“A morning headache is really common,” says Dr Nasima Shadbehr, neurologist and head of the headache clinic at Cedars Sinai Medical Center. If they happen occasionally, they’re probably no big deal. But having them regularly may point to a specific cause, and this is actually a good thing because that means there might be a simple way to prevent them. So, if you’ve been asking yourself lately, “Why do I wake up every morning with a headache?” here are some potential causes — and solutions — to keep in mind.
What types of headaches are more common in the morning?
If you’re having chronic morning headaches, they’re most likely a migraine or tension headache. “A migraine often starts between four and nine a.m.,” Dr. Shadbehr says. That could be because of migraine triggers like dehydration or poor sleep, or because endorphins and some hormones dip to their lowest just as you’re waking. Migraine is more common than you might think: It affects around 15% of the population, according to a 2018 study published in the journal Headache. For people assigned female at birth, that figure jumps to 20%.1
Tension headaches are another common culprit of morning headaches. How do you know if it’s a migraine or tension headache? The location and quality of the pain are two clues. A tension headache often feels like a tight band is gripping your whole head and the pain is usually dull, according to Johns Hopkins Medicine. A migraine, on the other hand, is often localised to one spot— say, right behind your eye. The pain is piercing, and you may have other symptoms, such as sensitivity to light or nausea.
It’s usually pretty easy to tell when you have a migraine versus a tension headache, but there could be other things going on too. Ahead are potential reasons you’re waking up with a headache.
What causes headaches and migraines, in general?
It’s important to understand that a migraine is not the same as a run-of-the-mill headache. While a headache is caused by nerves that signal muscles and blood vessels to send pain signals to the brain, migraine attacks are not as well understood. In fact, migraine is actually a neurological condition. Experts think this is what’s going on with migraine: Nerve cells in the brain overreact to various triggers, which then causes blood vessels to go haywire, leading to chemical changes in the brain that can lead to severe head pain and other symptoms like nausea and changes to your vision, according to the Cleveland Clinic.
Here's what you need to know.
What are the most common causes of morning headaches?
Whether it’s a migraine, a tension headache, or something else, here are 11 reasons you may be waking up with a headache:
1. You could have insomnia.
“There is an integral relationship between sleep and headaches,” Dr. Shadbehr says. “Poor sleep quality can cause headaches, and improved sleep quality can help relieve them.” There is also a link between insomnia and headaches. If you regularly have trouble falling asleep or staying asleep, and you don’t feel well rested after a night’s sleep, there’s a possibility you’re dealing with this common sleep disorder — and that it could be contributing to why your head is killing you in the morning.
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Treating insomnia (and in turn, morning headaches) starts with getting to the root of the problem. Insomnia can be both its own primary problem or a side effect of other conditions. Plenty of things can cause chronic insomnia, from certain mental disorders to stress and poor sleep habits. To get to the bottom of your insomnia (and possibly your headaches), speak with a healthcare professional.
2. Or you might have sleep apnea.
Sleep apnoea is a potentially serious condition that causes people to repeatedly stop breathing during their sleep. This condition is linked to a number of health issues, including causing you to wake up with a headache. Here’s what happens: A lack of oxygen can lead to increased pressure in the head that spurs a headache, says Vernon Williams, MD, sports neurologist and director of the Kerlan-Jobe Center for Sports Neurology and Pain Medicine at Cedars Sinai.
It can be tough to figure out whether you have sleep apnoea on your own, but if your partner complains that you snore a lot, you often feel tired even though you’ve gotten enough sleep, and you’re having morning headaches, it’s time to talk to a sleep specialist, Dr. Williams says.
3. You’re experiencing a migraine attack.
Migraine headaches can occur at any time, but plenty of people develop them overnight or early in the morning. One older study published in Headache: The Journal of Head and Face Pain found that migraine attacks follow a cycle, meaning people who have migraine typically get episodes in the same window of time.2 So it’s possible that the headache you keep waking up with is actually a migraine attack that hits while you’re sleeping.
Migraine is a genetically inherited neurological condition, which means it can be difficult to control migraine attacks says Amit Sachdev, MD, an assistant professor and director of the Division of Neuromuscular Medicine at Michigan State University. The good news? There are many ways to manage your symptoms.
