Software engineer Katyayani Vajpayi has faced debilitating migraines during significant life events, festivals, and ceremonies, including her own wedding. The migraines, typically striking on the left side of her head, induce nausea and disrupt her vision, sometimes rendering her incapacitated, confined to bed in a darkened room.
Vajpayi’s experience is not unique. Globally, approximately one in ten individuals endure migraine headaches at some point in their lives, with women and individuals from lower socioeconomic backgrounds disproportionately affected. Treatment efficacy remains limited, particularly once a migraine episode has commenced.
Expressing her frustration, Vajpayi laments the unpredictable onset of her migraines. «The headache would just attack without any warning. I wished I could see them coming,» she shares. «At least I would have been better prepared.»
A recent study, featured in the journal Neurology, reveals that smartphone applications or journals capable of monitoring sleep patterns, behavior, and emotional states can forecast headaches in certain patients. Notably, individuals experiencing morning migraines reported reduced energy levels the preceding day and poorer sleep quality the night before.
Lead investigator Kathleen Merikangas, a psychiatrist and epidemiologist at the National Institute of Mental Health in Bethesda, MD, underscores the potential of tracking energy levels, physical activity, and sleep patterns over time. «If people do track their energy levels, physical activity, and sleep over time, they may be able to identify how some of these may be related to headache attacks,» she suggests.
Furthermore, the study indicates that monitoring sleep and other triggering factors may not only predict migraines in some patients but also aid in the development of preventive measures.
Monica Bertagnolli, director of the National Institutes of Health, reflects on the study’s implications, noting that physiological and neurological changes precede the onset of headaches. «The findings suggest that changes in the body and brain are already taking place before a person first feels a headache,» she observes in a blog post.
Migraine is a complex disease
Migraine, characterized by frequent and severe throbbing pain typically localized to one side of the head, transcends the realm of ordinary headaches. While migraines can manifest at any hour, they often strike upon waking in the mornings. The timing of these episodes varies among individuals; some experience them predictably before menstruation, following periods of intense work-related stress, or during disruptions to regular sleep patterns, while others are caught off guard by their sudden onset.
Preceding the onset of the actual headache is the prodrome phase, which can commence up to 24 hours earlier. During this period, individuals may encounter various symptoms such as food cravings, mood fluctuations—including feelings of depression or euphoria—sleep disturbances, uncontrollable yawning, or increased urination.
In certain cases, individuals may experience neurological disturbances known as migraine aura either preceding or concurrent with the headache. These disturbances can manifest as dizziness, ringing in the ears, visual disruptions such as zigzag lines, nausea, vomiting, or heightened sensitivity to light and sound. Although aura may serve as a precursor to a migraine attack, it can also coincide with the throbbing headache itself. However, not all migraine sufferers experience aura.
Following the resolution of the migraine headache comes the postdrome phase, akin to a migraine hangover. This phase, lasting anywhere from several hours to as long as 48 hours, is characterized by fatigue, difficulty concentrating, dizziness, weakness, and diminished energy levels. For some individuals, the postdrome phase mirrors the aftermath of an alcohol-induced hangover, and the cycle may immediately repeat itself, while others may enjoy periods of symptom-free intervals between attacks.
The etiology of migraines is believed to involve abnormal activation of specific nerves and associated blood vessels on the brain’s surface, although the precise cause remains elusive. Furthermore, while various triggers can precipitate migraines, treatment options targeting specific mechanisms are limited. Donald Penzien, a headache and pain specialist at Wake Forest School of Medicine in Winston-Salem, NC, emphasizes the importance of identifying personal risk factors and adapting lifestyle choices accordingly to mitigate headache incidence.
Tracking sleep to prevent headaches
In a bid to unravel the intricate relationship between an individual’s mood, sleep patterns, energy levels, and stress, researchers enlisted 477 volunteers from Washington, DC, and its environs, spanning ages seven to 84, comprising 186 males and 291 females, with or without a history of migraines.
Utilizing a smartphone application, participants were tasked with logging their anxiety, mood, energy, stress levels, and headaches four times daily over a two-week period. Additionally, each morning, volunteers reported on their previous night’s sleep quality, which was corroborated by data from wearable devices.
The researchers then juxtaposed the initial occurrence of headaches among those with a migraine history against those without.
The findings revealed a heightened likelihood of morning headaches among individuals experiencing poor sleep quality or lower energy levels the preceding day.
Praising the study’s breadth, migraine specialist Jelena Pavlovic from Montefiore Medical Center in Bronx, NY, lauded the inclusion of a substantially higher percentage of male participants, a departure from the norm in migraine research.
Contrary to expectations, afternoon or evening headaches weren’t attributable to subpar sleep or diminished energy levels the prior day. Instead, they were more closely associated with heightened stress levels or above-average energy levels the day before.
«Disrupted sleep primes individuals for morning attacks, whereas heightened stress levels and energy are conducive to afternoon attacks,» explains Pavlovic.
Surprisingly, the study found no correlation between feelings of anxiety or depression and subsequent headaches, provided sleep or energy levels remained undisturbed.
While acknowledging the potential impact of migraine symptoms such as nausea and vomiting on sleep, the study overlooked certain dietary and hormonal factors that could trigger headache episodes. The revelation that migraine attacks coincide with reduced energy levels the preceding day suggests potential physiological changes before sleep onset that may disrupt sleep quality. However, whether sleep disruption serves as a trigger or symptom of migraines remains unclear. «We are currently employing overnight sleep EEG monitoring to delve into this inquiry,» notes lead researcher Merikangas.
Nevertheless, the study underscores a lesson many migraine sufferers glean from experience: adhering to regular eating, hydration, sleep, and physical activity regimens can diminish the likelihood of headaches.
«This study reaffirms that a consistent good night’s sleep is among the most effective treatments for migraines,» emphasizes Pavlovic. While acknowledging the inevitability of some migraine attacks, Pavlovic stresses the benefits of early intervention, which typically leads to shorter and less burdensome symptoms.
«In terms of preventing or mitigating headaches, the benefits of tracking and predicting migraine attacks, while seemingly modest, are comparable to many other treatments,» concludes Penzien.