Since 1970, scientists have known that there is a connection between certain types of nocturnal headaches (i.e., a headache that occurs in association with sleep) and certain stages of sleep such as slow wave sleep or rapid eye movement (REM) sleep. (REM sleep is often called the "dream" stage of sleep). Just why nocturnal headaches would only occur during a certain sleep stages continues to perplex scientists. A nocturnal headache awakens you with a sudden, short-lived pain. Once the pain subsides, you may go back to sleep, only to be awakened a few hours later by another headache. There are various types of nocturnal headache.
Types of Nocturnal Headaches
Five types of nocturnal headache are:
(2) cluster headache
(3) chronic paroxysmal hemicrania
(4) episodic paroxysmal hemicrania
(5) hypnic headache.
The pulsating, throbbing pain of a migraine headache is felt on one side in the temple area. Most people who have migraines do not have an aura (i.e., symptoms that herald the headache); for others an aura may occur a day or hours before the onset of the headache. Examples of an aura are seeing zigzag lines, shimmering spots, stars, or blind spots. During a migraine, nausea, vomiting, constipation, or diarrhea may occur. Avoiding lights, loud sounds, and physical movement may help in managing the pain of a migraine. When migraine occurs at night, it is usually after a person has had an increased amount of REM sleep or slow wave sleep. Slow wave sleep is the deepest stage of sleep; it is sometimes called "delta sleep."
A cluster headache begins with a sudden, severe (but not throbbing), one-sided pain felt around the eye. The headache can last from fifteen minutes to three hours. During the headache, tearing of the eyes, eye reddening, nausea, nasal congestion, facial sweating, contraction of pupil, drooping of upper eyelid, and swelling of the eyelid may occur. Unlike a migraine sufferer who wants to lie quietly, a person will move around in pain. Cluster headaches occur one or more times at night for a period of time (called a cluster), and then abruptly stop. The abrupt cessation usually lasts from months to years, although for some people the cessation can be a little as two weeks. Cluster headache comes in two forms: chronic cluster headache and episodic cluster headache. Cluster headaches are considered episodic if attacks have occurred for six months or less and chronic if attacks have lasted more than six months. The episodic cluster headache is associated with REM sleep, whereas the chronic cluster headache is not.
CHRONIC PAROXYSMAL HEMICRANIA (CHP)
Chronic paroxysmal hemicrania (which means "sudden one-sided headache") is similar to a cluster headache but differs in its much shorter duration (2 to 45 minutes) and more frequent attacks (at least five attacks daily). Pain is felt on one side of the head around the eye or around the temples and is accompanied by tearing, nasal congestion, runny nose, eyelid swelling, etc. The attack occurs most often during or just after REM sleep.
EPISODIC PAROXYSMAL HEMICRANIA (EHP)
Episodic paroxysmal hemicrania involves frequent attacks (e.g., 6 to 30 attacks) that are short-lived (e.g., one to thirty minutes). The pain is a one-sided severe throbbing pain around the eye or temple area. This may be accompanied by symptoms such as tearing of the eyes, nasal congestion, eyelid swelling that occur on the same side as the headache. After a period of daily attacks, there is a remission period lasting months to years. These attacks occur during or just after REM sleep.
The hypnic headache occurs in men and women who are 50 years old or older. It is felt as a throbbing, generalized pain that does not produce symptoms such as tearing of the eyes, eye swelling, and eye redness. An attack lasts fifteen minutes to three hours. Hypnic headaches are associated with REM sleep. Some people have a hypnic headache with every REM sleep period, which occurs approximately every two hours..
Treatment for sleep-related headache involves one of several approaches:
1. By altering how the neurotransmitter serotonin (which appears to play a role in headache) is used in the brain. Some drugs that alter serotonin transmission are sumatriptan, lithium carbonate, tricyclic antidepressants (e.g., imipramine), and methysergide.
2. By blunting pain through the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Examples of drugs used in this approach are indomethacin and caffeine taken in combination with ergotamine or in combination with an NSAID.
3. By reversing dilation of blood vessels. The pain of headache occurs when blood vessels suddenly dilate (i.e., become open). An example of a drug that prevents the sudden dilation of blood vessels is timolol.
4. By increasing the level of the neurotransmitter gamma-amino butyric acid (GABA). GABA inhibits the firing of nerves in the brain, thereby lessening pain. An example of a drug that increases GABA levels is valproic acid.
5. By blocking the spasm of arteries that occurs before their sudden dilation. Examples of drugs that prevent spasms of blood vessels are verapamil and flunarizine.
Nocturnal headaches may reduce the quality of your quality of life and interfere with sleep. In some cases, a hidden sleep disorder that interferes with sleep such as sleep apnea may contribute to problems effectively treating nocturnal headaches. Therefore, you may need to be assessed for a sleep disorder as part of your treatment approach for nocturnal headaches.
Did You Know . . . ?
Awakening with a headache may be associated with sleep apnea. In sleep apnea, tissues such as tonsils block airflow through the upper airway. This causes the blood oxygen level to fall. A person ultimately arouses briefly to take some deep breaths that restore the blood oxygen level to normal. Sleep apnea-related headaches are usually felt in the front of the head above the eyebrows, tend to be dull in character, and may last for at least one to two hours after awakening, and have no other symptoms (e.g., nausea) that typically occur with migraine or other type of nocturnal headaches.
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