SLEEP AND HEADACHE
Sleep patterns are closely related to headaches. Both are controlled by the same neurotransmitter (serotonin). Both seem to be regulated in a deep area of the brain called the "brainstem." Furthermore, sleep is an excellent method of stopping a headache. Insomnia and worsening of headaches seem to parallel each other; headaches seldom get better if the sleep pattern does not improve.
Typically, the normal sleep pattern consists of 4-6 ninety-minute sleep cycles. These consists of four quiet and one active (REM) stages. The quiet stages of sleep become progressively deeper through the night.
Either too much sleep or too little sleep may trigger the onset of a headache. Workers who switch shifts or have interrupted sleep are likely to develop headache problems. Irregular sleep hours may increase the frequency of headaches. The following recommendations are to improve sleep hygiene and thus improve headache control.
• Follow regular sleep hours, even on weekends. Awakening late on weekends may trigger headaches.
• Get enough sleep. We recommend 7-8 hours per night.
• Use your bed for sleeping (not solving problems, reading, watching TV, etc.)
• Prepare for sleep: take a warm bath, listen to quiet music or drink warm milk.
• Eliminate stimulants such as nicotine and caffeine.
• Avoid napping during the day as this disrupts nighttime sleep.
• Exercise regularly, but not before bedtime.
• Improve your sleep environment. Your bedroom should be dark, quiet (mechanical noises may mask more irregular disruptive noises) and cool (about 65 degrees).
If you have difficulty breathing, choking spells, or loud snoring during sleep please bring this to our attention. If you have been diagnosed with a sleep disorder, such as obstructive sleep apnea it is absolutely necessary for you to follow treatment recommendations such as using CPAP every night. If you continue to have a sleep disturbance we may use headache medications which act on brain chemistries in such a way as to promote both sleep and reduce headaches.
HEADACHE AND EXERCISE
The interaction between headaches and exercise is a complex one. Regular exercise is important for health maintenance and headache control. Although exercise may temporarily worsen your headache; it is not dangerous. You should try to exercise gently even if the headache is always present.
Exercise may also stop a headache once it begins. Decreased headache pain with exertion is thought to occur due to vasoconstriction of cranial blood vessels as well as increasing amounts of available epinephrine, steroids and other serum chemicals.
Regular exercise is an important part of a headache control program. Vigorous aerobic workout stimulates brain chemicals such as serotonin, endorphans and enkephlins that can decrease headaches and pain perception. Serotonin related sleep cycles and mood (depression and anxiety) are also improved with exercise.
We recommend aerobic exercise 5 days per week for sessions of at least 30 minutes. Select an exercise type you like.... or at least tolerate. Swimming, rapid walking, jogging, biking, jumping rope, aerobic dancing, skating or racket sports are excellent. Begin slowly with a warm-up and progress to your target heart range (THR).
AGE TARGET HEART RATE
20 140-180
25 136-175
30 133-171
35 129-166
40 126-162
45 121-156
50 116-149
55 112-144
60 101-139
65 105-135
By counting the pulse beats in 15 seconds and multiplying by four you can determine the beats per minute corresponding to your THR.
Headaches decrease appetite, thus with headache relief, there is a tendency toward weight gain. In addition, many medications that are effective in preventing headaches may increase appetite. Exercise is an essential component in a healthy, long-term weight control program.
We believe that you will feel better, sleep better and have significantly better headache control with a regular exercise program.
MOVING TOWARD HEADACHE CONTROL
While most headache conditions cannot be “cured,” they can be controlled. Headache control involves a partnership between you and your doctor. The medical staff will work with you to help you gain control over your headaches. However, medication can only do so much, and there are many things you can do to take charge of your life.
DIET - Eat 3 well-balanced, low sugar meals on a regular schedule, including breakfast. This will decrease fluctuations of blood sugar and enhance headache control. Familiarize yourself with the headache diet.
SLEEP - Sleep patterns are closely related to headaches. Either too much or too little sleep may trigger the onset of a headache. Regular sleep patterns involve going to bed and getting up at about the same time each day of the week including weekends. We recommend 7-8 hours of uninterrupted sleep at set times, including weekends. Avoid napping. Sleep can be an excellent method of stopping a headache.
