Migraines and Insomnia: Some Coping Skills

by Sondra McElhinney, EdD

Migraineurs often find themselves in a double bind. A break in the sleeping pattern or not getting enough rest/sleep can trigger migraines or make migraine pain worse. The insomnia symptom can develop as a result of migraine pain, increasing during the worst of the pain or after the pain has leveled out. In other words, insomnia comes and goes at will. Sometimes it manifests itself in the person not being able to get to sleep at all or the person falls asleep, wakes after a couple of hours and then is unable to get back to sleep.

As each person's migraine is different and treated differently, so are the coping techniques for relaxation and sleeping. Some migraineurs have success with the non-medication techniques, others need medication to provide relief, and still others need a combination of medications and non-medication techniques. Coping skills and relaxation techniques can range from the very simple to the very complex. They are as individualistic as migraines themselves are. What brings relief to one migraineur may not bring relief to another; what brings relief to a migraineur last week might not bring relief this week. In many cases, the repertoire of techniques used by migraineurs is varied. Some try many different methods and others find that continued use of their tried and true will work for them.

This becomes as frustrating as dealing with the migraine pain itself. There are no right answers, there are no wrong answers, there are only a wide variety of answers. In essence, it comes down to what works for the migraineur at a given time with a given pain. The vicious cycle just goes on and on. Have the pain, not able to sleep, no sleep makes the migraine worse, as the migraine worsens, frustration sets in, as frustration sets in, stress enters and as stress enters, the pain escalates and as the pain escalates the migraineur may be less likely to be able to sleep.

What, then, are some of the purported techniques? Where better to look than within the membership of HOPA. One of our male members reported that he was lucky about getting to sleep. His routine began when, in his own words:

I was just a little pup, 12-13, or so, and I attended a youth camp. One of the courses we took was a four hour yoga session. The yoga master went through a simple relaxation routine. Starting from the toes, imaging each nerve cell, muscle fiber and blood cell. Focusing in on each one and allowing the stress to drain out of it, move out to the toe as a whole then the foot, feet, leg etc. Releasing negative energy through each body part, letting the stress flow from the body. You should actually be able to physically feel each body segment relax. Finally as you reach the head or stress center, do not focus on that part, remove your mind to a pastoral scene, field of wheat, ocean or my personal favorite, a placid lake in the valley of two snow-capped mountains,:-{). Then, within your mind, smooth out each ripple of water, just simply remove it from the scene and soon you are asleep before you know it. I also play a relaxation tape of ocean sounds. I have used this system for many years and ask (wife), when I crash to sleep I am gone in about 2-3 minutes.

From a female HOPA member:

One of the coping skills for me is getting to the chat room and laughing and forgetting all the woes of the day.

One of our HOPA mothers begins telling of her coping skills by qualifying "Well, here goes nothing":

I have had the worst problems with relaxing and getting to sleep. I have 2 kids, 3 if you count my husband. As you can imagine, I have a heck of a time getting any personal time, seems like the bathroom is the only place to be left alone and only if I lock the door. Anyway, I will get on with it. I take long hot baths. I will lay all of my head in the water except for my face, then I will put a hot wash cloth on my face, over my eyes and lay there. I usually end up staying that way in the bath until the water gets cold. I also put Epsom salt in the bath. I get some bath crystals in a smell that I like and mix that with the Epsom salts. I get the best of both worlds, nice smell and the help of the Epsom salt.

She concludes her comments with "Just an idea, nothing original or anything":

I'm sure I have a million coping techniques...but this morning in church I was taking in deep breaths through my nose, imagining the air swirling up around the area of my head that was throbbing, then exhaling through my mouth--imagining that the pain was leaving with the exhaled air. Sound crazy? Maybe, but it got me through a bad point "drug free" as it were!

Some members use medications to counteract the insomnia:

I have tried many medications Xanax, Ambiem, Remeron, and now Trazadone. Nothing seems to help. Sometimes, if I take the medications, then a hot shower, then go to bed and read, I will sometimes actually fall asleep. But if I am in that twilight period and someone phones or questions from hubby, I am immediately awake and up for the rest of the night. I've done the biofeedback, I've done the guided imagery, hot showers and baths, mood music, hot packs on my head, cold packs on my head, massage therapy, pressure point massage and nothing seems to work the same all the time. It is very frustrating which in itself is a hindrance to getting to sleep and staying asleep.

One member combines medications and progressive relaxation techniques:

When I have a migraine and I need to sleep, I try progressive relaxation techniques first and if that doesn't work, I have to resort to Xanax unfortunately. Some of the non-medical ways that I relax are warm baths, chamomile tea and reading. I also use visualization techniques to deal with the pain; I visualize the pain expanding to fill a balloon, hard to explain but it does work. My balloon of course is very big, not the party balloon size but more like one of those that carry people.

Another member swears by gel packs:

I keep them in the freezer--a couple at a time so I can switch them off when they get too warm--and wrap them in a hand towel. I apply this to the base of my skull and this always relaxes me and/or puts me to sleep. You can find these in most drug stores where they keep the ace bandages, etc. My nephew, who started having migraines at age 7 uses them all the time as well. I never had problems sleeping when my husband was alive, another member tells us. I find if I exercise during the day I sleep great at night. I like to walk if it is a nice day, otherwise I'll get on my treadmill. Exercise also helps my migraines.

Another HOPA member tells us that soft relaxing music and sounds can induce sleep:

For relaxing at night and trying to fall asleep, I use to play music softly for an hour or so to relax me and sometimes several hours a night when I couldn't sleep as I have found that if I can make myself stay in bed and relax even if I don't sleep that I can sometimes get enough rest to help me deal better with the pain the next day. I think the music would be different for each person depending on what they find relaxing and maybe different music for each night. I use a series called Nature & Relaxing. There are several in this series that I find to be relaxing. I like classical music but it can be very stimulating so you need to be selective in what you choose. There is a series of tapes or CD's I use: Meditation-Classical Relaxation. Some of these combine nature sounds with the music. When the music no longer relaxes me at night like now, I use a Sound Machine or Sound Spa that emit sounds of nature such as Mountain Streams, Spring Rain, Ocean Waves etc. I set mine for an hour and I keep it by the bed so I can reach over and keep turning it back on again as needed during the night.

For learning to relax, I am trying Relaxation tapes during the day which includes deep breathing which is suppose to be good for relaxing and pain. I have one which guides you with deep breathing, stretches and massaging neck, face and head. I have just started these so don't know if they will work or not. You need to give them at least a month or so. During a mild migraine after taking meds, I go lie down in a dark room, put on soft relaxing music and use an ice bag on my head and the back of my head when I can tolerate it. During a bad migraine I can't stand any sound or anything touching me. But I think some of our members have different types of headaches and maybe could tolerate some of these things.

How, then, does one then decide what works best? It is a long process of trial and error and repetition. Have medical examinations to determine that nothing physical is causing the problem of not being able to sleep. Explore all the non-medical options as well as medical options if the insomnia continues.

© Sondra McElhinney

Sondra McElhinney was the founder of HOPA ~ HeadOffPain Advocators, a nonprofit organization.