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The Connection Between Migraines & Sleep-Breathing Problems

Posted Jul 23 2011 12:54am

Michelle Bachmann’s recent revelation that she suffers from migraines brings up an important point that most doctors and the lay public don’t appreciate: the importance of proper breathing at night. It’s commonly known that sleep deprivation can cause or aggravate migraines, but what’s usually assumed is that migraine sufferers are breathing well at night. If you’ve read my articles or listened to my teleseminars, I can make a convincing argument that migraine sufferers all have some variation of a sleep-breathing disorder, of which only a small fraction have obstructive sleep apnea.

Not Your Normal Migraines

The classic migraine headache is described as a one-sided, debilitating, pounding, intense headaches that’s associated with nausea, vomiting, light or sound sensitivity. Notice that classically, migraines get better with sleep. Recently, neurologists have expanded the definition of a migraine attack. Any time the nerves in any part of your body becomes oversensitive or overly excitable, then you’ll experience symptoms that are specific to that part of the body.

For example, if the nerve endings in your sinuses are suddenly extra sensitive, then you’ll feel pain, pressure, nasal congestion, and post-nasal drip. In fact, it’s been shown that the vast majority of chronic sinus headache and pain sufferers actually have a variation of a migraine, with normal CAT scans. Many people are placed on oral antibiotics empirically, when there’s no bacterial infection.

You can also have migraines in your stomach. This can present as nausea, vomiting, diarrhea, constipation, or bloating. It’s been suggested that children who suffer from chronic abdominal pain actually suffer from migraines.

If you have a migraine attack in your inner ears, you’ll feel dizzy, lightheaded, feel fullness, or have hearing loss or ringing. This is called vestibular variant of migraine.

Problems Due to Your Tongue?

One anatomic feature that I see all migraineurs have in common is the very small nature of their upper airways, especially in the space behind the tongue and in the nose. I talk about how most modern humans have smaller jaws and facial skeletons due to a radical change in our diets and lifestyles. This leads to dental crowding, which narrows the space behind your tongue, especially if you lay flat on your back. When you go into deep sleep, since your muscles will relax, you’ll stop breathing and wake up to turn over to your side or stomach. This is why most people with this type of anatomy can’t sleep on their backs.

You Are A What?

These breathing pauses usually aren’t long enough to be called apneas (at least 10 second pauses), and usually don’t lead to lowered oxygen levels. However, it does lead to more frequent arousals and sleep fragmentation. Essentially, you can’t stay in deep sleep. In most cases, you won’t even realize that you’re waking up. What you will feel is not feeling refreshed when you wake up in the morning, or feeling like you only slept for 2-3 hours.

In the early 1990s, a new type of sleep-breathing problem called upper airway resistance syndrome (UARS) was described. Young women and men who didn’t meet the official criteria for obstructive sleep apnea were recruited and underwent esophageal pressure monitoring. What they showed was gradually increasing negative inspiratory pressures leading to an arousal, but not severe or long enough to be called apneas or hypopneas. Officially, apneas require at least 10 second breathing pauses, whereas hypopneas require 30 to 50% drop in airflow, along with arousals or oxygen level drops. However, if you don’t reach the 10 second threshold for apneas or hypopneas, then they’re not scored at all. So in theory, you can stop breathing 20 to 30 times every hour and not officially have obstructive sleep apnea.

En garde

Not being able to get deep, refreshing sleep can lead to a physiologic state of stress, where your entire nervous system can become heightened and hypersensitive, even carrying over into the daytime. Poor sleep quality also cause muscle tension and tightening, which can predispose to headaches, TMJ, neck spasms or backaches. Even your senses can become overly sensitive, especially to weather changes, chemical, scents or odors. In this particular situation, even your creativity or intuition can be heightened.

Notice how many of the features of a migraine attack are very similar to suffering from a hangover: nausea, vomiting, brain fog, and sensitivity to bright lights and loud noises. This is your involuntary nervous system over-reacting to something that’s not normally bothersome.

Simple Steps to Take

So if you suffer from any of these migraine types, what can you do besides take prescription medications? Here are 5 basic steps for better sleep and less headaches:

1. Don’t eat anything within 3-4 hours of bedtime. Having juices in your stomach can promote reflex into your throat, causing more arousals and less efficient sleep.

2. Don’t drink any alcohol within 3-4 hours of bedtime. Alcohol relaxes your throat muscles, causing more frequent obstructions and arousals.

3. Keep your nose clear. If your nose is stuffy for whatever reason, do everything possible to keep it open. Having a stuffy nose creates a vacuum effect downstream in the throat which causes your tongue to fall back more often. Use nasal saline irrigation systems, nasal dilator strips, allergy medications, decongestants and even surgery if the former options don’t work that well.

4. Don’t sleep on your back. Back sleeping promotes tongue collapse due to gravity.

5. Do more yoga, tai chi, or deep breathing exercises to calm your nervous system. Take 4-5 slow deep breaths anytime you have 15 to 30 seconds, such as while standing in line, in-between major activities, on hold one the phone, or walking to another room. This helps to activate your parasympathetic nervous system, which helps to calm and relax your body. Acupuncture can also help.

Other Steps to Take

Once you’ve tried these conservative options, and you wish to take it to the next level, consider undergoing a thorough ear, nose and throat evaluation to see of you have any narrowing in your breathing passageways. In particular, your doctor should focus on your nasal septum and turbinates, your nostrils (to see if they collapse), tonsils, adenoids, lingual tonsils, soft palate and tongue base areas.

Many people with migraines will have either UARS or sleep apnea. Standard treatment options can help to alleviate migraines significantly. Dental appliances and specialized orthodontics are also an excellent option—these options are more important if you have any significant dental crowding, bite issues, or if you have a very small mouth. Dentists can also help with TMJ, which can overlap significantly with migraines and various other facial pain syndromes.

Botox can also be used for migraines, but just like using prescription migraine medications, are only covering up the causes, rather than treating it.

To a certain extent, OTC medications, and  natural herbs or supplement (like feverfew), while they do work to various degrees, doesn’t help everyone. But it’s worth trying, if you’re interested.

Avoiding migraine triggering foods: red wine, aged cheeses, chocolate, and MSG.

I don’t usually recommend surgery, but it can be a viable option if the more conservative options don’t help. There are a number of different options, depending on where the narrowing occurs in your breathing passageways.

Hope for Migraine Sufferers

One of the most gratifying experiences is to have patients tell me that their migraines (or even cluster headaches) went away after various forms of surgery. It even happens sometimes with some of the non-surgical, conservative options.

It’s a given in our culture that migraines must be treated with a pill, and I want to dispel that stereotype. I believe that trying to achieve the best possible sleep (by breathing better) is a better way of improving migraines. It’s important to combine the various conservative steps along with techniques to help you breathe better and sleep better. Rather than focusing on the migraine only, it’s more important to re-evaluate your entire life situation, and be willing to make the lifestyle changes that can not only improve your migraines, but also significantly improve your overall quality of life.

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