Morning headaches are common, and most of the time, there’s no reason for concern. However, if you find yourself frequently waking up with headaches, it’s important to pay attention to the type of pain you feel and if you’re experiencing any accompanying neurological symptoms. With this knowledge, you can take the right steps to treat your pain.
I have a quick procedure I follow to assess headaches and determine whether they are a sign of something more serious. I categorize the headache, look for the cause, and then determine the right course of treatment.
In this article, I’ll teach you how to categorize your morning headaches. I’ll describe some specific symptoms to watch for, possible causes of morning headaches, and neurological symptoms to be aware of. I’ll also provide some general guidelines for when to see your doctor, information about the treatments they might recommend, and some other key takeaways. If you’re wondering why you wake up in the morning with a headache, this may help you narrow down the potential cause, actions you should take, and treatments to consider.
Types of Headaches
There are many different types of headaches, each with varying symptoms and severity levels. Knowing the difference between them can help you assess the type of headache you have and what may be causing it.
- Tension Headaches: Tension-type headaches are the most common type of headache. They’re caused by tight muscles in your shoulders, neck, scalp, and jaw. Tension headaches can be triggered by stress, anxiety, or depression with varying severity. Pain from these headaches usually builds slowly and can last from 30 minutes to several hours, but rarely prevents you from daily activities.
- Sinus Headaches: Sinus headaches are caused by a swelling of the sinuses, known as sinusitis, and typically occur in the face, bridge of the nose, or cheeks. They are often associated with seasonal allergies.
- Migraine Headaches: Migraines are a type of recurring headache. They can be triggered by a variety of causes ranging from stress and anxiety to changes in your environment. Even certain foods and aromas can trigger a migraine. Some researchers believe genetics also plays a factor.
- Cluster Headaches: Cluster headaches are less common. They appear suddenly and consistently for a period of time. Attacks last from 15 minutes to three hours and can occur daily—or almost daily—for weeks or months. The attacks are separated by pain-free periods that last at least one month or longer.
- Hypnic Headaches: Hypnic headaches are a rare type of headache that occurs exclusively during sleep, usually waking the sufferer up. This type of headache more commonly affects people over 50, and can last for years.
Symptoms of Morning Headaches
So, you woke up with a headache. Despite the pain, you still need to go to work. What should you do? The first thing I ask patients is whether they’re feeling just headache pain (that is, isolated pain) or pain plus neurological symptoms. Such neurological symptoms could include:
- Balance and coordination issues, including an inability to walk in a straight line
- Difficulties holding a pencil or pen
- Tingling sensation or numbness in hands or feet
- Changes in vision—double or blurry vision
- Eye pain
- Drooping eye(s)
- Swelling in eye(s)
- Uncontrolled vomiting
Before delving into what these symptoms could mean, let’s first separate morning headaches into two categories, which I’ve called “pain” and “pain-plus”:
Isolated pain is far more common than “pain-plus” headaches. The majority are tension headaches, which present as isolated pain in the head and neck, or sinus headaches.
- Tension headache symptoms: Symptoms include moderate pain in your neck and/or pain in both sides or the bottom of your head.
- Sinus headache symptoms: Symptoms include facial pain and pressure under the cheeks and forehead, congestion and other cold-like symptoms.
An isolated pain headache is the most common type of morning headache, and it’s the most common type of headache overall. Sinus headache pain may be felt in your cheeks, jaw, or forehead. Pain from tension headaches usually builds slowly. Nausea or vomiting can also occur.
Morning headaches that appear with related neurological symptoms can be subdivided into two major categories:
- Migraines: If you’ve ever suffered a migraine, you know the symptoms that are typical and unique to you. Migraines normally involve throbbing and intense pain with sensitivity to light, sound, and movement. Some people experience other neurological symptoms, and if you’ve already been evaluated by a doctor for those symptoms you may recognize them as part of a “normal” migraine.
- Headaches with unusual neurological symptoms: If your morning headache is accompanied by unfamiliar neurological symptoms, such as any of those listed above, it merits immediate medical attention. Even if you suffer from migraines—and even though these symptoms could be related to those migraines—any new neurological symptoms need to be immediately investigated with a physician.
