Sleep and headaches

Antonio Culebras MD (

Dr. Culebras of SUNY Upstate Medical University at Syracuse received an honorariums from Jazz Pharmaceuticals for a speaking engagements.

Originally released February 13, 1995; last updated March 22, 2020; expires March 22, 2023


There is an intimate association between headaches and sleep. Some headaches are triggered by sleep, other forms occur exclusively during sleep, and yet some are ameliorated by sleep. The author reviews the different forms of sleep-related headaches and describes the manifestations of those that are cause for concern. A section on management closes the article.

Key points


• There is an intimate relationship between sleep and headaches.


• Certain types of headaches may be associated with specific stages of sleep and, thereby, lead to sleep disruption.


Migraine headaches, cluster headaches, paroxysmal hemicrania, hypnic headache, and headache on awakening are the most emblematic sleep-related headache disorders.


• Migraine headaches may be provoked by sleep, but the most common association is sleep following a migraine attack.


• Proper sleep-wake hygiene is paramount to aid in the prevention of sleep-related headaches.

Historical note and terminology

Practitioners of medicine are aware of the intimate relationship between sleep and headaches. In 1873 Liveing wrote about the effect of sleep in terminating an attack of headache (Lance et al 1983; Sahota and Dexter 1990). In 1913 Freud mentioned "headache-dreams" and gave a psychodynamic interpretation of their occurrence (Freud 1988). Early morning headaches were cited by Bing in 1945 (Sahota and Dexter 1990), and later, Gans wrote about treating migraines with sleep-rationing (Gans 1951). Dexter and Weitzman reported the relationship between headaches and sleep stage patterns (Dexter and Weitzman 1970), and Lance and colleagues provided a neurophysiological account of the relationship between the nucleus locus ceruleus and mechanisms underlying migraine (Lance et al 1983). The intriguing association between paroxysmal hemicrania and REM sleep (Kayed et al 1978) attracted attention to the circadian sleep rhythms and their influence on triggering headaches. The neurotransmitter serotonin has been extensively investigated by researchers of sleep and of headache syndromes and is often cited as a common link between the two. Sleep may trigger or terminate headaches, and different varieties of headaches may occur with any of the stages of sleep or sleep loss. Well-defined associations between sleep disorders and headache disorders include sleep-phase related headaches (Cohen and Kaube 2004), sleep apnea and headache, and parasomnias and headaches.

The International Classification of Sleep Disorders-3 (ICSD-3) recognizes the following headache disorders in association with sleep: migraine, cluster headache, chronic paroxysmal hemicrania, hypnic headache, and other medical, neurologic, psychiatric, and sleep disorders–associated conditions (American Academy of Sleep Medicine 2014). The diagnostic criteria require that the patient complain of headache during sleep or on awakening from sleep.

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