Why Such A Close Relationship
The balance of sleep and wakefulness, and its correct timing, relies on a finely tuned system, which is referred to as homeostasis. If too much overloads this system in favour of one state versus the other, such as staying up late, having fragmented sleep, sleeping in at the weekends, or sleeping at inappropriate times relative to your body clock , the system will try and compensate to redress the balance.
One idea might be that a migraine attack may actually represent one of these balancing mechanisms, an extreme and abnormally over-compensating one. If for example you are sleep deprived, suffering a migraine may actually force you to keep still and lie down in the dark, in the hope of trying to sleep as a way of ridding yourself of the migraine.
Having too much sleep may also have the opposite effect and keep you awake with a migraine on subsequent nights. Both scenarios may be a way of trying to redress both sleep pressure and circadian alignment and keep the system in equilibrium.
Recovery Or Postdrome Stage
This is the final stage of an attack, and it can take hours or days for a drained, fatigued or hangover type feeling to disappear. Symptoms can be similar to those of the first stage . Often, they mirror these symptoms. For example, if you lost your appetite at the beginning of the attack, you might be very hungry now. If you were tired, you might feel full of energy.
Being aware of the different stages of the migraine attack can be helpful. It can help you prepare for an attack, get a diagnosis and decide when to take acute treatment, such as painkillers or adapt your activities.
It is useful to have a rescue treatment plan for when attacks occur. This may include painkillers such as a triptan, a NSAID or paracetamol. It often also includes anti-sickness medication.
For other people, being aware of the stages and symptoms of a migraine attack can help their understanding. It may also help with the frustration and lack of understanding people often face around migraine, especially at work and in education.
How Is It Treated
If you are experiencing fatigue with migraine, talk with your doctor. Your doctor will ask you questions about your migraine symptoms, how often they occur, how severe they are, and how long they last. It may help to keep a migraine journal to record information on your symptoms, including migraine fatigue. The triggers for your migraine attacks may be the same for fatigue or prodrome, and reducing your exposure to these triggers may help reduce fatigue.
For some people, stress reduction techniques, regular exercise, and having a sleep/wake routine can help reduce fatigue.4 Each person is different, and talking with your doctor about your symptoms can help them work with you to find the appropriate treatment for you.
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What Are The Four Stages Or Phases Of A Migraine Whats The Timeline
The four stages in chronological order are the prodrome , aura, headache and postdrome. About 30% of people experience symptoms before their headache starts.
The phases are:
It can take about eight to 72 hours to go through the four stages.
Stick To A Regular Sleep Schedule
Not getting enough sleep and sleeping too much can both be headache triggers, according to the American Migraine Foundation. The organization recommends getting between seven and eight hours of sleep each night.
When possible, try to go to bed and get up at about the same time each day, suggests Hamilton. Irregular sleep and wake times increase your chances of a migraine attack, she says.
Avoiding naps can help you sleep better at night, says Dr. Strauss. This isnt always easy, because sometimes sleep is the only thing that can help people during a headache, she says.
The issue is if youre taking excessive naps during the day, that makes it harder to go to sleep at night. Try to limit daytime sleeping and move all your sleep to the night and keep the same bedtime, she says.
Bedtime rituals such as taking a warm bath, reading, listening to calming music, doing yoga, or praying can help you fall asleep, according to the American Migraine Foundation.
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Preventative Medication And Therapies
If you experience frequent migraines, your GP might discuss preventative medication options with you.
It is important to note that preventatives for migraines are not pain medication, but help to reduce the number of migraines. They take time to work, so the minimum time period required may be three to six months. Contact your GP or specialist for further information. All of these treatments have their advantages and disadvantages and some of the medications might not be suitable for everybody.
You might find that this medication reduces the frequency and severity of your attacks but does not stop them completely. You will need to continue your other migraine treatments when you experience an attack.
National Institute for Health and Care Excellence recommends that GPs and specialists should consider the following drugs and therapies if they think you might benefit from preventative treatment:
Beta blocking drugs
These drugs are traditionally used to treat angina and high blood pressure. It has been found that certain beta-blockers prevent migraine attacks. Beta-blockers are unsuitable for people with certain conditions.
Topiramate
This drug is typically prescribed for the treatment of epilepsy but has also been found to help reduce the frequency of migraines. Again, it is not suitable for everyone. In particular, women who are pregnant or thinking about getting pregnant should be advised of the associated side effects.
