Morning headaches are a common problem for many people face. According to a 2004 study, 1 in 13 people report waking up with a headache at least occasionally.
An occasional morning headache could just be the result of a poor night’s sleep and nothing to be concerned about. However, regularly waking up with headaches or migraines, could indicate something more serious.
If you experience morning headaches or head pain that does not go away easily with over-the-counter pain medications, consult with your doctor to rule out more serious conditions.
What Causes Headache and Migraine in General?
Studies like this one show that there is a link between headache and insufficient sleep, low quality sleep and sleep disorders.
In my own neurology practice I treated thousands of headache patients, with many of them experiencing chronic headaches and migraine attacks. During the treatment process I discovered that almost all headaches are a result of underlying sleep disorders.
By improving my patients’ sleep quality, their sleep disorders, chronic headaches and migraine attacks were dramatically reduced or eliminated, and their overall health improved.
Exception #1: Working Nights
The first exception to this success by improving sleep was if someone worked nights, which is unnatural and interferes with an individual’s circadian rhythm. If that person continued to work nights, we were not able to achieve the proper healing through sleep necessary to resolve sleep-related headaches.
Exception #2: Brain Tumors
The second instance in which improved sleep would not resolve a headache would be if it were due to what we call in neurology a “space-occupying lesion”, such as a brain tumor or blood clot.
In this case, the pressure of the tumor is what is causing the headache, not issues with sleep.
Because non-life-threatening headache symptoms can feel so similar to a headache related to brain tumor, if you have frequent headaches, it is important to get a brain scan to rule out any serious issues.
Why Poor Sleep Causes Headaches
During sleep is when your brain performs bodily repairs that are required for you to feel energized and to function properly during the day. These repairs happen during REM and deep sleep stages.
Most people need approximately 8 hours of sleep each night to allow the body to recover from that day and prepare for the next. However, the quality of sleep is even more important than the amount of sleep you get each night.
The restorative stages of deep sleep and REM sleep will be broken up, but should total approximately 2 hours of each.
Optimal sleep is approximately 2 hours of REM and 2 hours of Deep sleep.
Types of Morning or Sleep-Related Headaches
Headaches are given many different names such as hypnic headaches (waking), post-prandial headaches (after eating), post-coital headaches, (after sex) tension headaches, sinus headaches and so on, based on their location or the timing of when they occur.
Many people also have a common location where their headaches start which affects what they call them; such as starting in the neck first, then spreading to the back of the head. Or in the cheeks first spreading to the forehead. These headaches are all “migraine” in origin but they start as a mild headache, in a specific location and as they become more severe they spread out.
In my opinion, all except Cluster Headache (abrupt, severe pain on one side, usually surrounding the eye, with tearing and runny nose, commonly causing the person to wake at the same time every night and coming in a surprisingly dependable seasonal pattern in the same month every year) and Sinus Headache (with active infection) have their origin in the genetics of migraine. So unless you have an active infection in a nasal sinus with draining pus, that “sinus headache” could really be “migraine” just starting first in the face instead of the neck.
All of these headaches, that may begin as a mild headache but on occasion progress to include other symptoms such as light, sound or smell sensitivity, nausea or confusion are rooted in the genetic disorder called migraine and are all related to sleep.
There are two types of headaches named for happening during and after sleep.
Hypnic headache
Hypnic headaches are headaches that occur in the early morning hours during sleep, usually between 2am-4am, multiple times a month. They can be painful enough to wake you up from sleep with moderate to severe pain.
Awakening headache
Awakening headaches often occur in the early morning after 4am. They may awaken you from sleep or you may simply notice them when you first wake up. They are also known as ‘morning headaches’.
For the majority of people, the underlying cause of morning headaches is poor sleep quality, insufficient sleep or a sleep disorder. (And yes, you can have a sleep disorder causing your headaches and not know it!)
In some cases, frequent and/or severe morning headaches are a symptom of a serious health condition that requires immediate attention, such as a brain tumor, stroke or brain bleeding.
To determine the reason you are waking up with headaches it is helpful to consider the surrounding circumstances and symptoms that accompany your head pain.
Ask yourself these questions to help assess how suboptimal sleep may be contributing to morning headaches in your situation:
Symptoms:
- How severe is the pain of your morning headaches?
- How often do you wake up with a headache?
- Do your headaches happen at the same time every morning?
- Do you have other symptoms in the morning such as nausea or neck pain?
Sleep Quality
- Are you aware of having a sleep disorder?
- How many hours do you sleep at night? (8 hours is ideal)
- What time do you go to bed at night? (10pm is ideal)
- How often would you say you wake up during the night? (zero is ideal)
- Could snoring be contributing to unrestful sleep?
Diet & Medications
- Are you taking medications that may interfere with your sleep?
- Do you regularly take pain relief medicine (more than once a week)?
