The relationship between childhood sleep disturbances and headaches has fascinated physicians for more than a century. Kids who have headaches experience a wide range of sleep problems, including getting too little sleep, snoring, struggling to fall or stay asleep, and having problems staying awake at school. These issues negatively impact physical and psychological health as well as academic performance.
Studies have shown that sleep disorders are more frequent in children and adolescents who have headaches than in the general childhood population. The modern study of this sleep-headache connection dates back to 1962, when Swedish school physician Bo Bille found that 47 percent of children with migraines suffered from sleep disorders, as well. More recent research indicates that children with headaches also have a higher prevalence of other sleep problems, such as excessive daytime sleepiness, narcolepsy and insomnia.
The most common form of headache in pre-adolescents is migraine, followed by chronic daily headache (CDH), a condition in which headaches occur more than 15 days per month. Adolescents, on the other hand, more frequently have CDH, as opposed to migraine alone.
The sleep disorders seen in young headache sufferers vary depending on their age and headache type (see sidebar). Younger kids with headaches tend to get very little sleep, co-sleep with their parents and snore. If they have migraines, they also tend to resist sleep and have sleep anxiety.
Older children with migraines and headaches don’t get enough rest because they have difficulty falling asleep and wake frequently during the night. This sleep deprivation can directly impair daytime function, academic performance and overall mood.
Jonathan’s Story
Jonathan was evaluated for chronic headaches when he was 15 years old. His earlier medical history was normal, and his academic performance was above average until his headaches began 18 months prior to his evaluation.
Initially, the headaches were sporadic and moderately severe, but Jonathan soon began to experience them constantly. He described the pain as “squeezing,” and it worsened with activity. These were not typical migraines, as they were not associated with nausea, vomiting, or sensitivity to light and sound.
For two years before his headaches became constant, Jonathan’s parents noticed he had problems falling asleep at night and getting up in the morning. These sleep problems exacerbated his headaches and his classroom issues. As a result, his grades dropped, and he occasionally fell asleep during class.
Jonathan’s primary care physician and neurologist evaluated him, but all laboratory tests came back negative. They tried a regimen of pain medications, but nothing relieved his headaches.
Jonathan was eventually diagnosed as having several problems: insomnia, delayed sleep phase syndrome (a condition in which sleep and wake times get pushed later and later), medication overuse headache and somatoform disorder (a condition in which patients manifest psychological stress in physical ways). He was admitted to the inpatient adolescent pain program at the Cleveland Clinic, where he stopped using medications and caffeine and began a regular sleep routine. He also began daily psychological counseling and group therapy, entered a physical rehabilitation program, engaged in occupational and physical therapy, and ate a more balanced diet free of additives, such as nitrates and MSG.
Within 10 days, he reported changes in his function and attitude. After three weeks, his sleep quality improved dramatically. As for his headaches, they still occurred daily, but they were shorter and less severe and interfered less with his daily activities.
A Multidisciplinary Treatment Approach
Jonathan’s outpatient treatment addressed the entire spectrum of issues children with headaches typically face. Because there are many co-morbidities associated with pediatric headaches, including school absences, medication overuse and sleep disturbances, a multidisciplinary treatment program is the best approach.
To successfully treat complex headache disorders, it is essential for children to get into a normal sleep pattern. That’s why a consultation with a sleep specialist or an evaluation in a sleep laboratory can help. An expert diagnosis followed by treatment that promotes restorative sleep is a major component of a successful headache-prevention regimen.
In addition to regulating sleep patterns, it is common to prescribe medications, psychological treatment, and lifestyle changes to relieve chronic headaches and migraines.
If a child experiences headaches for more than 10 days a month—and if the headaches interfere with daily functioning or are associated with medication overuse and frequent school absences—then the child should see a doctor. Though these headaches are not life-threatening, they, along with their associated problems, can have a significant negative impact on quality of life and sleep.
Although the connection between childhood headaches and sleep disorders has held the interest of physicians for many years, more research is needed to fully understand this relationship. In the meantime, a multidisciplinary regimen that combines lifestyle changes—such as getting adequate hydration, eating right, losing weight and exercising regularly—and regulation of sleep patterns is the most effective treatment for these complex disorders.
A. David Rothner, MD, is the director of the Pediatric/Adolescent Headache Clinic and chairman emeritus of child neurology at the Cleveland Clinic Foundation.