Amitriptyline
Acupuncture
Botulinum toxin type A
What Medicines Help Relieve Migraine Pain
For mild to moderate migraines, over-the-counter medicines that may help relieve migraine pain include:
- An acetaminophen, aspirin, and caffeine combination
People who have more severe migraines may need to try abortive prescription medicines. A medicine called ergotamine can be effective alone or combined with other medicines. Dihydroergotamine is related to ergotamine and can be helpful. Other prescription medicines for migraines include sumatriptan, zolmitriptan, naratriptan, rizatriptan, almotriptan, eletriptan, and frovatriptan.
If the pain wont go away, stronger pain medicine may be needed, such as a narcotic, or medicines that contain a barbiturate . These medicines can be habit-forming and should be used cautiously. Your doctor may prescribe these only if they are needed and only for a short period of time.
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Common Symptoms Of A Migraine
The main symptom of a migraine is usually an intense headache on 1 side of the head.
The pain is usually a moderate or severe throbbing sensation that gets worse when you move and prevents you carrying out normal activities.
In some cases, the pain can occur on both sides of your head and may affect your face or neck.
How Fatigue Is Evaluated
If you experience a lot of fatigue, it’s important to see your healthcare provider so they can determine the source of it. For instance, is your fatigue related to your headache disorder? Another medical or psychiatric condition? Or “idiopathic,” meaning no known cause?
Your healthcare provider will ask you questions to better understand what “fatigue” means to you, including:
- How would you describe your fatigue?
- When did your fatigue start?
- With the treatment of your headaches, is your fatigue improving?
- How long does your fatigue last? Does it occur daily?
- What makes your fatigue better or worse?
- How does your fatigue affect your job or your interpersonal relationships?
Your healthcare provider will also inquire about sleep hygiene and any medications or supplements you are taking, as they could be causing or exacerbating your fatigue.
To rule out an underlying medical cause for your fatigue, like cancer or an autoimmune disease, your healthcare provider will perform a thorough physical examination and order laboratory studies.
Finally, to examine the potential role of psychiatric illness in your fatigue, your healthcare provider will screen you for disorders like depression, anxiety, and substance abuse.
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What Medications Are Used To Relieve Migraine Pain
Over-the-counter medications are effective for some people with mild to moderate migraines. The main ingredients in pain relieving medications are ibuprofen, aspirin, acetaminophen, naproxen and caffeine.
Three over-the-counter products approved by the Food and Drug Administration for migraine headaches are:
- Excedrin® Migraine.
- Advil® Migraine.
- Motrin® Migraine Pain.
Be cautious when taking over-the-counter pain relieving medications. Sometimes overusing them can cause analgesic-rebound headaches or a dependency problem. If you’re taking any over-the-counter pain medications more than two to three times a week, report that to your healthcare provider. They may suggest prescription medications that may be more effective.
Prescription drugs for migraine headaches include:
Triptan class of drugs :
Drugs to relieve migraine pain come in a variety of formulations including pills, tablets, injections, suppositories and nasal sprays. You and your healthcare provider will discuss the specific medication, combination of medications and formulations to best meet your unique headache pain.
Drugs to relieve nausea are also prescribed, if needed.
All medications should be used under the direction of a headache specialist or healthcare provider familiar with migraine therapy. As with any medication, it’s important to carefully follow the label instructions and your healthcare providers advice.
Alternative migraine management methods, also known as home remedies, include:
What Questions Should I Ask My Healthcare Provider
- Will my child grow out of their migraines?
- What medications do you recommend for me?
- What should I change about my lifestyle to prevent my migraine headaches?
- Should I get tested?
- What type of migraine do I have?
- What can my friends and family do to help?
- Are my migraines considered chronic?
A note from Cleveland Clinic
Migraine headaches can be devastating and make it impossible to go to work, school or experience other daily activities. Fortunately, there are some ways to possibly prevent a migraine and other ways to help you manage and endure the symptoms. Work with your healthcare provider to keep migraines from ruling your life.
Last reviewed by a Cleveland Clinic medical professional on 03/03/2021.
References
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Anterior Cingulate Orbitofrontal And Dorsolateral Prefrontal Cortex As Well As Other Limbic Areas
The involvement of limbic areas on functional brain imaging in pain states is thought to be related to the higher processing of nociceptive input, cumulating the sensory, cognitive, and affective components of pain . The involvement of such areas prior to pain onset in migraine has been more recently shown and suggests that this is not an affective or cognitive consequence of pain and is probably responsible for mediating attentional, mood, and cognitive deficits early in the attack. Some of these areas are part of the default mode network , which has been implicated in the sensory integration, cognitive, and attentional aspects of pain in migraine .
