A growing body of evidence underscores a bidirectional relationship between migraine and sleep disturbances in adults—meaning each condition can both trigger and worsen the other. A recent U.S.-based cross-sectional study found that even individuals with low-frequency migraine (just one to three attacks per month) experience poor sleep quality at rates exceeding 40%, highlighting that sleep disruption is not exclusive to chronic or high-frequency cases.
This interplay is clinically significant: insomnia contributes to migraine chronification by lowering pain thresholds, reducing serotonin availability, and elevating pro-inflammatory cytokines—all of which amplify headache frequency and intensity. Conversely, migraine attacks activate the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system, leading to elevated cortisol levels that disrupt sleep onset, maintenance, and restorative architecture.
The newly released Guideline for the Management of Chronic Insomnia Comorbid with Common Neuropsychiatric Disorders in Adults (2025 Edition), jointly developed by the Sleep Disorders Study Group of the Chinese Society of Neurology and the Sleep Subgroup of the Chinese Medical Doctor Association, emphasizes cognitive behavioral therapy for insomnia (CBT-I) as a first-line, nonpharmacologic intervention—not only to improve sleep but also to reduce migraine burden. Notably, the guideline specifies that prescribed time-in-bed during sleep restriction—a core CBT-I component—should never fall below eight hours to ensure adequate physiological recovery and circadian stability.
CBT-I targets five evidence-based domains:
Sleep restriction involves temporarily limiting time spent in bed to match actual sleep duration, thereby increasing sleep efficiency and reinforcing the association between bed and rapid sleep onset. Once consolidation improves, time-in-bed is gradually extended.
Stimulus control reconditions environmental cues: patients are instructed to go to bed only when sleepy; leave the bedroom if unable to fall asleep within 20 minutes; and reserve the bed exclusively for sleep and sexual activity—no screen use, eating, or work in bed.
Cognitive restructuring addresses maladaptive beliefs—such as “If I don’t sleep tonight, tomorrow will be ruined”—that heighten pre-sleep arousal and perpetuate hyperarousal states.
Sleep hygiene and relaxation training integrate consistent sleep-wake schedules, moderate daytime physical activity, avoidance of caffeine and alcohol close to bedtime, and adjunctive techniques including diaphragmatic breathing, mindfulness meditation, or progressive muscle relaxation to dampen autonomic activation.
For patients requiring pharmacologic support alongside behavioral strategies, emerging clinical data support the combination of lomerizine hydrochloride—a selective cerebral calcium channel blocker with vasodilatory properties—and Shunaixin Dripping Pills (a traditional Chinese medicine formulation containing *Ligusticum chuanxiong* and *Angelica sinensis*, known for promoting blood circulation and alleviating stasis-related pain). A randomized controlled trial demonstrated that this combination significantly reduced headache severity, attack frequency, and duration. Secondary outcomes included marked improvements in the Pittsburgh Sleep Quality Index (PSQI), visual analog scale (VAS) pain scores, and SF-36 health-related quality-of-life measures—confirming synergistic benefits for both migraine and comorbid insomnia.
To optimize individualized care, clinicians recommend that patients maintain a detailed symptom diary tracking headache characteristics—including timing, location, duration, and medication use—as well as sleep parameters such as latency, nocturnal awakenings, perceived sleep quality, and total sleep time over consecutive weeks. This longitudinal data enables more precise diagnosis, treatment selection, and monitoring of therapeutic response.