Migrane from CPAP? Help

[EO_123]

The last 2 mornings (including right now...) I've woken up with a screaming migrane/sinus headache. Yesterday it was a reasonable fluke, two days in a row is a pretty big problem. Waking up with headaches is not something that is normal for me. My AHI was .2 so it's not that. Humidifier was 4.0 or 4.5, can't remember.

What's wrong with me? I don't have a cold or any real congestion. Please tell me my CPAP isn't making me feel this way, and that there is some way to fix it.

[SleepyToo2]

Have you tried turning the humidity down a bit? If you have nasal congestion, what have you been doing to try and reduce that?

[Pugsy]

Any chance it is the bed pillow and neck position causes the AM headaches? Does the headache stay with you all day or fade away in an hour or so? Any associated cervical spine discomfort?

[Mary Z]

How is your headgear fitting? Any pressure points?
Good idea about changing the humidity if it's a sinus issue.
Good luck, bummer of a way to wake up.

[robysue]

You say there's no cold and "not really any congestion" and you describe the pain as migraine/sinus. Have you been officially diagnosed with migraines? Because if you have, then my guess it may indeed be a migraine headache and not a sinus headache. The two can be difficult to distinguish at times.

What are the usual migraine triggers for you?

How do you usually treat a migraine? And if you do that, does it help?

[EO_123]

I haven't been diagnosed with migraines, and I think a more accurate description is a sinus headache that involves nausea and light sensitivity. I do have 100% success treating it with Sudafed + Liquid Advil caps, and it is often triggered by a change in barometric pressure (which we've just had in NC) What is unusual is that I am waking up with these headaches, that's never happened before.

I don't think it's my neck or pillow as that isn't really bothering me. I switched from nasal pillows to nasal mask for the last few days just because the pillows had decided not to seal perfectly, so I was trying to alternate. I love my nasal mask and it fits well, I just don't like when my nose itches.

With the change in weather, I don't know if I need more or less humidity. I can feel it coming on in my sleep and it's very unpleasant, and I wake up basically non functional. This morning I ripped the mask off at 5 a.m. but I'm so conditioned to sleep with it on, that I really can't go back to sleep.

Even though I am prone to this kind of headache under certain conditions, I can't help but think that cpap is triggering it, since it starts when I'm wearing it. Once my drugs have settled in, I'm find for the rest of the day. But it is an AWFUL way to start the day.

[Pugsy]

You might play with the humidity settings a bit. Some people like more and some people like less.
Especially if you are a bit congested. I am miserable with too dry of a setting and others are miserable with more moisture. If you normally breathe better after a hot steamy shower then perhaps a little more moisture.

Cooler nights or if you already are using furnace means the ambient room air contains less moisture.
Perhaps the nasal pillows with the direct forceful air is drying out the sinuses and nasal mucosa more than the over the nose mask seems to with same ambient conditions.

[BlackSpinner]

Probably it is somewhat related to cpap as it is already creating pressure within the sinuses. You may want take an antihistamine before you go to bed.
It could also be that your body is adjusting to the new therapy and hormones are flowing differently. What time of the month is it?

[EO_123]

it's not that time of the month, and I don't have any congestion at all, however, I do know my sinus tissue is sensitive to barometric pressure changes. The furnace isn't on yet....

As far as humidity, I don't like too much, but I need to have some. I turned my machine up to 4 so that the air would get warm enough. This is all very confusing. I may just have to medicate before bed.

[robysue]

it's not that time of the month, and I don't have any congestion at all, however, I do know my sinus tissue is sensitive to barometric pressure changes. The furnace isn't on yet....

If your sinuses are sensitive to changes in the barametric pressure and you've got also got sensitivity to light and some nausea, then it does sound more like a migraine than a sinus headache due to congestion. (That doesn't mean the Sudafed + liquid Advil should be ineffective in treating the headaches; it's just the pain reliever in the advil may be playing a larger role in treating the pain that you think.) So first things first, you might want to talk to your PCP about whether these weather change headaches really are migraines. (Weather changes---i.e. changes in barometric pressure are a pretty common migraine trigger.)

And if barometric pressure changes can trigger your headaches, then yes, BlackSpinner is right when she says:

Probably it is somewhat related to cpap as it is already creating pressure within the sinuses.

and that bit of extra pressure could indeed be triggering the headaches.

As someone who fought this battle, I can say it does get better. Eventually the body gets less sensitive to all the new and annoying stimuli created by the CPAP. And once that happens, the frequency of the CPAP-"migraines" should decrease.

