Learn more about the types of headaches that happen at night and how to treat them before bed. Headaches are among the most common health issues faced worldwide. According to the World Health Organization (WHO), about 50% to 75% of adults have at least one episode a year. Given how widespread this issue is, it’s little wonder that many
Headaches are among the most common health issues faced worldwide. According to the World Health Organization (WHO), about 50% to 75% of adults have at least one episode a year. Given how widespread this issue is, it’s little wonder that many complain of headaches at night.
What causes nighttime head pain and other symptoms? Many arise due to primary headache disorders, those that occur independently of other symptoms, including tension headache, migraine, cluster, and hypnic headache. This article covers the basics of nighttime headaches, including their causes and what you can do to treat them.
While mornings are the most common time of day people have headaches, many occur at night. While the exact mechanisms of nighttime headaches aren’t fully understood, they’re likely related to the activity of the hypothalamus, a brain region associated with both pain perception and your natural sleep-wake cycle, known as your circadian rhythm. As this region changes activity throughout the day and night, it can spur both nighttime headaches as well as those when you wake up.
There’s a close association between the quality and quantity of sleep you get and the incidence of headache disorders. For instance, people who experience migraines are 2 to 8 times as likely to experience sleep disorders, such as insomnia (inability to fall or stay asleep) and sleep apnea (snoring and breathing disruption during sleep), among others.
By far the most prevalent headache, tension headaches are a common cause of nighttime headache. Lasting anywhere from 30 minutes to a week, they cause:
Tension headaches are caused by the contraction of muscles in the scalp and neck. They can also be set off by a number of triggers, including:
Migraine is a recurring type of headache that is moderate to severe in intensity. Migraine is a relatively common headache disorder that represents about 30% of all headache cases. Attacks of this condition go through stages and last anywhere from four to 72 hours. Migraine doesn't just cause head pain; its typical symptoms can include:
There are several different kinds of migraine, and specific symptoms can vary from person to person.
In some cases, migraine can set on while you’re asleep and wake you up. They most often arise towards the tail end of your sleep cycle, coming on between 4 and 9 AM. While the exact causes of nighttime migraines are not known, poor sleep and sleep disorders can trigger attacks, and they can also be the result of medications wearing off overnight.
Hypnic headaches set on exclusively at night, waking people up from sleep. Attacks frequently recur 10 or more times a month and last anywhere from 15 minutes to four hours. It’s sometimes called an “alarm clock headache” because symptoms tend to arise at the same time every night. Though hypnic headaches can be severe, they are generally milder than other kinds.
Considered the most severe and debilitating of the primary headache disorders, cluster headaches can also arise at night. As the name suggests, they arise in “clusters”—periods of time with multiple attacks in a day—that can last for weeks or even months. These are then followed by significant periods of remission.
Cluster headache symptoms include:
There’s no singular cure for headaches at night, so treatment may require a combination of approaches. A great deal depends on the underlying headache disorder you’re having, and everything from over-the-counter medications to lifestyle changes and other treatments can help.
Over-the-counter (OTC) analgesics, such as Tylenol (acetaminophen) and non-steroidal anti-inflammatory drugs (NSAIDs) like Aleve (ibuprofen) and Bayer (aspirin) are typically the first line of treatment for headaches. The use of these drugs should be monitored, especially in chronic cases.
In more difficult or chronic tension headache cases, medications may be prescribed if OTC drugs aren’t yielding results. These include muscle-relaxers, such as Flexeril (cyclobenzaprine), and tricyclic antidepressants like Elavil (amitriptyline) and Palemor (nortriptyline).
Taking too many OTC drugs and other kinds of pain medication can cause or worsen headaches (a condition called medication overuse headache (MOH)). The risk for this rises if you take these drugs more than three days a week.
