Migraines and OSA

I'm trying to find evidence that links or disproves that snoring and OSA causes migraines. Obviously not ALL migrane sufferers have OSA...but "the boyfriend" gets nasty, debilitating migraines that will drag him down for an entire day, at times. He also sounds like a chainsaw when he snores. Other assorted issues have me trying to get him to at least try therapy for a couple days.

Mine decreased a lot when I started cpap therapy. Mostly I would have afternoon headaches which would turn into migraines if anything else (like a weather change) would happen before cpap. It is more like I am now starting the day with an empty bucket and it takes more crap to make it overflow and to trigger the migraine.

Also remember lack of O2 will damage the brain and if you are already into migraines that doesn't help.

I think a lot of people have headaches when first waking up with OSA, and possibly those who are otherwise prone to migraines may have worse ones (can't say). I never get headaches normally, but did have them before starting Cpap, and they went away immediately. Your boyfriend needs to see a neurologist to rule out migraines, before thinking of them as part of OSA one way or the other.. and certainly don't use them as deciding factors about his having OSA or not otherwise.

His aren't daily, but I wonder if he gets them when his nightly round of snoring and snorting are more excessive than normal. The irregular sleep schedule can't help much, either.

Great question, TL: my migraines have almost disappeared/improved in intensity since getting effective treatment for my sleep apnea. They were very similar to those you described. Now the major triggers seem to be excess coffee, and chocolate (grr!). However, finding an answer to your question may not be simple. A pediatrician told me that migraine and sleep apnea are both associated with inflammation in the brain, but did not know if one caused the other. Some links on PubMed may help to clarify or further confuse the issue:
http://www.ncbi.nlm.nih.gov/pubmed/24973419; http://www.ncbi.nlm.nih.gov/pubmed/25416461; http://www.ncbi.nlm.nih.gov/pubmed/24928423; http://www.ncbi.nlm.nih.gov/pubmed/24132786; http://www.ncbi.nlm.nih.gov/pubmed/24117275; http://www.ncbi.nlm.nih.gov/pubmed/23232042; http://www.ncbi.nlm.nih.gov/pubmed/22963547

The bottom line is that it appears that the use of CPAP may improve other factors associated with good sleep that lead to an improvement in migraine. However, no definite benefit has been established in the literature in the search that I did. Meantime, I am very happy to have no/few migraines for the past 5 years on CPAP. You may have to be content with anecdotal reports of benefit. Good luck with getting the boyfriend onto CPAP. It took a fall in the middle of the night and 20+ stitches in my forehead to get me to have a sleep study (even the neurologist said it was a last resort).

I was sent for a sleep test by my headache DR. and that was the start of cpap treatment. I think for me it has cut down on the number of morning migraines ... still have all the triggers , tyramine, ounions, beer/wine/any alchol and several others. If he has never looked at it google tyramine and migraines .
That is the one thing that is in all my major triggers.

I will have to look to find references, but here is what I know from my own case.

I have a Patent Foraman Ovale (PFO), or a hole in my heart. Many people do (10-30% of population), and it is never seen in echocardiograms, or even causes any problems. For some people, it can cause migraines, TIAs and stroke. When I started having lots of long lasting migraines, my cardiologist checked to see if that could be an issue.

What does this have to do with sleep apnea? Well, the way that PFO causes migraine, is that when there is excessive pressure in the chest cavity, it forces blood in the heart backwards through the hole, preventing it from going to the lungs, where the blood is oxygenated and also where impurities and small blood clots are removed. When forced backwards, the blood goes straight to the brain, carrying far too little oxygen, and possible impurities. I could see this clearly when they did the transcranial doppler on me. They inject tiny bubbles into a vein, and if the PFO leaks, the bubbles show up in the arteries in the brain.

The pressure in the chest can be induced by straining to have a bowel movement, coughing, giving birth, and struggling to breathe during an apnea.

So, a little round about, but can be a possibility. If the blood is not carrying enough O2, or is carrying toxins that inflame the brain, you will get a migraine, or something similar. Good luck getting him to listen!

Tatooed Lady wrote:I'm trying to find evidence that links or disproves that snoring and OSA causes migraines. Obviously not ALL migrane sufferers have OSA...but "the boyfriend" gets nasty, debilitating migraines that will drag him down for an entire day, at times. He also sounds like a chainsaw when he snores. Other assorted issues have me trying to get him to at least try therapy for a couple days.

If you do a forum search on "migraine", there's 58 pages of posts going back a long ways.
I remember it being frequently discussed in the past. You may find some evidence to support what you're looking for in those archives.


Den

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Wulfman... wrote:

Tatooed Lady wrote:I'm trying to find evidence that links or disproves that snoring and OSA causes migraines. Obviously not ALL migrane sufferers have OSA...but "the boyfriend" gets nasty, debilitating migraines that will drag him down for an entire day, at times. He also sounds like a chainsaw when he snores. Other assorted issues have me trying to get him to at least try therapy for a couple days.

If you do a forum search on "migraine", there's 58 pages of posts going back a long ways.
I remember it being frequently discussed in the past. You may find some evidence to support what you're looking for in those archives.


Den

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i started the search, but either wound up with every instance of the word (seems to come up a lot) and in too broad a field, or only roughly 2 threads. The first i tried to slog through but lost focus (like in a boring class), the second wasn't quite the right info. Guess i have to re-slog later when i get the chance.

