Few people are lucky enough to venture through life without at least an occasional headache. Headaches due to a wide variety of causes differ with regard to the location, timing, characteristics and intensity of the pain, and possible accompanying symptoms. Certain types of headaches tend to occur most frequently when you first wake up. The many possible culprits for waking up with a headache include a migraine or tension-type headache, caffeine withdrawal, medication overuse and sinusitis, among others.
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Migraine or Tension-Type Headache
Tension-type headaches and migraines are the most common primary headache disorders, meaning they are not due to another underlying cause. Both migraines and chronic tension-type headaches tend to occur in the morning, although both can develop at any time of the day or night. A relatively high level of adrenaline and low levels of endorphins and enkephalins -- natural painkillers -- in the early morning may contribute to awakening with these types of headaches.
Migraines tend to involve one side of the head with throbbing pain, which is often accompanied by sensitivity to light and sound, and possibly nausea and vomiting. Tension-type headaches typically involve nonpulsating, aching pressure affecting the forehead or the back of the head, possibly radiating into the neck. The muscles of the head and/or neck are often tender with tension-type headaches.
Caffeine or Medication Withdrawal
If you're a regular coffee or caffeinated tea drinker, a mild headache upon awakening that goes away shortly after having a cup of your favorite brew might be due to caffeine withdrawal. Headache is a common symptom of caffeine withdrawal and usually occurs 12 hour or less after the last consumption.
Similarly, morning headaches might be due medication withdrawal if you regularly take an over-the-counter pain reliever for headaches or other aches and pains. The morning occurrence of these headaches -- known as rebound headaches or medication-overuse headaches -- is due to a decreasing medication level during the night while you're asleep.
Commonly used medications that can cause rebound headaches when used on a daily or near daily basis include aspirin, acteaminophen (Tylenol), ibuprofen (Advil, Motrin) and other over-the-counter headache pain relievers. Some prescription medications can also cause morning rebound headaches, including some migraine medicines and opiate pain relievers.
Sinusitis, or inflammation of the sinus, often causes morning headaches located in the forehead, temples or on the top of the head. Sinus headaches tend to be worst or occur only in the morning because mucus builds up in the involved sinuses during the night. This type of headache usually diminishes gradually once you get up. Accompanying symptoms may include nasal stuffiness and drainage, sore throat, postnasal drip and possibly fever.
Head and Neck Disorders
Certain head and neck disorders can potentially cause morning headaches. Nighttime grinding of the teeth, or bruxism, is a relatively common cause of awaking with a headache, usually in the temple area. Morning jaw soreness is another telltale symptom of this condition. Tooth pain or wearing of the teeth can also occur if nighttime bruxism goes unrecognized for a lengthy period.
A musculoskeletal neck problem, such as a herniated disc, might be responsible for morning headaches, especially if you're not sleeping with a pillow that properly supports your head and neck. Headaches arising from neck problems are typically located at the back of the head but may radiate to the front. Neck soreness and tenderness may also be present.
Although relatively uncommon, cluster headaches notoriously cause morning headaches that often awaken a person from sleep. Cluster headaches cause severe, one-sided pain located around or above the eye, or in the temple area that typically lasts 15 minutes to 3 hours. Characteristic accompanying symptoms during an attack include:
- Eye redness and tearing
- Nasal stuffiness and drainage
- Facial sweating
- Eyelid drooping and possible swelling on the affected side
Numerous other medical problems can potentially lead to morning headaches, although other causes are more common. Examples include:
- Severe high blood pressure
- Heart, kidney or liver failure
- Sleep apnea
- Brain tumor or blood clot, or head injury
- Pericarditis, or inflammation of the sac around the heart
- Underactive thyroid (hypothyroidism)
- Overactive adrenal gland or adrenal tumor
Warnings and Precautions
Waking up with a headache is unquestionably an unpleasant way to start your day but, in most cases, does not signal a serious condition that might threaten your long-term health. However, because there are many possible causes and some of are serious, see your doctor as soon as possible if you experience frequent, severe or worsening morning headaches, or a headache that wakes you up.
Seek urgent medical care if you experience a morning headache after a previous injury to your head, have HIV or experience any accompanying warning signs or symptoms, including:
- Stiff neck
- Facial or body rash
- Fever and/or chills
- Confusion, extreme drowsiness or other mental changes
- Facial or body numbness, loss of coordination, weakness or paralysis
- Vision changes
- Unexplained vomiting
Reviewed and revised by: Tina M. St. John, M.D.