Migraine treatments focus both on managing symptoms and developing ways of preventing attacks. If OTC medications aren’t yielding results, you may be prescribed triptans, such as Imitrex (sumatriptan) and Zomig (zolmitriptan), among others. In addition, for more difficult cases, several drugs work to prevent attacks. These include:
A common approach to treating hypnic headache is caffeine, as in a cup of coffee or black tea, before bed. This has been shown not to prevent you from getting good sleep. That said, this condition is notoriously difficult to treat and several other medications and supplements may also help:
Cluster headaches, like other primary headache disorders, can be challenging to treat. Several treatments take on attacks, including:
As with migraine, some drugs may also help with prevention. Evidence suggests Verelan (verapamil), lithium carbonate, and Topamax may help reduce the frequency of attack.
Since stress and tension are often at the root of headache problems, working on relaxation strategies is a common means of prevention and minimizing the intensity of attacks. Typically employed strategies include:
A big part of headache treatment involves making significant changes in your lifestyle, while being strategic about how to practically manage your condition. This can involve:
Critical in managing a primary headache disorder like migraine, hypnic headache, or cluster headaches is learning about your condition. This means recording what medications you’re taking, tracking when headaches arise and how severe they are, and any triggers you’re finding.
Learn More: Making a Headache Diary Template
Some evidence has shown some complementary therapies that can accompany other treatments to help with headaches. Stretching-oriented activities like yoga, meditation, and acupuncture are all options. Additionally, the supplements riboflavin, magnesium, or co-enzyme Q10.
In chronic, difficult to manage headache cases, neurostimulation is another option to manage pain. This involves using magnetic fields or mild electrical shocks to stimulate nerves associated with pain perception. Overstimulating these nerve pathways blocks pain perception, and, in some cases, prevents headaches. Among these devices are:
While headaches can be very debilitating, not all of them require medical attention. However, especially if you live with a condition like a migraine, cluster, or hypnic headache, it’s important to know the signs that you do need help. Get emergency help if you experience:
It’s also important to get help if you experience any of the following alongside headaches:
Nighttime headaches can arise due to a range of disorders and health issues. In particular, this issue can be a feature of tension, migraine, and cluster headaches and is the primary symptom of hypnic headache. While the exact causes aren’t known, they’re linked to the activity of the hypothalamus.
Nighttime headache symptoms vary depending on the headache type. Tension headaches cause duller pain and pressure on both sides of the head. More severe migraine headaches focus on one side, with attacks also causing symptoms like nausea and vomiting, light and sound sensitivity, and visual disturbances. Cluster headaches arise as groupings of severe headaches within a short period of time (clusters). Lastly, hypnic are headaches that arise exclusively while you’re sleeping.
Treatments for nighttime headaches focus on managing symptoms, preventing attacks, and making positive lifestyle changes. OTC and prescription medications are available to ease pain after onset. Additionally, ensuring proper and healthy sleep, not skipping meals, and managing stress can also help.
There’s no denying that nighttime headaches can be debilitating, causing not only physical pain but also a significant emotional and personal toll. Taking on this burden means being proactive about seeking out care, learning about your condition, and making meaningful lifestyle changes. If you’re struggling, it’s important not to give up hope; today’s treatments can effectively ease this weight, paving the way to better outcomes.
While there’s more research needed, it’s believed headaches when you wake up are related to changes in the activity of the hypothalamus. This brain region regulates pain perception as well as your natural sleep-wake cycle (known as your “circadian rhythm”).
As a result, there’s a distinct connection between sleep and headaches, with disruptions of the former leading to the latter. This can arise due to sleep apnea, sleep disruptions or disorders, migraines, teeth and grinding, among other causes.
Most headaches aren’t signs of severe or dangerous diseases or conditions; however, it’s important to know when your issue may be something more serious. Get help if you experience any of the following:
Daily headaches are a rarer issue, but one that’s very debilitating. It can be the sign of underlying conditions, such as inflammation of blood vessels, stroke, infections (like meningitis and encephalitis), high or low intracranial pressure (pressure on the brain), tumors, or traumatic brain injury (TBI).
Additionally, primary headaches, such as tension headaches, migraines, and new daily persistent headaches (NDPH), can become chronic or even strike daily.