Posted by Greg Harper on May 02, 1998 at 07:56:26:

In Reply to: Nocturnal Headaches posted by BarryJ on April 26, 1998 at 14:03:52:

Barry,

I don't have any solutions, but here is what I have found out about sleep and headaches.

Headache is a symptom of illness. That is, there is something else physically causing the problem and the headache is the result.

Headaches can develop in people who have sleep apnea. This type of headache can either
awaken them from sleep or they can wake up in the morning with it. It is a migraine-type of
headache that is caused by the obstruction of the airway with then causes carbon dioxide(CO2) to build up in their bloodstream. This build up of CO2 is called hypercapnea. There is also a decrease in oxygen (O2) in the bloodstream which is called hypoxemia. When these two events combine the body responds by increasing blood flow to the brain by dilating the blood vessels that run through it. When these blood vessels dilate, within the enclosed compartment of the skull, pain results. As the person arouses and opens up the airway, the CO2 is decreased in the bloodstream through exhalation and O2 is elevated in the
bloodstream through inhalation. Awhile after normal CO2 and O2 levels are established in the body, the blood vessels will constrict and the pain will subside.

This is similar to the “altitude sickness” that mountain climbers experience at high elevations.
They do not experience problems with hypercapnea because they can get rid of CO2 easily through breathing. It is hypoxemia that they have a problem with because there is less O2 to breathe in at higher elevations.

There are three types of headaches that may be triggered by sleep that can cause insomnia-
migraine, cluster, and chronic paroxysmal hemicrania headaches.

A migraine headache occurs periodically and the pain initially happens in one side of the
head. It may be accompanied by nausea, vomiting, and, in some cases, special sensory
disturbances, loss of sensation in one side of the body, and inability to move one side of the
body. There can also be mood changes, visual field deficits, blind gaps in the visual field
surrounded by sparkles, paresthesias (a feeling in the skin of tingling, prickling, or
numbness), and sensitivity to light. The pain is usually throbbing in nature. Although
migraine headache can be provoked by sleep, most people report that sleep aids in the
remission of the symptoms. Attacks usually last from several hours to several days.

A cluster headache is characterized by constant, severe pain in and around one eye, the area
around the eye, and the temporal area on the same side. This type of headache usually has
extended periods when they don’t occur. There are usually complaints of nasal congestion,
tears, runny nose. There are usually no sensory deficits with this type of headache. In contrast
to migraine headache, these attacks appear to be triggered during sleep and occur on a daily
basis for up to several weeks. The attacks are usually sudden in onset and go away quickly.
Most cluster headaches do not last longer than two hours. 75% of cluster headaches occur
between 9:00 PM and 10:00 AM. The highest frequency is between 4:00 AM and 10:00 AM.

Chronic paroxysmal hemicrania is also a headache that occurs on one side of the head that
occurs much more frequently than a cluster headache. The attacks are shorter lasting than
those of either cluster or migraine types of headache and predominantly occur at night. There
is usually no prolonged symptom-free interval.

There are several new pharmacological treatments available for headaches. If the problem is
hypercapnea and hypoxemia associated with sleep apnea, then the headache pain should go
away with treatment of the apnea.

It sounds like you have the "cluster-type" headache.

I hope you can find some relief soon and get a good night's sleep.

Sincerely,

Gregory Harper, RRT, RCP
Respiratory Care Practitioner

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