Can Obstructive Sleep Apnea Cause Headaches?

The link between OSA and headaches is well established. “Morning headaches have long been recognized as a marker for sleep apnea,” says Avram Gold, MD, director of the sleep medicine fellowship at the Renaissance School of Medicine at Stony Brook University in Stony Brook, New York.

In many cases, treating OSA can help ease headaches. But sometimes, additional treatments are needed. Here’s what you need to know to keep headaches at bay.

Headaches can stem from many causes, including alcohol, poor posture, stress, and underlying health problems, such as dehydration and sinus infections. But researchers have a few theories about how OSA might contribute to head pain:

• OSA dials up your body’s stress response. “Headaches [from] sleep apnea are caused by the stress response to fluttering of the throat during sleep,” says Dr. Gold. Sometimes that flutter is audible, as snoring. Other times, it’s silent. “Normally, during sleep, you should be de-stressing,” he says. “That should be your lowest period of stress during the day.” With OSA, your airway is continuously obstructed throughout the night, sending your sympathetic nervous system into overdrive, says Gold. You might not realize it, but you’re spending the night in a fight-or-flight stress response, which can elevate heart rate, dilate blood vessels, and trigger muscle tension that can cause headaches.
• OSA robs you of oxygen. Research found

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  that participants with OSA who had difficulty breathing at night had more than triple the headache risk of those who breathed more easily during slumber. Low oxygen levels from disrupted nighttime breathing may contribute to morning headaches, researchers say. Other research

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   suggests low oxygen could contribute to headaches through multiple mechanisms, such as cortical spreading depression, meaning a change in neuron activity throughout the brain.
• Poor sleep from OSA might alter your perception of pain. One study

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   found that participants with headaches from sleep apnea slept worse, moved their limbs more at night, and woke up more often during the night than people without the headaches. The researchers say dysregulation in brain regions that modulate sleep and pain perception could be the culprit.
• Serotonin dysfunction may be linked to OSA and headaches. Many people with tension headaches and OSA have altered levels of serotonin, a neurotransmitter that affects pain perception. This has led some researchers to suggest serotonin dysfunction could play a role in both disorders.

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OSA can cause different types of headaches. Knowing which kind you have can help you get the right treatment. Here are the most common headaches that affect people with OSA:

• Morning Headaches As the name implies, these headaches are noticeable immediately when you wake up. One common type of morning headache, known as a sleep apnea headache, is exclusive to people with OSA. It usually affects both sides of the head, lasts four hours or less, and resolves when sleep apnea is successfully treated.
• Tension Headaches These headaches cause a feeling of tightness around the head. One study

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   found that participants with OSA had an 18 percent higher risk of developing tension headaches than those without OSA.
• Migraine Attacks Migraine atttacks usually cause throbbing or pulsing pain on one side of the head, sometimes accompanied by nausea or visual disturbances. In one study,

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  participants with OSA had an 85 percent higher risk of developing migraine than participants without OSA, even when adjusted for age, sex, race, and health problems.

• Medication Overuse Headaches These headaches can affect people who take pain-relieving medication 10 or more days per month. A rebound effect causes pain hypersensitivity that leads to more aches.
• Hypnic Headaches Also known as alarm clock headaches, hypnic headaches start during sleep and jolt you awake.
• Cluster Headaches These rare, painful headaches strike one side of the head, sometimes causing a teary eye, droopy eyelid, and nasal congestion.

If you have sleep apnea and also wake up with headaches, you may need to consult more than one doctor:

See a Sleep Medicine Physician

Find a Headache Specialist

If headaches persist even with OSA treatment, make an appointment with a neurologist who specializes in treating headaches. Treatments include:

• Over-the-counter pain relievers, such as ibuprofen
• Prescription medications, such as antidepressants, anti-seizure medications, beta-blockers, calcitonin gene-related peptide inhibitors, and triptans
• Procedures, such as Botox injections, nerve blocks, and trigger point injections
• Lifestyle management to improve your diet, exercise regimen, and stress levels

• It’s not exactly clear why sleep apnea can cause headaches, but it’s thought that an increased stress response and lack of oxygen during sleep can lead to headaches during the day.
• Obstructive sleep apnea can lead to different types of headaches, including morning headaches (or sleep apnea headaches), tension headaches, and migraine attacks.
• Treating sleep apnea can help ease some of the headaches you may be experiencing. If that doesn’t help, you may need additional treatments, such as antidepressants, beta-blockers, and nerve blocks.