Suffering through a stressful or difficult day and feeling a headache brewing as you struggle through mishap after mishap is an incredibly common experience for many. What’s a bit more unusual is waking up in the morning with a headache already pounding in your skull. In fact, the common causes of waking up with a headache tend to fall more into the category of headache disorders and underlying health conditions than run-of-the-mill tension headaches.
Meet the experts: Melissa Moore, M.D., a neurologist at Tampa General Hospital and a headache and pain medicine specialist at the USF Health Headache Center; Oluwatosin Ajao, M.D., an internal medicine physician and founder of Hydration Bar MD.
“Typically, we expect headaches to start more so throughout the day,” says Melissa Moore, M.D., a neurologist at Tampa General Hospital and headache and pain medicine specialist at the USF Health Headache Center. “There are certain types of headache disorders which occur more upon waking or that wake you up throughout the night.”
Read on to discover the most common causes of waking up with a headache and when to call your doctor about these headaches.
Common causes of waking up with a headache
“Some types of headaches more commonly have onset upon waking up,” Dr. Moore says. Here are the headache causes that doctors see most often.
Cervicogenic headaches
These are headaches caused by pain that originates from the neck, Dr. Moore explains, and are one of the most common causes of headaches upon waking that she sees in her clinic. In other words, if you sleep with your neck in an awkward position, you may wake up with a headache.
Sleep apnea or altered sleep patterns
Untreated obstructive sleep apnea is another cause that Dr. Moore sees frequently in her patients. “In this condition, breathing stops many times during sleep,” explains Oluwatosin Ajao, M.D., an internal medicine physician and founder of Hydration Bar MD. “The headache usually feels like a dull, pressure-like pain on both sides of the head when you wake up and it typically goes away within a few hours.” Sleep patterns that don’t align with your circadian rhythm, such as working the night shift, may also contribute to headaches upon waking, Dr. Moore adds.
Migraines
“Migraine headaches can begin while you sleep or may be present when you wake up. They are often triggered by poor or interrupted sleep the night before,” says Dr. Ajao. However, she adds that migraines are more likely to start between late morning and early evening than overnight.
Temporomandibular disorders or bruxism
Temporomandibular disorders (TMDs) are a group of conditions that cause pain and dysfunction in the jaw joint and surrounding muscles that can frequently cause headaches, according to the National Institute of Dental and Craniofacial Research. Morning headaches caused by TMD are the third cause that Dr. Moore sees most often. Similarly, grinding or clenching your teeth during sleep (a.k.a. sleep bruxism) can cause pain in your temples when you wake up, notes Dr. Ajao.
Medication, alcohol, or caffeine overuse
Overdoing it on pain relievers, alcohol, or caffeine can lead to a headache upon waking, says Dr. Ajao. “Taking pain relievers too often can cause headaches,” she explains. “You often wake up with these headaches because the medicine wears off overnight.” Likewise, overusing caffeine or alcohol can lead to withdrawal or a hangover in the morning, during which headaches are a frequent occurrence.
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Idiopathic intracranial hypertension
Idiopathic intracranial hypertension (IIH) is a rare, non-life-threatening disorder in which a buildup of cerebrospinal fluid in your skull causes increased pressure around your brain, per the Cleveland Clinic. “This intracranial pressure naturally increases when we lie flat,” explains Dr. Moore, which can lead to headaches upon waking.
Depression and anxiety
“Mental health conditions like depression and anxiety contribute to morning headaches,” Dr. Ajao says. “Those without these conditions tend to have fewer headaches.” She points to an older landmark study that found that people with depression or anxiety were over five times more likely to experience morning headaches than those who didn’t have either of these conditions.
Cluster headaches
“Cluster headaches are well known for happening at night. They often wake people from sleep, and many attacks occur at about the same time every night,” says Dr. Ajao. “They are also usually very severe and may be accompanied by a red or watery eye, a stuffy or runny nose, or a drooping eyelid on the same side as the pain.”
Hypnic headaches
“This rare headache is called the ‘alarm clock headache.’ It happens only during sleep and wakes you up,” Dr. Ajao explains. “The condition usually begins around age 60, often affecting both sides of the head for about two hours.” According to the National Library of Medicine, only 1.4% of older adults with headaches have this disorder.
More serious neurological causes
“There can be more acute issues that lead to headaches upon waking where the headache is secondary to the problem,” Dr. Moore says. The most prevalent are brain tumors, which can cause fluid buildup when you’re lying flat, and vascular issues such as aneurysms, she explains. “Typically, these would continue to worsen with time and commonly lead to other neurological symptoms,” Dr. Moore adds.
When to call your doctor about headaches upon waking
The good news: Many of these issues and disorders have treatments that may help banish chronic headaches upon waking, so bringing them up to your doctor is key. “I recommend talking to your doctor if you are noting any sort of pattern in your headaches, ideally ruling out secondary causes and treating headaches appropriately,” says Dr. Moore.
But if you experience a totally new headache upon waking that feels completely different than anything you’ve had in the past, if it’s the worst pain you have ever experienced, or if it’s accompanied by other troubling symptoms, Dr. Moore says you should head to urgent care or the emergency room that same day to rule out anything serious. Once you determine the cause, you can get the treatment you need.
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