Why Do I Wake Up With a Headache?
## Reasons and Cures
Medically reviewed by Rochelle Collins, DO
Why might you wake up with a headache? And how do you get rid of it fast so you can get on with your day?
There can be a number of obvious reasons for an early-morning headache, like drinking too much the night before, and other more complex causes such as sleep disorders. Figuring out what triggered the pain is important for determining how to find relief.
This article reviews common causes of morning headaches and explains what you can do to treat or prevent them.
Types of Morning Headaches
First, it's important to know that not all morning headaches are the same. You can wake up with any of these types:
Tension headache: This involves dull tightening or pressure on both sides of the head. It may start at the forehead and radiate to the back of the head.
Migraine: Incapacitating pain occurs, usually on one side of the head, plus nausea, sensitivity to light and sound, and sometimes visual phenomena called an aura.
Cluster headache: Brief, severe, sudden-onset headaches may occur multiple times a day, affect one side, and cause red, inflamed eyes, flushing, and runny nose.
Medication-overuse headache: Taking too much headache medication can lead to daily rebound headaches. These don't respond to headache medications.
The characteristics of your headache can help your healthcare provider determine what you may be dealing with and guide them toward a possible cause, which may include any of the following concerns.
Dehydration
Dehydration is a common cause of headaches in general. It happens when you lose more water than you take in. Dehydration is often caused by excessive sweating, vomiting, diarrhea, or a fever.
Morning headaches are especially likely if you get dehydrated overnight. This may be due to sweating while you sleep, either because of a warm environment or the night sweats of menopause.
Other symptoms of dehydration include:
Increased thirst
Fatigue and lack of energy
Dizziness, especially when you first stand up
Dark urine or low urine output
Dry mouth
Irritability
Treating Dehydration
If your headache is from dehydration, it'll likely go away when you replenish your fluids and electrolytes.
In mild cases, you can relieve dehydration with water. If you've lost a substantial amount of fluid, you may need a rehydrating beverage like a sports drink. Severe dehydration requires immediate medical attention.
Preventing dehydration is better than treating it, so try to replace the fluids you lose during the day. That can put a stop to morning dehydration headaches.
Learn More: Understanding Dehydration as a Headache Trigger
Alcohol
Drinking alcohol, especially in large amounts, can contribute to morning headaches.
Hangover headaches are technically called delayed alcohol-induced headaches. They come on the morning after you drink and tend to:
Throb
Get worse with physical activity
Hurt on both sides of the head
Be located on the forehead and/or temples
Researchers don't fully understand what causes hangovers and their associated headaches. Potential factors could include:
Dehydration
Overactivation of certain pathways in the brain
Increase in blood sugars in the brain
Disrupted sleep
Inflammation
Exposure to a chemical called acetaldehyde, which your body produces as it processes alcohol
Withdrawal as the effects wear off
Hangover symptoms may last anywhere from a few hours to three days. The duration depends on how much you drank, how dehydrated you got, and several other factors.
Hangovers aren't the only way alcohol leads to morning headaches. If you get migraines, cluster headaches, or tension headaches, alcohol may be a trigger for them. Since drinking often takes place in the evening or at night, it's common to wake up to them.
Treating a Hangover
Hangover treatments, which may help ease your morning headache faster, include:
Rehydration
Eating or drinking carbohydrates to raise blood sugar
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Caffeine
B vitamins
Zinc
You can avoid hangovers and the associated morning headaches by drinking alcohol in moderation or not at all. Drinking water when you have alcohol beverages is also a good idea.
If you do drink enough to cause a hangover, drink plenty of water before you go to bed so you don't get dehydrated.
Learn More: Treat and Prevent Hangover Headaches
Strained Muscle
Sleeping on the wrong pillow or in the wrong position can leave your neck muscles aching in the morning. That muscle strain may lead to a morning headache.
When your muscles contract, it limits blood flow. That leads to chemical reactions that create a build-up of waste products including lactic acid, carbon dioxide, and water. They irritate your nerves, leading to pain.
