Through treatment of sleep apnea with oral appliance therapy, patients can experience improved sleep while also resolving headache pain.

A common indicator of sleep apnea is waking up with headaches. In fact, at least 50% of people who wake up with headaches might have sleep apnea.1 Another common problem that might cause headaches upon waking is bruxism (teeth grinding). This means we as dentists need to pay close attention to what our patients are saying. When your patients complain of headaches, what do you do?

How are Headaches and Sleep Apnea Related?

Headache and sleep have an interdependent relationship.2 “Headache may be intrinsically related to sleep (migraine with and without aura, cluster headache, hypnic headache, and paroxysmal hemicrania), may cause sleep disturbance (chronic migraine, chronic tension-type headache, and medication overuse headache) or a manifestation of a sleep disorder like obstructive sleep apnea,” report Niranjan N. Singh and Pradeep Sahota in Current Treatment Options in Neurology. While our understanding of sleep and headaches has improved over the years, we continue to discover more information as we study this relationship more.

Headache sufferers have a greater risk for developing sleep apnea and other sleep disorders. In fact, their risk is 2 to 8 times greater than those who don’t suffer from frequent headaches.3 The pathophysiologic background for a relation between sleep apnea and morning headache is multifactorial, with theories including changing oxygen saturation and cerebral vasodilation and increased intracranial pressure due to cerebral vasodilation but the definite cause of headaches in sleep apnea patients is not yet clear.4

Nearly half of all migraines occur between 4 am and 9 am. The pattern of waking up frequently with a headache is an indicator that the headache may be sleep-related. A good proportion of sleep apnea-related headaches will improve or resolve completely with treatment for the sleep apnea.3

Classification of Sleep-Related Headaches

Sleep-related headaches with a high association with obstructive sleep apnea include the following types:

  • cluster headache;
  • hypnic headache; and
  • headache related to OSA.2

The second grouping of headaches related to sleep apnea include headaches with high prevalence of insomnia, medication overuse, and psychiatric comorbidity (chronic migraines and chronic tension-type headaches).2

Providing Treatment for Sleep Apnea

Mayoor Patel, DDS, MS

Mayoor Patel, DDS, MS

Sleep-related headaches are a throbbing pain, which can include nausea and vomiting. As a dentist, you can help provide relief through the availability of an oral appliance. Many times, bite guards or oral appliances can help relieve aching jaw muscles caused by bruxism or misaligned jaws that might be leading to sleep apnea. Morning headaches associated with OSA often respond well to oral appliance therapy.

Through treatment of sleep apnea with oral appliance therapy, your patients can experience improved sleep while also resolving any pain they might be experiencing from headaches. In addition to oral appliance therapy, it is also important for patients to maintain a regular sleep schedule.

It’s time for us to take charge of our patients’ health by providing proper treatment of sleep apnea and headaches. Listen to your patients—if you hear them mention headaches, ask more questions. The more we know, the better our chances of finding the cause and providing proper treatment.

Mayoor Patel, DDS, MS, is the owner of Atlanta’s Craniofacial Pain and Dental Sleep Center of Georgia.

References

1. O’Brien SM. Managing headaches in patients with sleep disorders. Clinical Advisor. 2017 Feb 09. Available www.clinicaladvisor.com/the-waiting-room/managing-headaches-in-sleep-disorders/article/637016
2. Singh NN, Sahota P. Sleep-Related Headache and Its Management. Curr Treat Options Neurol. (2013).15:704. doi:10.1007/s11940-013-0258-1.
3. Rains J. Sleep Disorders and Headaches. American Migraine Foundation. 16 Dec 2016. Available americanmigrainefoundation.org/understanding-migraine/sleep
4. Boostani R, Rezaeitalab F, Pourmokhtari B, Ghahremani A. Sleep Apnea Headaches. Reviews in Clinical Medicine. Winter 2016:3(1):1-3. Available rcm.mums.ac.ir/article_6025.html