A good place to start is identifying your migraine triggers—stress, poor sleep, and diet are some of the biggies, Dr. Sachdev says. Avoid them as much as you can. And if you’re pretty sure you have migraine, make an appointment with a neurologist, who can help you come up with a treatment plan.
4. Maybe you’re going through caffeine withdrawal.
This is most common in people who chug coffee from morning till night, but it can happen to anyone. Why? Caffeine may impact blood flow to the brain, Dr. Sachdev says, and if you don’t have as much as usual, it can cause neurological side effects that are similar to withdrawal from other drugs like alcohol (yes, caffeine is considered a drug). A big part of that is a raging headache. And since many people drink coffee in the morning, it can come on first thing.
To combat caffeine-withdrawal headaches, try to avoid caffeine in the afternoon says Jennifer Kriegler, MD, a physician in the Center for Headache and Pain at the Cleveland Clinic. And be sure to wean yourself off slowly. She recommends substituting a quarter cup of your regular coffee with decaf, and then gradually decreasing how much caffeine you have over time.
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5. You could be grinding your teeth at night.
Grinding your teeth can cause tension in your temporomandibular joints (TMJ), which connect your lower jaw to your skull in front of your ear, and it can also cause changes in the positioning of your jaw, Dr. Sachdev says. All this leads to tension, which can escalate into a headache. On top of a headache, you might also feel tightness or pain in your jaw, pain that feels like an earache, or pain or sensitivity in your teeth.
If you suspect that your morning headaches are due to teeth grinding (or your dentist has flagged you as a grinder), talk to your doctor about next steps, which can include wearing a protective bite guard at night, Dr. Kriegler says.
6. You had an alcoholic beverage (or several) before bed.
Whether you had one glass of wine with dinner or were at a bar until 4 a.m., drinking can cause you to wake up with a headache. That’s because alcohol has an effect on several neurotransmitters in your brain associated with headaches says Jennifer Wider, MD, a women’s health expert. Alcohol is also a diuretic (meaning, it causes you to pee), and many people wake up dehydrated after drinking, which can exacerbate a hangover headache or cause one to form, she says.
The solution is pretty simple: Avoid drinking too much. And if you notice certain adult beverages give you a headache more than others, even when you have just a glass, it’s probably best to take a pass on them in the future.
7. You’re using too many OTC pain relievers.
Taking over-the-counter (OTC) pain medications, such as paracetamol and ibuprofen, too often or for too long can cause medication overuse headaches. Taking them regularly can actually turn an episodic headache into a chronic one, Dr. Shadbehr explains. It’s also important to note that waking up with a headache is a common sign of medication overuse headache because your body is essentially withdrawing from the medications overnight.
Researchers don’t know exactly why rebound headaches develop. One theory is that repeated use of these medications makes certain nerves “hyper-excitable” or oversensitive, which triggers chemical changes in the brain that lead to head pain. Another possibility is that long-term medication use changes the way your brain metabolises or breaks down the medication, which makes it less effective over time.3
To avoid medication overuse headaches, over-the-counter pain relievers should be used no more than 10 days a month or a couple of times a week, says Dr. Shadbehr. If you’ve been taking pain medication more often than that, talk to your doctor who can help you gradually wean off the meds.
8. It could be a medication side effect.
Sometimes the medications you take for other health conditions can actually trigger morning headaches. Birth control pills, hormone replacement therapy, and nitrate medications (used to treat heart conditions) are all common culprits.
If the pill seems to be the problem, you can switch to a method of birth control that may be less likely to cause a headache, such as pills that contain the lowest level of oestrogen, a progestin-only pill, a pill that has fewer inactive days to avoid an oestrogen drop, or an intrauterine device, which only delivers hormones to your uterus or contains no hormones at all (depending on which you choose). If headache and hormone replacement therapy go hand in hand for you, it may be best to switch to the method with the lowest oestrogen dose, which is the least likely to cause headaches, according to the Mayo Clinic.
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Headaches are unfortunately very common with nitrates and your best option may be to wait until your body adjusts to the medication. If your headaches persist, talk to your doctor about the best way to proceed with your treatment plan.