As for what to do in the meantime: You might want to talk to your PCP about taking an OTC migraine med. They come in two kinds:

• OTC pain formulas based usually on one or two NSAIDs (like the liquid Advil) and often a small dose of a stimulant (like caffeine). It could be that your Sudafed is acting in a fashion similar to the caffeine added to the NSAIDs in OTC migraine formulas.
• OTC and/or herbal preventatives. There are several OTC formulas out there that are supposed to help reduce the frequency and severity of migraines. The PA in my neurologist's office recommended a migraine vitamin formula to me. The forumla boils down to a daily dose of:
  • 400 mg Vitamin B2 (riboflavin)
  • 400 mg Magnesium
  • 100 mg Feverfew Extract

Since I'm sensitive to ragweed and the compounds with feverfew in them warn about being careful taking feverfew if you're allergic to ragweed, I've opted to just take the magnesium and Vitamin B2. I take 200 mg of each twice a day. And it does seem to help, along with a prescription vitamin called Deplin that I take because of a gene mutation.

[Bobby269]

Does it look like your humidifier water is going down? If you are using the climate control hose and have it locked into place. Upon it locking it will say climate control and give you a choice of temperature only from 60 to 86 . If it's your sinuses. Being to dry would not be a good thing for them.

[EO_123]

Thank you so much Robysue (and everyone) Sadly, no, I don't have a heated hose. My DME says they cause trouble. This probably means they're good.

You make some good points that I might actually talk to my doctor about. I can almost always tie a headache to a shift in pressure, but I was never sure what was the true criteria for Migranes. I never go to the doctor (because I'm always taking someone else) it's a miracle I got cpap at all. But I have dealt with these headaches for over half my life. Your speculation about why my 'cocktail' works is also interesting. I do know the sudafed raises my blood pressure, and I've become very sensitive to it over the years (I do better on Sudafed PE than I did on the original stuff) I also must take both together, taking one or the other is not effective at all. I probably only get 6-8 of these a year, so to have them 2 days in a row is really not fun. I always have this 'empty head' sensation once the meds kick in.

I think tonight I will try pre medicating and see if that helps. I'm a big vitamin guru, but sometimes this means I buy them, I don't always take them like I should... So I'll try that too. I like that option even better than drugs.

[BlackSpinner]

Yes the addition of sensitivity to light and the nausea means it is a migraine.

I am lucky - mine shifted to being ocular migraines which means I get the pretty sparklies in the eyes, the dizziness and light sensitivity and "sea sickness" but the pain is not there.

Mine are also usually sinus related. They may tell you that sinuses can't affect your eyes and that the two are not related but mine are also weather and allergy related, except of course that this may not be allergy but sensitivity or intolerance so then they go off on a rant. However a lot of migraine meds contain powerful antihistamines so WTF are they going on about?

Fresh Ginger root tea helped me a lot - but it also raises blood pressure - but it helps with the nausea.

The trick with many migraine meds is to take them as you feel them coming on before they get bad. I had problems with that because often my headaches or auras would sort of trickle away and then I would be stoned on the meds and useless.

There are relaxation techniques called Autogenics - you go in and out of meditative trance in one minute intervals - this changes your blood flow and helps cut them down - it is a preventative method that needs to be practised at least 20 minutes a day (in bits and pieces).

[robysue]

I'm a big vitamin guru, but sometimes this means I buy them, I don't always take them like I should... So I'll try that too.

Sounds like me before the War on the Migraines that were triggering vertigo severe enough to cause problems (and before the War on the Migraines, I had almost daily low grade headaches that would last most of the day and leave me very sensitive to sound and light but were NOT overly painful, just highly annoying and capable of making me very irritable.)

In the early part of this War, I was on daily prophylatic migraine meds that had to be taken on schedule. I wound up buying a 7-day pill reminder container (and boy did that make me feel old) and I learned to leave it out on the dining room table in plain site.

I couldn't tolerate the meds due to side effects. Long story short, the problem with tolerating the meds was that I have a mutation on my MTHFR gene and that let the meds build up in my system far faster than they should have. So I'm now on a daily prescription vitamin called Deplin. In order to remember to take it, the vitamin B2, the magnesium, the vitamin D, the multivitamin, the calcium supplement, and a zyrtec, I still use the pill container, actually two---one for morning vitamins and one for evening vitamins. Without the pill containers, I'd never manage to remember to take them.

So get yourself a 7-day pill container to put the vitamins in once a week and leave the container in plain site where you eat breakfast. That will help you remember to take them.

[ozij]

it's not that time of the month, and I don't have any congestion at all, however, I do know my sinus tissue is sensitive to barometric pressure changes. The furnace isn't on yet....

As far as humidity, I don't like too much, but I need to have some. I turned my machine up to 4 so that the air would get warm enough. This is all very confusing. I may just have to medicate before bed.

The humidifier doesn't warm the air, it only creates more humidity - and that may be what's causing your problems bugging you.

I use a heated hose year round to make cpap air tolerable. Got my hose from the Australian company that makes it http://www.sleepzone.com.au they call it a "heated tube". Unlike ResMed's climate line, these heated hoses are very durable: I used my first one for 5.5 years, and changed it simply to have a backup.