Got migraines? Your sleep apnea may be to blame!
Sleep apnea can cause headache and neck pain. The mechanism of the headache is complex, but probably involves decreased oxygen in the blood that occurs during apneas, and the resultant dilation of small blood vessels in the brain to deliver more oxygen. Also, increased venous pressure and “glymphatic pressure” occurs with sleep apnea, and can lead to sluggish lymphatic and venous return. This by itself can cause increased intracranial pressure and stretching of pain sensitive structures in the head. In some cases this can lead to brain swelling.
The neck pain is thought to be caused by neck hyperextension that occurs when a patient involuntarily attempts to open their airway during apneas that occur in sleep. This hyperextension leads to increased pressure on nerves as they exit the cervical spinal canal, and can worsen “cervical radiculopathy.”
Kansas City Neurologists at the Rowe Neurology Institute in Lenexa, Kansas, saw many patients over the years with the primary complaint of intractable headache, who also had sleep problems. A retrospective chart review was carried out for patients with the primary complaint of headache or intractable headache. The results can be viewed here.
New patients with primary headache diagnosis
Of the 700 headache patients included in the study, 71% had a diagnosed sleep disorder, and 277 of these had an overnight sleep study or polysomnogram. Many patients also had EMG studies if they had any symptoms of pinched nerves in their neck.
It showed that almost 71% of the headache patients had a sleep disorder.
New Patients with Primary Headache Diagnosis with Diagnostic Polysomnogram
The most common sleep study diagnosis of the headache patients who were able to carry out sleep studies was Obstructive Sleep Apnea (OSA) or its milder variant, Upper Airway Resistance Syndrome (UARS).
81% of these headache patients also had a pinched nerve in their neck, as diagnosed with EMG studies.
Most of these patients slept on their side or abdomen, because the presence of sleep apnea or increased upper airway resistance during sleep makes it very difficult for someone to sleep on their back.
What do these findings tell us
In short, your sleep apnea and migraines could be related. These findings strongly suggest that lateral and prone sleep positions (sleeping on the side or tummy), necessitated by even mild sleep apnea or increased upper airway resistance during sleep, are associated with pinched nerves in the neck, which then can be a major predisposing factor for headache, intractable headache, and the migraine cascade.