Morning neck-strain headaches tend to be tension headaches or migraines. They often feature:
Mild to moderate pain
Mild nausea
Less often, increased sensitivity to light or sound (usually not both)
Blood flow can't resume until the muscle relaxes. At that point, the waste is flushed out and the irritation can ease.
Treating Strained Muscles
You can ease strained muscles with:
Once you've identified strained muscles as the cause of your morning headaches, you can try a different pillow or change your sleep position.
Grinding Your Teeth
Regularly grinding your teeth at night is a disorder called sleep bruxism. This can be both a symptom of poor sleep and a cause of it. It's also tied to high stress levels.
Tooth grinding can aggravate your jaw joint and contribute to temporomandibular joint disorders (TMJ). Pain in the jaw, as well as the surrounding muscles and connective tissues, can lead to a dull, constant headache.
Research published in 2020 showed a direct relationship between nighttime grinding and morning headaches.
Treating Bruxism
To prevent you from grinding your teeth, you may be given:
A custom-fitted mouthguard to prevent clenching
Antidepressants to regulate chemical messengers called neurotransmitters
Relaxation techniques for easing the tension in your jaw and mouth area
You may not be aware that you grind your teeth while you sleep. If you have a sleep partner and morning headaches consistent with bruxism, ask them if they've noticed you grinding.
Related: 8 Things That Make TMJ Worse
Insomnia
Insomnia is a common sleep disorder that can:
Make it hard for you to fall asleep
Wake you up frequently overnight
Make you wake up too early
Poor sleep can be a headache trigger because the same brain regions and neurotransmitters deal with both sleep and pain processing.
Insomnia is often associated with chronic migraines and chronic tension headaches.
Treating Insomnia
Insomnia treatments include:
Lifestyle changes such as adjusting the time you go to sleep and your routine
Sedative drugs (sleeping pills) such as Ambien (zolpidem) and Lunesta (eszopiclone)
Specialized cognitive behavioral therapy, a type of talk therapy
To help your doctor diagnose insomnia, keep a sleep journal that details how long it takes you to fall asleep, the amount of time you sleep, and how often you wake up overnight.
Learn More: Headache Disorders and Sleep
Obstructive Sleep Apnea
Obstructive sleep apnea (OSA) involves pauses in breathing that disrupt your sleep. Sleep disruption can be a headache trigger by itself.
It's also possible that low oxygen leads to high carbon dioxide levels in the brain, which increases blood flow and pressure inside your skull, leading to morning headaches.
These headaches typically:
Occur more than 15 times a month
Affect both sides of the head
Have a squeezing quality
Don't involve migraine symptoms (nausea, dizziness, vision changes, noise and light sensitivity)
Resolve within four hours of waking
The pain of morning OSA headaches is often described as aching rather than sharp. These headaches don't occur at other times of day.
Treating Obstructive Sleep Apnea
Obstructive sleep apnea is treated with:
A continuous positive airway pressure (CPAP) machine, a breathing therapy device
Other wearable or implantable devices
Neurostimulation therapy
Sleep apnea and other sleep disorders are often diagnosed with polysomnography (a sleep study).
Improving Your Sleep Hygiene
If you often don't sleep well and have regular morning headaches, you may benefit from better sleep hygiene—habits and an environment that encourage good sleep.
This includes:
Going to bed and waking up at the same time each day
Keeping your bedroom dark, quiet, relaxing, and a comfortable temperature
Avoiding caffeine, alcohol, and large meals close to bedtime
Getting more exercise during the day (but not near bedtime)
Keeping electronic devices out of the bedroom
Learn More: OSA Headache Diagnosis and Treatment
Anxiety and Depression
The brain regions and neurotransmitters tied to sleep and pain also impact your mood. Common physiology is at least part of why anxiety and depression are both common in people with migraines and sleep disorders.