- Have you recently stopped taking any medications?
- Do you drink coffee or alcohol regularly?
- Have you recently stopped drinking coffee or alcohol?
Possible Causes of Morning Headaches
Caffeine and Alcohol
There are lifestyle factors such as caffeine or alcohol consumption that could contribute to or aggravate headache pain in the morning because they can interfere with the quality of sleep that you get.
So, it goes without saying that if you drink alcohol before going to bed, you may wake up with a ‘hangover headache’ in the morning due to getting poor sleep during the night.
Likewise, drinking caffeine at night or even caffeine withdrawal can play a role in causing morning head pain due to sleep interference.
The Myth of Medication Overuse Headache
Other authors talk about medication overuse headache or rebound headache. The theory is that the prolonged use of the medication you’re using to treat your headaches could, over time, become the source of the headache itself. I disagree with this explanation. I think the pain medication just stops working and you still have a headache every morning because we are not getting to the root cause of the headaches, that sleep disorder hiding in the background.
Sleep Disturbances
Every night, while we sleep your brain repairs and re-stocks every cell. You make the tools the cells need to work for you effectively all day long. When you wake up, every cell in your brain is supposed to be fully stocked with everything it needs to do its job perfectly for the full 16 hours that you’ll be awake that day. These repairs happen in the stages of REM and Deep sleep.
Sleep disturbances during the night can prevent you from entering these special stages of sleep, and thereby, limit your repairs. Your head pain system is supposed to be in the “off “ position when you wake (waiting to turn “on” if you hit your head). So, you may experience a morning headache if you slept poorly the night before and your head pain system starts the day mistakenly in the “on” position because it didn’t get properly provisioned during the night.
In some cases, you may not even be aware of the poor quality of sleep you get at night. It may appear adequate on the surface, but in reality you might not be getting enough restorative sleep.
For example, you might go to bed early and wake up in the morning after 8 hours of sleep. This is an ideal scenario, however, not all sleep is equal. If your body is unable to enter into the deeper stages of sleep, you may still wake up with a headache and/or feel tired during the day.
If you miss getting into the deeper, restorative stages of sleep for too long you may experience stronger and more frequent headaches and eventually develop other health conditions because your body is not performing normal nightly repairs.
Sleep Disorders and Morning Headaches
Insomnia
Morning headaches are a common side effect of sleep deprivation and insomnia. Insomnia sufferers have difficulty falling asleep and/or staying asleep.
Insomnia symptoms can include:
- waking up with a headache
- waking up too early
- daytime sleepiness
- anxiety or depression
- irritability
- difficulty focusing
Sleep Apnea
Nearly one-third of all people with sleep apnea experience morning headaches.
Sleep apnea is a serious sleep disorder that causes breathing to stop and start during sleep. The most common type is obstructive sleep apnea (OSA). This is when throat muscles relax in such a way that it impedes breathing.
A less common type called central sleep apnea (CSA). This causes the individual to stop and start breathing randomly while sleeping, not related to the breathing tube. Both OSA and CSA can be related to improper function of the brain stem sleep switches that control paralysis during sleep. In other words your brain chemistry is off and your throat, or even your diaphragms, get too paralyzed during sleep.
Sleep apnea symptoms can include:
- morning headaches
- snoring
- waking up with dry mouth
- waking up gasping for air
- daytime sleepiness
- irritability
Circadian Rhythm Sleep Disorders (CSRD)
Over 40% of people with circadian rhythm sleep disorders have reported regularly waking up with a headache.
Circadian rhythm refers to the body’s internal clock, which regulates our sleep patterns.
Someone with a circadian rhythm disorder falls asleep very late at night and sleeps well into the day. Their internal clock is malfunctioning. It moves their sleep cycle to an abnormal time, like 4 am to 12:00 noon. Circadian rhythm disorders make it difficult to wake up at a normal time and can result in sleep deprivation as a person attempts to function on fewer hours of sleep each night getting up to go to work on time.
Circadian rhythm sleep disorder symptoms can include:
- headaches in the morning
- daytime sleepiness
- difficulty falling asleep
- difficulty waking up
- difficulty focusing
- depression and anxiety
Teeth Grinding at Night (Sleep Bruxism)
Teeth grinding at night, or sleep bruxism, is a manifestation of suboptimal paralysis during deep sleep. It is estimated that up to 17% of adolescents grind their teeth at night, often without even realizing it.
Sleep bruxism symptoms can include:
- tooth pain and sensitivity
- worn tooth enamel
- tight jaw muscles
- jaw and/or neck pain
- Morning headache
More Serious Causes of Morning Headaches
As discussed earlier in the article, any process that takes up space and/or increases pressure in the head could be the cause of a headache.
Brain Tumors & Brain Bleed
My professional experience has shown me that most headaches are related to an underlying sleep disorder, however there are headaches that can be signs of serious, life-threatening conditions.
