for headache.