Kathleen Felton
Waking up to a throbbing headache is never a pleasant way to start the day, and head pain can frequently strike at this time. Around one in 13 people experience recurring morning headaches, research suggests, with women and those between the ages of 45 and 64 more likely to have them.
Chronic morning headaches may signal an underlying health condition, so it’s useful to determine what, exactly, is causing them. But because morning head pain can be aggravated by a long list of potential culprits – from obvious ones, such as drinking too much alcohol the night before, to conditions such as sleep apnea, bruxism or migraine – pinpointing the cause can take a little detective work.
Here are some of the most frequent reasons morning headaches occur, as well as serious symptoms to look out for.
You have sleep apnoea
Sleep apnoea, a disorder that causes frequent blockages in the upper airway during sleep, is one of the most common causes of morning headaches, says Sait Ashina, an assistant professor of neurology and anaesthesia at Harvard Medical School and director of the Comprehensive Headache Centre at Beth Israel Deaconess Medical Centre.
“As a sleep doctor, we always ask, ‘Do you wake up in the morning with a headache?’” says Phyllis Zee, chief of sleep medicine in the department of neurology at Northwestern Medicine. If the answer is yes, “we probe a little bit more” about related symptoms, she adds, since snoring, gasping for air or excessive daytime sleepiness can all be additional signs of the condition.
It’s not clear why people with sleep apnoea might wake up with a headache, but reduced oxygen intake throughout the night could play a role, Zee says.
In a 2023 study, participants who were treated for obstructive sleep apnoea experienced a 72 per cent improvement in the severity of their morning headaches.
You have migraine
Migraine, a neurological disease characterised by recurring headaches, affects one out of seven people worldwide. It’s also one of the more common reasons for morning headaches, since attacks often begin late at night or just as someone is waking up, says Niushen Zhang, a clinical associate professor and division chief of headache and facial pain at Stanford Medicine.
Migraine headaches can feel like a pulsing, throbbing pain and may be accompanied by other symptoms, including light-and-sound sensitivity, nausea and vomiting, neck pain and brain fog. About 30 per cent of those with migraine develop aura, where shiny patterns such as zigzags affect vision.
Although migraine often starts in adolescence or early adulthood, it’s possible for people to develop symptoms for the first time in their 30s or 40s, Zhang says.
Additionally, relying too heavily on medications to treat migraine or other headache disorders can lead to medication-overuse headaches, known as rebound headaches, in the morning. “What happens is, overnight, you wear off this medication, and in the morning, kind of wake up with a headache,” Ashina says.
You have insomnia
Not getting enough high-quality sleep (from any cause) can lead to headaches in the morning. “People living with insomnia also have a very high prevalence of morning headaches,” Ashina says.
One study found that around 14.4 per cent of people with insomnia disorder experience chronic morning headaches, compared with 6.9 per cent of those who don’t have trouble sleeping.
Insomnia is also a known risk factor for migraine, he adds.
You need a new pillow
Sleeping in an uncomfortable position or on an unsupportive pillow may set off neck or head pain first thing in the morning, Ashina says. In these cases, the headache might feel like it originates from the neck and radiates to the front of the head.
You have bruxism or a jaw condition
Some people may wake up with a morning headache because they’ve been grinding or clenching their teeth during the night, a condition called bruxism, or have temporomandibular disorders (TMD), a group of conditions that can cause pain, stiffness and limited jaw movement.
Whether from TMD or grinding, tension in the joint of your jaw can generate muscular pain, Zee says, and this “can be transferred to the frontal area because all of those muscles are tightened when you are flexing.”
You have depression or anxiety
Research suggests that people with mood disorders such as depression and anxiety have higher rates of morning headaches, as well as different types of headache in general, including migraine.
Experts aren’t quite sure whether mood disorders themselves cause morning headaches or whether they lead to worsened sleep, which then contributes to headaches, “but we do see those associations,” Ashina says.
A study of more than 18,000 people who answered telephone questionnaires found that anxiety and depressive disorders were among the most significant factors associated with chronic morning headaches.
You drink too much alcohol and/or caffeine
It probably comes as no surprise that heavy alcohol consumption has a significant association with morning headaches, but drinking too much caffeine also can lead to head pain first thing in the morning.
“If you drink a lot of coffee, for example, you can have withdrawal headaches [when you wake] because there are low levels of caffeine in your body,” Ashina says.
When to see your doctor about morning headaches
Recurring morning headaches always warrant a checkup, experts stressed. While less common, morning headaches can be signs of more severe neurological conditions, brain tumours or brain bleeding. Hypertension has also been associated with headaches in cases of severe blood pressure spikes, which would be considered a medical emergency.
Red flags for more serious conditions include morning headaches with neurological symptoms such as weakness, numbness or speech disturbances, as well as extreme pain, Ashina says.
If your symptoms aren’t urgent, “primary care doctors are an excellent resource,” says Zhang, and they can be a helpful starting point to treat conditions such as migraine. Depending on your visit, your doctor may then refer you to a specialist such as a sleep medicine doctor, neurologist or headache medicine specialist, she adds.
When preparing for your appointment, Zee recommends keeping track of any related symptoms (such as if you’ve been snoring, not getting enough sleep, experiencing jaw pain or having other migraine symptoms), as well as potential triggers, such as alcohol, caffeine or any specific foods that seem associated with your head pain.
Take note, too, of any patterns. For example, Zhang says, are your morning headaches a new phenomenon or have they suddenly become more frequent? If you’re someone who has had a tendency for headaches throughout your life but then those headaches start to feel different, that’s also worth telling your doctor, she says.
Washington Post
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