EXERCISE - As part of your headache control program, we strongly recommend exercising on a regular basis. If you have physical conditions precluding vigorous exercise, consult with your doctor first. When you begin your exercise program, chose a form of exercise you enjoy. Begin your program slowly and build up your endurance gradually. Your goal will be to improve headache control, but other benefits include weight control, better sleep, lower stress levels and an overall sense of well-being.
MEDICATION - It is important that you understand the medications you are taking, why they are prescribed and the potential side effects. It is also important that you take your medication as it is prescribed. Side effects can be expected but will often decrease over time. Be Patient. It is important that you keep a list of all your medications. Many acute headache medications and analgesic medications will increase the frequency and severity of headaches if taken frequently. Do not discontinue any of your medications without first discussing with your doctor.
TRIGGERS - Try to identify your headache triggers. Once you have identified them, avoid them whenever possible. Some triggers, i.e. a change in barometric pressure, are unavoidable. Headaches are more likely when you experience more than one trigger at a time. For example, you should try to avoid known triggers during times of stress or around your period.
HABITS - Cigarette smoking is incompatible with good health habits and decreases the likelihood of headache control. Besides being a pollutant and irritant to the nasal passages, it decreases the oxygen carrying capacity of the blood and acts as a vasoconstrictor narrowing the blood vessels. Even secondary smoke is harmful. If you drink alcohol, please do so in moderation. Alcohol can be a headache trigger.
Caffeine likewise causes constriction of blood vessels. While caffeine may be helpful for an acute headache, when used regularly, it will inhibit headache control.
HEADACHE CALENDARS – You will be instructed on how to keep a Headache Calendar. Complete the information each day. Bring your calendar with you to each visit for review.
We strongly encourage family education regarding headaches. If at any time your family members wish to accompany you to a visit, they are welcome. You must educate yourself. The more you know about the headaches, the more you can help yourself.
IS CAFFEINE GOOD FOR TREATING HEADACHES?
Caffeine is a unique chemical that is not only found naturally in foods but also added to foods, beverages, and certain medications. It is best known for its stimulating effects. Caffeine is often added to pain relievers to enhance their analgesic potency, and some over-the-counter and prescription headache medications contain caffeine. The caffeine in medications is the same as that in coffee or sodas, so an old-time headache remedy was an aspirin and a coke!
However, caffeine or caffeine-containing analgesics taken for headache relief can actually contribute to a headache condition. Excessive caffeine causes fluctuations in the blood vessels that can cause headaches. Caffeine only stays in the body for several hours and when the effects wear off, the headache returns. This requires additional doses of caffeine to obtain relief. During the night, your body doesn’t receive the doses of caffeine it’s accustomed to during the day. You may awaken in the morning with a withdrawal headache.
In summary, caffeine is often useful in relieving a headache episode but taken regularly, caffeine probably causes more headaches than it helps.
BOTOX INJECTIONS for HEADACHES
What is it?
Botulinum (Botox) is a toxin produced by a certain bacteria which in high doses is responsible for some forms of food poisoning. Botox is used clinically in very small doses to reduce stiffness in spastic muscles by causing muscle weakness.
How does it help headaches?
The usefulness of Botox for decreasing the frequency of migraines was discovered by a plastic surgeon treating patients’ wrinkles. It is not known exactly how Botox helps headaches. Botox causes muscle relaxation and may travel through the nerves of the face and head into the brain to help decrease pain. Botox treatment for headaches is now being studied in clinical trials. The benefit for individual headache patients varies.
What to expect:
Botox treatment involves injection of the medication in up to 11 sites on the face. Injections can also be given in the temples, back of the head, neck, and shoulder area. These are all done at one visit. You may have some swelling and bruising at the injection sites. Some people develop temporary eyelid weakness. It may take up to 1 month to notice any improvement in your headaches. If you experience improvement, it may last 2-4 months. After about 3 months, we recommend repeating the injections. The amount of Botox and location of injections may be adjusted for better results.
Cost:
Although clinical trials are under way to obtain approval for Botox in headache, it is not currently FDA-approved for this condition. Therefore, most insurance companies may not reimburse for the medication and treatments. Check with your insurance ahead of time to see how much, if any, of the cost of the medication and injections will be paid. Prior authorization may be necessary.
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