There have been studies demonstrating brain metabolite differences in the ACC of migraineurs compared to healthy controls using magnetic resonance spectroscopy, suggesting altered neurochemistry in this region in migraineurs. It is postulated that this difference may contribute to neuronal hyperexcitability in migraine . Another study has also suggested orbitofrontal cortex hypofunction in migraine, in the context of medication overuse headache, using 18F-FDG positron emission tomography imaging. It was demonstrated that, although most of the pain matrix areas recovered to almost normal metabolism following medication withdrawal from hypometabolism during analgesic overuse, the orbitofrontal cortex remained hypoactive .
Data Sources Search Strategy And Data Extraction
Studies were identified by searching papers indexed on PubMed and Scopus. Two investigators conducted an independent search on both databases using the search terms âheadacheâ OR âmigraineâ AND âsleepâ. The search was carried out from January 1, 1990 to November 30, 2018, and was restricted to humans, and to articles published in English language. Duplicate publications were removed by checking manually. Titles and abstracts were screened to verify study eligibility. Full texts of selected studies were evaluated if appropriate. The reference lists and Google Scholar citations for all primary and review articles were also searched. Discrepancies between reviewers were resolved by discussion.
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Migraine Is More Than A Headache Learn About Other Symptoms Of Migraine Including Uncommon And Surprising Signs
How do you know if your symptoms add up to migraine? A migraine attack typically involves moderate to severe head pain, often on one side of the head. Headache is a general term to describe head pain and is a common symptom of migraine. However, not all headaches are caused by migraine, and not all migraine involves head pain.
For the 39 million people living with migraine in the U.S., attacks usually involve other symptoms besides head pain. Some common symptoms are nausea, vomiting and sensitivity to light, smells and sounds. But other signs are less common or overlooked. Many people who experience these symptoms may not realize they are related to migraine.
Knowing all the symptoms of migraineeven the uncommon onesis important for getting the proper diagnosis and treatment. Weve outlined nine surprising symptoms of a migraine attack to help guide you.
What May Cause Headache And Fatigue
Fatigue and headache are shared symptoms of many conditions. Not all of these conditions are considered serious. However, some may require lifestyle changes or ongoing treatment.
As you consider the reasons why you may be experiencing headache and fatigue, make sure to think about your lifestyle, including your sleeping patterns, diet, and any medications youre currently taking.
Here are 16 conditions and other factors that could cause both headache and fatigue:
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Migraine Fatigue: Its Beyond Feeling Tired
- Reactions 0 reactions
Migraine attacks come with a plethora of symptoms and side effects. These can be from both the migraine itself or even our self-care measures like the abortive medications we use to help ease an attack. The one thing that holds true about migraine fatigue for me is that it is way beyond just being tired. Many people experience fatigue as part of other conditions and situations in their life. Lack of sleep, heavy exertion, and jet lag are three common factors that can cause fatigue. For a migraine sufferer, though, fatigue takes on a whole new aspect during an attack.
Practice A Relaxation Technique
Many people who have migraine have difficulty falling asleep, according to Rosen. He tells his patients to build relaxation skills with regular exercise, deep abdominal breathing, and biofeedback.
There are many studies being done now on mindfulness and headache, says Rosen. Practicing yoga positions while being mindful before bedtime may be just what the doctor ordered to quiet an active mind and manage migraine.
Yoga nidra, a form of guided meditation that is practiced lying down, may be the most relaxing type of yoga. A monthlong study published in September 2020 in Current Psychology found that people who practiced an 11-minute yoga nidra meditation showed lower stress, greater well-being, and improved sleep quality compared with a control group.
Free yoga nidra recordings in a variety of languages can be heard on the Yoga Nidra Network website.
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How Does Your Body Know When To Sleep
You have a circadian rhythm which lasts around 24 hours.
Your body and mind go through a range of changes over this time. It controls your sleep-wake pattern and also changes how alert you are.
Your rhythm mainly responds to changes in light. The body clock in your brain controls this. In the evening, it starts to get dark and your eyes signal this to your body clock. Your body clock then tells the brain to release the hormone melatonin. This makes you sleepy. When it gets lighter, the brain reduces the amount of melatonin it makes. This starts to wake you up. However, we each have a slightly different rhythm which is why some people are more alert in the morning and others, later.
Even within the states of sleep and wakefulness, there are faster, shorter cycles of brain activity.
Advocating For My Needs
I am a big advocate of sharing what I experience and how it impacts my daily life with my doctors. I always try to take the time and write out what I want to discuss with them prior to having an appointment. It really helps me to get the most out of my visit, and because my memory and cognitive functions are not always at their best it helps me to stay focused and cover what I wanted during the visit. Having another person with you as an informed advocate is another layer of preparedness I try to have in place to keep things productive during a visit. My wife, who also suffers from migraines, is my greatest advocate and I appreciate her help and insights during my visits immensely.
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