9. You’re dealing with anxiety or depression.
People with depression and anxiety are prone to headaches, especially tension-type headaches, according to the National Institute of Neurological Disorders and Stroke. There’s also a connection between anxiety and depression and migraine. People with migraine have a higher incidence of depression and anxiety; these conditions overlap and feed each other in complicated ways, Dr. Shadbehr says.
People with migraine also experience more fatigue than those who don’t, which can negatively impact your everyday life. “You may feel your symptoms aren’t being acknowledged or addressed. Or your eating habits may change as a result of the depression or the headaches,” says Dr. Shadbehr. ”These psychosocial conditions can make you situationally depressed.”
10. You ate something that doesn’t agree with you.
If you have food allergies or food sensitivities, they could trigger migraine, according to a 2019 study published in the Journal of Headache and Pain. The reason could be inflammation: When you eat certain foods, your body responds with inflammation, and that inflammatory environment is exactly what’s needed to spark a migraine attack.4
“In about 20% of people with food sensitivities, the food can trigger migraines,” Dr. Shardbehr says. Processed foods, nitrates in processed meats, red wine, and aged cheeses are some common migraine triggers, according to a 2020 study published in the journal Nutrients.5
11. In rare cases, it could be something more serious.
When people describe morning headaches, Dr. Williams says it gets his attention because there’s a small chance it could be due to something potentially serious, like increased pressure from a brain tumour or mass.
People with brain tumours often wake up early with a headache because cerebrospinal fluid pressure rises during the night when you’re lying down, Dr. Kreigler says. “If the tumour is causing swelling, this will stretch the coverings of the brain and cause headaches,” she explains.
This is obviously rare and not the most likely cause of morning head pain, so don’t assume the worst. If you did have a brain tumour, Dr. Williams says you’d probably also experience symptoms like changes in vision, loss of vision, changes in balance, feelings of drowsiness, and changes in your mental status. It's much more likely that your morning headaches are caused by something much less serious.
How to treat morning headaches
The right treatment depends on what’s causing your morning headaches. If you have migraine attacks, your doctor will probably recommend abortive medications like these, according to the Mayo Clinic:
- Nonsteroidal anti-inflammatory drugs (NSAID), like ibuprofen or naproxen
- Triptans to calm overly active pain-sensing nerves
- CGRP antagonists relieve pain and symptoms like nausea and sensitivity to light as quickly as two hours after taking it
- Antiemetics to reduce pain and help with nausea and vomiting
- Ergot alkaloids such as Dihydroergotamine (DHE) to shrink your blood vessels and lower inflammation
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For tension-type headaches, OTC pain relievers can provide temporary relief, according to the Mayo Clinic, but you’ll want to identify the health condition or problem that’s causing tension in the first place. For example, hunching over a laptop for 8-plus hours a day can lead to neck and shoulder pain that triggers a headache; a physical therapist could help release those muscles and teach you how to improve your posture while working.
Other ways to treat morning headaches caused by tension include a warm or cold compress to ease the pain, a warm shower to relax tense muscles, or a massage to loosen trigger points.
Before talking to your doctor about your morning headaches, Dr. Shadbehr recommends keeping a log of them, addressing questions like these:
- When did it start?
- How long did the headache last?
- What part of your head hurts?
- What triggers do you notice?
- Did you wake up a lot the night before?
- What did you eat for dinner the night before a morning headache?
- Do you have sensitivity to light?
- Are you nauseated?
“Knowing these details can help your doctor better figure out what kind of headache you have,” she says.
How to prevent morning headaches
As you can see, preventing morning headaches is mostly about understanding the root cause and taking steps to fix it—whether that’s cutting back on drinking, getting a mouth guard to prevent grinding, or trying an elimination diet to find out which foods trigger morning headaches for you. If you’ve tried all of these things, and you’re still waking up with a headache, it’s probably time to talk to your doctor. What you think is a run-of-the-mill headache could be migraine or another condition that needs more targeted treatment.
Sources:
- Headache, The Prevalence and Impact of Migraine and Severe Headache in the United States: Figures and Trends From Government Health Studies
- Headache: The Journal of Head and Face Pain, 24-Hour Distribution of Migraine Attacks
- StatPearls, Medication Overuse Induces Headache
- Journal of Headache Pain, Association of Diet and Headache
- Nutrients, To Eat or Not to Eat: A Review of the Relationship Between Chocolate and Migraines
This feature originally appeared on SELF.