A brain tumor can cause pain that feels like a “regular” headache. As can a stroke (related to clot cutting off blood supply to the brain) or bleeding in the brain.
A thunderclap headache is a term used to refer to a sudden, extreme headache that peaks within about 60 seconds. This can also be serious or life-threatening and be related to potential bleeding of the brain.
Because these life-threatening symptoms can sometimes be indistinguishable from non life-threatening ones, if you are experiencing…
- persistent headaches
- abrupt headaches
- extreme headaches
- or a new set of symptoms, such as:
- body weakness, numbness or tingling on one side
High Blood Pressure
Rather than thinking of high blood pressure as a disease, think of it as a sign. High blood pressure can be a sign that you have a sleep disorder. Some people have high blood pressure and accompanying headaches others have high blood pressure but never suffer from headaches so they don’t always come together.
In fact, medical doctors are currently trained that having high blood pressure is a potential sign of sleep apnea and are therefore more likely to send patients who have high blood pressure to a sleep lab to see if sleep apnea may be playing a role.
When to See Your Doctor
If you wake up every morning with a headache or your headaches do not go away with over-the-counter pain relievers it is a good idea to talk to a doctor.
Seek immediate medical care if you are experiencing additional symptoms with your headache such as nausea, vomiting, changes in vision, numbness, paralysis, speech difficulties, dizziness or vertigo.
How To Stop Morning Headaches
Once you’ve assessed your morning headache symptoms and ruled out any serious health conditions, you can begin to focus on improving your sleep to stop your morning headaches.
The importance of sleep on your overall health cannot be underestimated. Good sleep is absolutely critical in healing any ailment that you may suffer.
To completely restore your sleep it can take several months, up to a year or longer. However, with the right approach your early morning headaches and/or other symptoms could be eliminated much sooner.
When you’ve had several months of good sleep, meaning you sleep through the night and you wake feeling refreshed and clear headed, your brain has had time to make the brain repairs that will prevent morning headaches.
How long it takes for your headaches to stop completely can depend on how long you’ve been experiencing headaches. The longer your sleep has been abnormal the longer it will take for your brain to right itself and sleep normally.
Short-Term Morning Headache Relief
Although it may take several months to completely restore your sleep, there are some things that you can do that may have a positive impact on your sleep in the short-term.
First off, since sleep is so important to the healing process, it is recommended that you take naps, if you are able, whenever you feel tired. Napping during the day is an absolutely fine way to make up for sleep that you missed at night.
Pain Medication for Headaches
For relief for headaches in the short term, you can take over-the-counter pain medications such as acetaminophen and ibuprofen, or combination medications that contain pain medications with another ingredient like caffeine.
If you find that you are taking these medications daily, you should consider discussing this with your doctor since these medications are not designed for long-term use, and to rule out more serious conditions.
If there is not a more serious issue present, then you may want to pursue improving your sleep, to resolve waking headaches over the long term.
Sleep Medication that Could Improve Waking Headache
In some cases, certain minerals and supplements can help improve your sleep and reduce the frequency of headaches.
Many over-the-counter sleep aids are available, such as:
- melatonin
- valerian root
- magnesium
If your sleep issues are mild, supplements like these may help you in the short term.
Sleep Hygiene to Improve Waking Headaches
While your waking headaches may be due to an underlying sleep disorder, it can be helpful to make sure that sub optimal sleep hygiene is not getting in the way of your restorative sleep.
Sleep hygiene can include sleep habits such as: going to sleep at a consistent time, making sure you are in a quiet and cool environment without sleep disruption, and that you are in a comfortable sleep position. Avoiding caffeine after 5pm as well as excess alcohol consumption can also help set you up for the best sleep possible.
Optimizing your sleep hygiene can be helpful if you occasionally sleep poorly and wake with a headache. However, if you have a sleep disorder, whether it has been clinically diagnosed or not, improving sleep hygiene alone is less likely to help.
Short-term Solutions Recap:
- Take naps when you feel tired
- Use pain medication to relieve head pain if necessary
- Use a an over-the-counter sleep medication if necessary to fall asleep and stay asleep at night
- Adjust your sleep habits and environment to best support your sleep
Permanently Stop Morning Headaches
The key to waking without headaches is to get enough restorative sleep. That means improving your internal chemistry to give the brain what it needs to make bodily repairs each night.
My research has shown that there is an integral link between vitamin D and sleep. When your vitamin D level is optimal (60-80ng/ml) you’ll naturally begin to sleep better and morning headaches will become a thing of the past.
Bottom Line
Morning headaches can be quite frustrating. However, by understanding the underlying causes, you can start to treat them effectively.
Since morning headaches are almost always a result of poor sleep, restoring your sleep can often resolve headaches. Most people who heal their headaches through improved sleep, also report improved health and vitality.