Do you find you’re reaching for the bottle of painkillers each morning while you make your coffee? Maybe you don’t even think before you take them because it’s been going on for so long — the intense head pain you feel as you wake, like someone set a vice around your head as you slept. If you’re lucky, the pain medication kicks in — but it just masks the pain until later.
Morning headaches are often a symptom of something more serious — your body is trying to tell you something! Unfortunately, the average neurologist might not pick up on the underlying cause of your pain — that an airway sleep disorder is the culprit. How well you sleep sets you up for the day, but an undiagnosed airway sleep disorder is insidious, slowly degrading your health, and creating a real impact to your daily life. If you’ve ever canceled brunch or an important breakfast meeting due to morning head pain, then let me be the first to tell you: you don’t have to feel this way.
What Does a Sleep Apnea Headache Feel Like?
A sleep apnea or other airway sleep disorder headache is also known as a morning headache — but I feel this name seriously understates the severity of the pain my patients face when they wake. The pain goes hand in hand with brain fog, and feeling unrefreshed after sleep.
The link between good quality sleep and the absence of headaches is a fascinating one. I’ve covered how important adequate rest is to curing brain fog, but it is just as crucial to reduce symptoms of morning headache and migraine. Put simply, deep sleep, with adequate oxygen supply, improves the cleansing of your brain through autophagy, and the correct function of your glymphatic system. These processes help you avoid neurodegeneration, crucial in mid to late age.
Good quality sleep can help with the symptoms of migraine because of these restorative qualities. Of course, if you suffer from an airway sleep disorder, no amount of sleep will ease your symptoms.
A morning headache may manifest in several ways:
- Tension headache — a headache that feels like a tight band around your head, often associated with stress or alcohol consumption, but also a classic symptom of airway sleep disorders.
- Cluster headache — a severe headache that occurs on one side of your head, often focused around one eye. Symptoms often include burning and tears in the affected eye, a runny nose, swelling of your eyelid, or a sweaty face. There is a higher prevalence of sleep apnea in cluster headache patients. An airway sleep disorder can have an effect on your hypothalamus and the related hypothalamic-pituitary-adrenal axis (HPA axis) — causing an increase in your cortisol levels (also known as your ‘stress hormone’). Certain activation of the hypothalamus has been linked with cluster headaches, indicating a fascinating mechanism behind airway sleep disorder induced cluster headache.
- Migraine — a neurological disorder that often begins with a visual disturbance known as aura, and progresses into nausea or vomiting, light and sound sensitivity, and throbbing head pain. There is an increased risk for adults with airway sleep disorders to develop migraine. In women with transformative (also known as chronic) migraine, sleep issues such as airway sleep disorder are common. Migraine attacks occur most frequently between 4 am and 9 am.
- Hypnic headache — an “alarm clock headache” which wakes you up between 1 and 3am, hypnic headache manifests in your middle age, and is an area that merits further research, but I believe that in many cases, an airway sleep disorder is to blame.
While cluster headaches are linked with the effect of airway sleep disorders on your hypothalamus, the other effect is that your undercorrected airway issue impedes airflow to the extent that your brain doesn’t receive enough oxygen — triggering a switch from deep to light sleep. This crisis also triggers the HPA axis, increasing the level of cortisol in your blood, putting your body on high alert. Your body’s response to stress often provokes oxygen deprivation headache and migraine.
Curing Your Headaches and Sleep Airway Disorder Together
Because your headaches and airway sleep disorder are bi-directional — that is, they feed off each other in an unhealthy feedback loop — it is important to treat your underlying symptoms in a thorough, systematic manner. In other words, we have to look at not just your airways, but the bones and muscles in your head, neck, and spine, that may be having an effect on your breathing at night. The right tests are key in establishing your course of treatment.
1.Undergoing a neuromuscular workup of your head and neck — enabling your doctor or functional dentist to check the muscles of your head, neck, and back by feel, noticing any tense muscles, tender nerve points, or impeded movement.
2. Having a cone beam computed tomography (CBCT) test — a fantastic state-of-the-art imaging technique, superior to x-ray, that allows us to see the alignment of the bones in your head and spinal column. Most importantly, we are able to examine the alignment of the spine down to the C6 and C7 vertebrae (figure shown below) — in my practice, we see a lot of patients with unresolved scoliosis as a result of this test.
3. Undergoing a MRI scan if your functional dentist or doctor suspects temporomandibular joints (TMJ) in the jaw or a masticatory muscle disorder. These conditions can be trigeminal triggers: the trigeminal nerve is a major nerve in the skull that can transmit pain from the spinal column, and make it seem to occur in your face or head. TMJ seems to go hand in hand with headache disorders a lot of the time. Unresolved clenching can have a huge influence on the flow of your airway at night.
4. Visiting a physical therapist who specializes in ergonomic analysis of your skull, neck, and spine. The physical therapist will be able to identify if the way you sit, work, or sleep is affecting your muscles, spine, or impeding your airway.
- In the case of TMJ, a custom-fitted dental appliance is required.
- In patients with scoliosis, combined treatment will be necessary.
- A functional manual physical therapist or chiropractor can help you realign your spine and neck muscles, and teach you gentle exercises you can do at home to prevent tension and ‘lock-up’. Postural changes are emphasized at work , home and while sleeping .
- Your functional dentist can advise you on how best to hold your jaw and mouth at rest — remember lips together, teeth apart and make sure your tongue sits right up to your palate.
- An AirwayCentric® night guard or sleep device is key to opening up your airway and improving your oxygen intake at night, easing your airway sleep disorder and reducing the frequency of your morning headache.
- Discontinue painkillers to rule out medication overuse headache — which can provoke a feedback loop of pain.
- Botox can be beneficial once physical therapy and an oral appliance have been brought into play. Although botox was originally a cosmetic procedure, injections of botox at particular points in the forehead, scalp, neck, and shoulders can reduce numbers of attacks in chronic migraine patients. The treatment has the potential to reduce the symptoms of other morning headaches, as it prevents tensing and spasming of the treated muscles, and blocks neurotransmitters and the local inflammatory response. Certainly, botox can help interrupt a cycle of stress response to a constricted airway, tension and headache.
As my plan of treatment shows, healing the headaches that go along with airway sleep disorders is not made up of a simple two or three steps. In functional dentistry, we don’t just treat the symptoms of pain and poor breathing, we track down the systemic root causes, and treat all aspects of your ill health. Don’t settle for feeling terrible every morning – you can get your optimal health back.
If you’d like to learn more about our AirwayCentric® approach, pick up a copy of GASP!: Airway Health – The Hidden Path To Wellness by Dr. Michael Gelb and Dr. Howard Hindin. If you’re struggling with morning headache in the New York area and suspect disordered breathing is to blame, fill out our contact form, or call to make an appointment with Dr. Gelb on (212) 752-1662.