I an a severe night owl who works an afternoon/evening shift that works well for me. I go to cat shows which require the opposite schedule of early mornings, which really messes with my sleep schedule once or twice a month on average. Because of this, I will have 2-3 really short nights since going to bed "early" for me still results in only 3-5 hours of sleep when I have to get up at 5 or 6am. Then, once I am home from the cat show, I will go to bed early and sleep late. I always include this day in my weekend schedule. My boss agreed to it many years ago when it was pretty evident that I had at least a 50/50 chance of being sick with a bad headache the day after the cat show. Back then, I assumed it was lack of sleep or maybe a caffeine thing. But once I started cpap, those headaches stopped, except the few times I didn't set up my cpap machine after my weekend. Those times, I got a horrible headache.

From what I can tell, because I was so tired, I slept longer than normal, which meant I suffered from severe sleep apnea (79+) much longer than normal, and thus starved my brain more, and caused a headache. And what do you do when you have a bad headache and feel like crap? You stay in bed even longer. So, my whole day was ruined.

Morning headaches are now very rare. Most are due to sleeping withing my cpap machine. The other (now) rare headaches usually have a change in weather later that day. And my sleep apnea doctor is also a headache doctor and believed them to be migraines. But they are very rare now.

My main reason for getting a second cpap machine was so that I could use it for travel and leave a machine fully set up at home. My biggest reason for not using my machine when I would get home is that I was tired and didn't want to get behind the furniture to plug in my machine. I would bring it in, and then fall asleep in front of the tv. This way, I have a machine fully ready to go when I get home, so no excuse, and I don't get punished with the headache. The only good thing about the headache is that it is the biggest incentive to keep using my machine every night.

OK, here are some references:

CPAP Improves Migraine Burden in Patients With Sleep Apnea
June 26, 2013
BARCELONA, Spain — For migraine sufferers with obstructive sleep apnea (OSA), continuous positive airway pressure (CPAP) treatment can decrease the frequency of migraine attacks, their duration, and intensity. In addition, medication use and lost days from work were reduced, a study shows.

Presenting results here at the 23rd Meeting of the European Neurological Society (ENS), Hildegard Hidalgo, MD, from the Department of Neurology at Kamillus-Klinik in Asbach, Germany, said that 25% of patients with OSA also have migraines and that the frequency of OSA in patients with migraine is similar to that in the general population: about 12% in migraine without aura and about 7% in migraine with aura.
http://www.medscape.com/viewarticle/806902

The Connection Between Migraines & Sleep-Breathing Problems http://doctorstevenpark.com/the-connect ... g-problems

When it comes to migraine, we do know that sleeping problems in general can trigger attacks. Diane Stafford and Dr Jennifer Shoquist write in Migraines for Dummies: Too much sleep, or too little, may lead to a migraine. Any type of off-kilter sleep (insomnia, sleep apnea, and so on) can spin off into a migraine.

A number of things may cause a relation here. It could be the oxygen/carbon dioxide balance, as is suspected when it comes to cluster. It could simply be interrupted sleep. James Weintraub (http://www.mhni.com/people_staff.aspx & http://www.swclab.com/about-swc/meet-our-medical-staff), neurologist and sleep disorder specialist writes: Migraine headaches occur in direct relationship to the number of REM sleep periods that one has during the night. This relationship is even more pronounced with cluster headaches.

Migraine headaches usually occur either during or after REM sleep or in delta sleep which is the deep sleep that we all require in order to feel alert and refreshed the following day. It remains unclear whether the changes in the neurotransmitter or chemical systems in the brain, hormonal influences, or a combination of several different phenomenon are the cause.
http://headacheandmigrainenews.com/slee ... -migraine/

Possible Links to Patent Foramen Ovale
Obstructive Sleep Apnea and Patent Foramen Ovale http://circ.ahajournals.org/content/109/7/e69.full
PFO and Right-to-Left Shunting in Patients with Obstructive Sleep Apnea http://www.aasmnet.org/jcsm/ViewAbstract.aspx?pid=28611
Patent foramen ovale and obstructive sleep apnoea: From pathophysiology to diagnosis of a potentially dangerous association http://www.sciencedirect.com/science/ar ... 3611000544 - This one is long, and a bit complicated, but worth reading if there is any chance of having a complication of migraine, OSA, and/or PFO.

No simple answer, but some questions that may be helpful.

There are many different kinds of headache, and I've had them all. Untreated OSA results in very harmful oxygen deprivation over a prolonged period - hours. The headaches I had for several years that were clearly OSA-related did not feel to me like my migraines, nor like my sinus headaches. My migraines throbbed, and sometimes felt almost hard-wired to the beating of my heart. The slightest exertion seemed to make my heart beat harder, and the pain would increase. Migraines also felt to me like they were at my temples or behind my eyeballs. Also, for any one migraine, that pain was usually on only one side of my head.

My sinus headaches gave me facial pain, as one would expect.

My low oxygen headaches were persistent (not throbbing) pains at the back of my neck. I felt like I'd been blackjacked from behind like in some cheesy cops & robbers movie. They happened mostly on weekends, which I later figured out came from my slightly longer times asleep on a Friday or Saturday night. Just one more hour of sleep meant one more hour of low oxygen.

When I went onto my CPAP those headaches (neckaches) disappeared. On the few nights since that I've been without my CPAP, I have again once or twice awakened in the morning with one of those headaches.

By the way, I don't remember if you told us the fellow's age, but by the time I get serious OSA, I was past 50 and was beginning to have the common problem for men of that age of an enlarged prostate. This can cause men to urinate more frequently, including during the night. Once past a certain age, it might not be uncommon for an otherwise-healthy man to get out of bed 2 or 3 times during the night to go to the bathroom.

So, a person might have OSA, but mis-attribute the frequent awakenings to his "normal" (enlarged) prostate.

read this: viewtopic.php?f=1&t=16275&start=30

or this (my letter to the editor is halfway down the page) http://www.bloomberg.com/bw/stories/200 ... holy-cross