Since I started working the night shift, my migraines have become more frequent. Is there a correlation between insufficient sleep and migraines?-CP, MINN.

Laura Connolly, BSN, RN and Bridget Parsh, EdD, RN, CNS respond-Although nurses understand that a healthy lifestyle includes sufficient sleep duration and quality, long hours and heavy workloads can hinder implementing this knowledge into practice.1 In the US, most adults (28.5% to 44.1%) consistently report short sleep durations of 7 hours or less in a 24-hour period.2 On average, nurses who work night shifts get about 4.66 hours of sleep between shifts.3 Unfortunately, many people do not view a lack of sleep as a serious issue, even when it is causing life difficulties, such as anxiety and depression.5 Getting a poor amount or quality of sleep is a risk factor for obesity, heart disease, diabetes, and depression.5 Poor sleep quality is also strongly associated with higher rates of burnout, as well as migraines for various healthcare workers, including nurses.4,5

Migraines

A leading cause of disability worldwide, about one in six Americans experience migraines, with the highest occurrence affecting those ages 18 to 44.6 Unlike most chronic health disorders, migraine disorder typically affects the young and healthy. Chronic migraines are headaches that occur 15 or more days per month for greater than 3 months, with migraine symptoms at least 8 of the days.6 Migraine is an episodic neurovascular disorder that often causes bilateral or unilateral pulsatile headache frequently associated with nausea, vomiting, photophobia, phonophobia, or osmophobia.6-8 Migraines can happen at any time and are typically triggered by stimuli specific to each patient.8 Migraines are often triggered by insufficient sleep or insomnia.5

While experiencing a migraine, some patients have difficulty or cannot participate in normal daily activities for at least 4 hours, due to migraine symptoms lasting anywhere from 4 to 72 hours.5 Migraine symptoms can cause disability and a reduced quality of life.5 During periods without symptoms patients can experience anxiety about the possibility of a migraine affecting an upcoming social situation.5

Often, migraines can be controlled by oral analgesics; however, medication-overuse headache, also called analgesic rebound headache, may result.5 There is also a financial burden from the costs of migraine medications that continues to increase annually.5

Sleep and migraines

In addition to poor sleep duration and quality, irregular routines and working the night shift are often triggers for migraines. They can cause symptoms to be more severe and debilitating.10,11 People with insomnia can have significantly more intense migraines than those without insomnia.5 Decreased migraine pain and frequency are correlated with improved sleep quality.5

Nonpharmacologic methods for better sleep

Sleep hygiene consists of a planned set of rituals to improve sleep, such as regular exercise; a consistent sleep schedule; refraining from naps longer than 30 minutes; and reducing caffeine, screen use, and exposure to sunlight before bed.7 These practices have been shown to improve both waking alertness and overall sleep quality.7

Mindfulness meditation training may improve the quality of sleep.11 Mindfulness meditation means paying attention in a specific way; being present and nonjudgmental with yourself, and creating awareness to encourage change in cognitive patterns and poor behaviors.13 Mindfulness meditation training effectively improved sleep quality in adults with sleep disturbances such as disrupted sleep-wake cycles, and was positively correlated with greater frequency of the meditation exercise.9 Many free smartphone apps will walk the user through mindfulness meditation exercises.13

Essential oils may help with sleep quality and migraine symptoms. Diffusing lavender essential oils while sleeping has been found to effectively improve sleep quality and decrease sleep disturbances, while rose, thyme, and sandalwood have therapeutic effects as well.12,14 Smelling essential oils, such as lavender, may result in lower-frequency brain waves that are correlated to reduced pain, affect vasomotor activity, and stop neurogenic inflammation contributing to migraine symptoms.8 Cannabidiol (CBD), a molecule found in cannabis, has therapeutic effects on sleep without causing a "high" or altering patients' consciousness in any way.15 Sleep scores have improved within the first month of taking CBD in a capsule form with dosage titrated up based on each participant's results, but effects may fluctuate with some patients over time.15

Noise is often a contributor to poor sleep quality. Playing constant low-level noise or white noise to mask background sounds may help one fall asleep faster and improve overall sleep quality.16

Pharmacotherapy for better sleep

An over-the-counter melatonin supplement is usually the first pharmacologic choice to improve sleep.17 One dose of melatonin is recommended to be taken 1 hour before the desired bedtime for best results; long-term use has not resulted in signs of addiction.18 Melatonin has been found to have minimal to no adverse reactions, low chances of drug-drug interactions, and often improves circadian rhythms.17 Some FDA-approved prescription medications can improve sleep in adults, including benzodiazepine receptor agonists, dual orexin receptor antagonists, a histamine receptor antagonist, and a melatonin receptor agonist.6 These medications have possible adverse reactions, such as abuse, misuse, diversion, somnolence, excessive daytime sleepiness, and cognitive impairment.6

Improving patients' sleep

As nurses, it is important to teach patients to incorporate sleep hygiene to improve sleep and overall patient care.17 Nonpharmacologic interventions are widely used to improve sleep duration and quality in hospitalized adults.17 Along with worsening migraine disorder, insufficient sleep decreases pain thresholds, prolongs wound healing, and decreases endocrine and immune responses.19

During the night shift, allow your patient to sleep by clustering care and avoiding unnecessary contact.17 Patients consistently identify noise from equipment, nurses' conversations, or other patients as impacting their sleep in the hospital.19 Consider giving patients earplugs and eye masks.19 Use soothing music and headphones before bed.17 Lastly, advocate for patient use of melatonin in the hospital as appropriate.17

Overall, improving sleep duration and quality has the potential for numerous positive effects on health.20

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