In fact, a 2020 study confirmed a link between headaches and increased anxiety and depression scores. The links were strongest between:
Medication-overuse headache (see below) and both anxiety and depression
Migraine and both anxiety and depression
Tension headache and anxiety
Treating Anxiety and Depression
Anxiety and depression are both real conditions that need to be diagnosed and treated by a healthcare practitioner. Treatments may include:
Anxiety: Psychotherapy, anti-anxiety drugs, antidepressants, beta-blockers, stress management
Depression: Psychotherapy, antidepressants, and brain-stimulation therapies
If you have both depression and anxiety, you may want to start with treatments that can help both of them, such as talk therapy and antidepressants. Some antidepressants have sedative effects, helping you sleep better too.
Related: Can Depression Make You Physically Sick?
High Blood Pressure
Hypertension (high blood pressure) often doesn't cause symptoms, but that's not always the case.
Research is divided as to whether mild or moderate chronic hypertension is associated with headaches and migraines. The link is better established between headaches and severely high blood pressure or a hypertensive crisis.
A hypertensive crisis is a sudden, sharp rise in blood pressure. It causes headaches that are often accompanied by a nosebleed and tend to be worse in the morning.
The reasons behind hypertensive headaches may vary for different headache types.
In non-migraines, researchers suspect it has to do with a disruption of the blood-brain barrier. This is a network of cells that prevent harmful substances from reaching your brain.
In migraines, evidence suggests it's because of common underlying mechanisms including:
A type of heart disease called endothelial dysfunction
Problems with the automatic regulation of your heart and blood circulation
Involvement of hormones that regulate blood pressure and blood volume
Recurring headaches of any severity are worth mentioning to a healthcare provider. This is especially important if you're pregnant and have frequent headaches. They could be a sign of a dangerous hypertension-related complication called preeclampsia, which can also cause blurry vision, swollen hands and face, and right-side abdominal pain.
Treating Hypertension
There are several options for treating hypertension. These include:
Physical activity
Weight loss
Stress management
Hypertension increases your risk of heart disease. It's important to have it diagnosed and treated by a healthcare professional.
You should get a blood pressure cuff and check your blood pressure regularly if you have a history of hypertension, hypertensive crisis, or headaches and nosebleeds that occur together.
Call 911
If you have a headache and a nosebleed at the same time, check your blood pressure if possible. If it's high, rest for five minutes and check it again. If your second reading is above 180/120, call 911 immediately.
Medication Side Effects
Several types of medications cause side-effect headaches in some people who take them. They include:
Hormonal medications used for birth control and menopause
Erectile dysfunction drugs such as Viagra (sildenafil) and Cialis (tadalafil)
Some heart and hypertension medications including:
Plavix (clopidogrel)
Zestril (lisinopril)
Nitroglycerin,
Procardia (nifedipine)
Dopamine
Myriad other medications and some supplements can cause headaches as well. If you've started a new medication or had a recent dosage increase and start having regular headaches, talk to your healthcare provider.
Treating Headaches Caused by Medications
Headaches and other medication side effects may eventually taper off if you stay on the medication. They should also clear up if you stop taking the drug in question.
However, don't stop taking a prescription medication without the advice of a healthcare professional. Doing so can cause side effects, as well as complications related to your condition going untreated. Your provider can work with you to find a different treatment or a dosage of your current treatment that works better for you.
Also, ask your healthcare provider or pharmacist what pain medications you can safely use to ease your headaches given other drugs you are taking.
Headache Medication Overuse
Ironically, the drugs you take to treat chronic headaches may eventually start causing them. The headache medications work at first, but over time, they become less effective.
Typically, you need to take the drugs more than 10 days a month for more than three months for this to happen.
When they wear off, your headache comes back—usually worse than it was before you took the medication. If you don't realize this is happening, it's natural to take another dose. However, that just compounds the problem.
