Through treatment of sleep apnea with oral appliance therapy, patients can experience improved sleep while also resolving headache pain.
A common indicator of sleep apnea is waking up with headaches. In fact, at least 50% of people who wake up with headaches might have sleep apnea.1 Another common problem that might cause headaches upon waking is bruxism (teeth grinding). This means we as dentists need to pay close attention to what our patients are saying. When your patients complain of headaches, what do you do?
How are Headaches and Sleep Apnea Related?
Headache and sleep have an interdependent relationship.2 “Headache may be intrinsically related to sleep (migraine with and without aura, cluster headache, hypnic headache, and paroxysmal hemicrania), may cause sleep disturbance (chronic migraine, chronic tension-type headache, and medication overuse headache) or a manifestation of a sleep disorder like obstructive sleep apnea,” report Niranjan N. Singh and Pradeep Sahota in Current Treatment Options in Neurology. While our understanding of sleep and headaches has improved over the years, we continue to discover more information as we study this relationship more.
Headache sufferers have a greater risk for developing sleep apnea and other sleep disorders. In fact, their risk is 2 to 8 times greater than those who don’t suffer from frequent headaches.3 The pathophysiologic background for a relation between sleep apnea and morning headache is multifactorial, with theories including changing oxygen saturation and cerebral vasodilation and increased intracranial pressure due to cerebral vasodilation but the definite cause of headaches in sleep apnea patients is not yet clear.4
Nearly half of all migraines occur between 4 am and 9 am. The pattern of waking up frequently with a headache is an indicator that the headache may be sleep-related. A good proportion of sleep apnea-related headaches will improve or resolve completely with treatment for the sleep apnea.3
Classification of Sleep-Related Headaches
Sleep-related headaches with a high association with obstructive sleep apnea include the following types:
- cluster headache;
- hypnic headache; and
- headache related to OSA.2
The second grouping of headaches related to sleep apnea include headaches with high prevalence of insomnia, medication overuse, and psychiatric comorbidity (chronic migraines and chronic tension-type headaches).2
Providing Treatment for Sleep Apnea
Sleep-related headaches are a throbbing pain, which can include nausea and vomiting. As a dentist, you can help provide relief through the availability of an oral appliance. Many times, bite guards or oral appliances can help relieve aching jaw muscles caused by bruxism or misaligned jaws that might be leading to sleep apnea. Morning headaches associated with OSA often respond well to oral appliance therapy.
Through treatment of sleep apnea with oral appliance therapy, your patients can experience improved sleep while also resolving any pain they might be experiencing from headaches. In addition to oral appliance therapy, it is also important for patients to maintain a regular sleep schedule.
It’s time for us to take charge of our patients’ health by providing proper treatment of sleep apnea and headaches. Listen to your patients—if you hear them mention headaches, ask more questions. The more we know, the better our chances of finding the cause and providing proper treatment.
Mayoor Patel, DDS, MS, is the owner of Atlanta’s Craniofacial Pain and Dental Sleep Center of Georgia.
1. O’Brien SM. Managing headaches in patients with sleep disorders. Clinical Advisor. 2017 Feb 09. Available www.clinicaladvisor.com/the-waiting-room/managing-headaches-in-sleep-disorders/article/637016
2. Singh NN, Sahota P. Sleep-Related Headache and Its Management. Curr Treat Options Neurol. (2013).15:704. doi:10.1007/s11940-013-0258-1.
3. Rains J. Sleep Disorders and Headaches. American Migraine Foundation. 16 Dec 2016. Available americanmigrainefoundation.org/understanding-migraine/sleep
4. Boostani R, Rezaeitalab F, Pourmokhtari B, Ghahremani A. Sleep Apnea Headaches. Reviews in Clinical Medicine. Winter 2016:3(1):1-3. Available rcm.mums.ac.ir/article_6025.html
Iam 54 years male having CSVD,WML in brain, Atrophy & Ulnar neuropathy. For the past 6 months I have been suffering from Sleeping disorder. Severe headache that too during noon short sleep that extends upto the night. Not able to concentrate. Taking Elesert 100 & Clonazepam 5. How can I stop my headache. Kindly advice
It all started with vivid dreams which I still remember.
SLEEP APNEA & BAD HEADACHE LEFT SIDE BACK ONLY
Can you still have headaches after using a sleep apnea machine is it because I do not get enough oxygen to the brain when I wake up in the morning I have headaches
I’m a veteran of the US Army, 54 y/o and I have been researching how the combination of migraines headaches and Sleep apnea are debilitating, to present my information to the VA for disability compensation. I have been diagnosed with migraines for years. I take toprimate 200mg, Rizatriptan, Excedrin migraine, & Compro prochlorperazine suppositories when they are extremely severe. I have recently had a sleep study my AHI is 48.8 and oxygen is 79%. What should my doctor be doing for me? I now have a cpap machine hoping this will help to minimize the morning migraines.
I am a veteran who has suffer from migraines for years . I currently receives compensation from 4he military fie mt migraines.I has been complaining about my lack of sleep so they gave me a sleep study and it came back that i have sleep apnea. I am trying to link it to my migraines my sleep doctor says its no connection can you help me. My sleep is disturbed all the time due to my migraines
I have sleep Apenea it works had a machine trying to get it back really need it headaches are horrible
1 am 67 years old and had been waking up with migraines for about 2 years. Then 6 month ago, I noticed severe shortness of breath just slowly climbing a flight of stairs. I was sent to a pulmonologist and so far had 3 tests done…… overnight pulse ox study, CT scan of lungs, and pulmonary function test.
I was diagnosed with a restrictive lung disease.. after taking the pulmomary function test. I do not yet know what specifically the disease is.
It was also discovered through an overnight pulse ox test that my blood oxygen levels go below 70 while I am sleeping, and as a result there is a build up of carbon monoxide in my body/brain causing the migraines.
I now sleep with oxygen every night/ all night, and never wake up with migraines any more.
At least the migraine mystery is solved. It is a gift from God. I almost have my life back. Now for the other test results.
Please ask for referrals for these tests.