You may find that when you're undergoing a stressful period in your life, or juggling your schedule to make accommodations for work or family commitments, you experience more headaches. Migraines commonly strike when the daily tasks of taking care of yourself — such as regular sleep, exercise, meals, and relaxation — are deprioritized and routines become erratic.

Other lifestyle habits, such as smoking and drinking, can also contribute to frequent migraines. These triggers are covered in detail later in this chapter.

According to the National Headache Foundation, over half of migraineurs cite “changes in sleep” as a trigger for migraine attacks. Not getting enough sleep is a problem for many Americans. Adults should get seven to eight hours of sleep each evening, and most children and teens require at least nine, yet over the past twenty years, the average sleep time for both adults and adolescents has steadily decreased. And migraineurs who have six hours of sleep or less report more frequent and severe headaches than those without sleep issues.

But it's not just a lack of sleep that can prompt a migraine. Too much sleep can also be a problem. So can sleep schedules that change frequently (e.g., revolving shift-work). Any change in sleep patterns, whether it be a delayed bedtime, sleeping in on a weekend, or an impromptu afternoon nap, has the potential to trigger a headache in a migraineur.

Polysomnography, or overnight sleep studies, have found that migraineurs have distinctive brain wave patterns and changes in levels of neurotransmitters like serotonin during sleep. Migraines often begin during REM (rapid eye movement) sleep, the stage or cycle of sleep during which dreaming takes place. REM is the fifth stage of sleep, and the first REM cycle during sleep happens about ninety minutes into sleep. During overnight sleep, four to six additional REM cycles, each longer than the last, occur. A three-year study of 1,698 migraineurs found that over half of migraine attacks in study subjects occurred during the hours of 4 to 9 A.M. — a time period that would be dominated by the longest stretches of REM cycle sleep. See Chapter 10 for comprehensive information on sleep and migraine.

While a large percentage of migraineurs report that stress is a trigger for headache attacks, clinical research has yet to verify a link between stress and migraine. It's possible the biological changes and fluctuations in hormones caused by chronic stress make migraine sufferers more susceptible to other headache triggers.

Another reported migraine trigger is “let down” or stress relaxation response. After periods of extreme stress, crying, or anxiety, some people may experience a migraine attack. The exact physiological relationship between stress and migraine is not understood.

Eating regular meals is an important preventative measure for migraineurs. Hypoglycemia, or low blood sugar, is a potential migraine trigger, so periods of fasting may stimulate a migraine attack. Certain stress hormones released during prolonged fasting may also contribute to migraine. If you must fast for a religious observance or medical test, break the fast with a light meal and be careful to avoid foods that may be triggers for you.