Drugs that can cause medication overuse headaches (MOH) include:
Advil (ibuprofen), Aleve (naproxen), and other NSAIDs
Codeine, Vicodin (hydrocodone-acetaminophen), OxyContin (oxycodone), and other opioid painkillers
If your headaches are getting worse despite taking pain medicine, talk to your healthcare provider.
Medication-overuse headaches are sometimes called medication-induced headaches, rebound headaches, drug-induced headaches, or medication-misuse headaches. However, not everyone who gets them has overused or misused the medication.
Treating Medication Overuse Headaches
To get rid of an MOH, it's usually recommended that you stop taking the problem drug. Your healthcare provider can help you find different treatment, if needed.
Ask your healthcare provider or pharmacist how to treat your headache while the drug is still in your body.
Learn More: Medications That Cause Overuse Headaches
Timing of Headache Medications
Migraines are most common early in the morning. There are several reasons for that:
Many pain medications last for between four and eight hours. If you take them before bed, they'll likely wear off while you're still asleep and leave you vulnerable.
If you're having MOH, it's even more common for drugs to wear off overnight.
Migraine treatments are most effective when taken soon after the migraine begins. If one begins while you're asleep, you may miss the ideal window for taking your next dose.
Treating Medication-Timing Headaches
Ask your healthcare provider about longer-acting or extended-release drugs.
You may also need to adjust the timing of your medications, but that should only be done under the direction of a medical professional.
Circadian Rhythm Disorders
Circadian rhythms are biological cycles, including the 24-hour sleep-wake cycle. These rhythms help you to fall asleep at night and wake in the morning while playing an important role in the regulation of hormones and body functions.
A number of health issues can disrupt your natural circadian rhythm, including:
These disorders can cause you to wake up during the sleep cycle, or you might sleep for too short or too long a period of time. This can create an ongoing problem in which you develop headaches because of sleep disorders and then the headache itself causes additional problems sleeping.
Treating Circadian Rhythm Disorders
To regulate circadian rhythm, your doctor may recommend at-home therapies such as:
Limiting your caffeine intake
Keeping a regular schedule for meals
Establishing a regular bedtime routine
Avoiding naps during the day
Exercising regularly
Managing light exposure including getting sunlight during the day and dimming light at night
Oversleeping
It may seem that getting extra sleep would be a good way to avoid a morning headache. However, sleeping too much is a type of sleep disorder that can leave you feeling terrible.
Serotonin, one of the neurotransmitters that regulate circadian rhythm, signals to your body when it is time to wake up at the end of the natural sleep cycle. At that point, your brain begins to work and your body starts to want food and water.
If you continue to sleep after your brain has received the "wake up" signal, your body will begin to become dehydrated and suffer nutrient loss. If you continue for too long in that state, it can trigger a headache.
Treating Oversleeping
If you experience a headache triggered by oversleeping as a one-time event or just occasionally, you can relieve the symptoms of your headache by rehydrating and taking over-the-counter pain-relieving medication such as acetaminophen or ibuprofen.
In some instances, people find themselves chronically oversleeping or unable to wake after a normal night's sleep. This could be a sign of hypersomnia and may result in other symptoms such as confusion, anxiety, and hallucinations.
Related: How to Stop Oversleeping
Exploding Head Syndrome
Technically, exploding headache syndrome is not considered a headache disorder because it doesn't cause a typical pain in the head. However, sometimes a stabbing sensation occurs along with the characteristics loud noises in your head. This can cause anxiety that further disrupts sleep and can lead to recurring headaches.
Treating Exploding Head Syndrome
In some instances, relaxation techniques may ease exploding head syndrome. There is also some research that has shown that the tricyclic antidepressant Anafranil (clomipramine) may help with symptoms as well.
Summary
Common morning headache types include tension, migraine, cluster, and medication-overuse headaches. They can be caused by a diverse array of triggers. These include sleep disorders, other medical conditions, and things like alcohol and medication use.
Treatments for morning headaches depend on the underlying cause. Treating a medical condition that triggers morning head pain may alleviate it. Getting good sleep may help, as well.