Serious Morning Headache Symptoms
There are two concerning exceptions of morning headaches that don’t fit neatly into the categories I mentioned above. While rare, they are still worth considering, as they may be overlooked:
- Infections: Any infection involving the lining of the brain causes extreme pain and usually a stiff neck. Because the lining of the brain is called the meninges, we call those infections meningitis.
- Carbon monoxide poisoning: Carbon monoxide is an odorless, colorless gas that is lethal when inhaled in large quantities. Unvented, fuel-burning space heaters can release carbon monoxide and this might cause you to wake up feeling light-headed and nauseous. If you have these symptoms and you have a space heater at home, and if anyone else in the house has the same symptoms, step outside immediately and consider seeing a doctor.
How to Evaluate Morning Headache Pain
The first step in evaluating your morning headache is to notice whether you have any neurological symptoms. This will help determine whether your headache pain needs urgent medical attention.
Keep in mind that morning headache pain with no neurological symptoms usually means that it’s just a tension or sinus headache. This type of pain is common and represents 90% of all headaches. The remaining 10% of headaches that come with other neurological symptoms are typically either migraines or headaches from ailments like earaches. While unpleasant, these types of headaches are usually not concerning, either. Only a very small percentage of headaches with neurological symptoms require immediate medical attention. The key is to identify these rare instances, which is why knowing how to recognize abnormal neurological symptoms is vital.
Possible Causes of Morning Headaches
Sleep apnea and sleep disorders
Obstructive sleep apnea (OPA) refers to episodes during which your breathing repeatedly stops and starts as you sleep. This causes your airway to be partially or completely blocked during sleep, reducing the oxygen in your blood being transported to your brain which can result in a morning headache.
Obstructed breathing patterns from snoring can also be a common cause for morning headaches.
Medication and supplement use
Medication overuse headaches or rebound headaches are caused by regular, long-term use of medication to treat headaches, such as migraines. If you take them more than a couple of days a week, they may trigger medication overuse headaches.
Alcohol-induced headaches happen when ethanol is released into the bloodstream and vasodilation occurs—meaning your blood vessels expand. Vasodilation can stimulate certain brain nerves and result in pain. Ethanol can also cause dehydration resulting in a headache among other symptoms.
Insomnia is the clinical term for people who have trouble falling asleep, difficulty staying asleep, waking up too early, or waking up feeling unrefreshed. Such sleep deprivation can often lead to morning headaches.
Depression or anxiety
The temporomandibular joint (TMJ) connects your jaw to your skull. When this joint tenses up, the pain can spread to the surrounding muscles and result in a headache.
Circadian rhythm disorders
Also known as sleep-wake cycle disorders, circadian rhythm disorders occur when your sleep-wake cycle is not properly aligned with your environment, interfering with daily life. This imbalance in sleep patterns may lead to poor sleep habits, daytime sleepiness, a general lack of sleep, and often, morning headaches.
The most common time for a migraine to happen is the early morning.
Teeth grinding, also known as bruxism, happens when an individual grinds or clenches their teeth and is highly common during sleep. This unconscious behavior puts strain and pressure on the TMJ and supporting muscles, often resulting in a morning headache.
Neurological Symptoms to Watch Out for With Morning Headaches
When neurological symptoms like the ones listed above accompany a morning headache, your doctor will most likely perform a neurological exam to determine the cause. If a migraine is ruled out as the culprit, then the following could be potential causes, but keep in mind that these are very rare:
A stroke occurs when part of the brain that is not receiving sufficient blood flow to deliver oxygen. This is due to either a blocked blood vessel or a bleeding blood vessel. The bleeding blood vessels are more likely to cause pain, but both causes lead to neurological symptoms. The type of symptoms will depend upon which part of the brain is not receiving enough oxygen. For example, if the part of your brain responsible for speech is not getting enough oxygen, you won’t be able to speak.
Since the skull cannot expand, any tumor that grows in the brain will cause swelling and pressure on important structures. This leads to pain, balance issues, numbness, double or blurry vision, tingling, dizziness, weakness, or other neurological symptoms. Those symptoms can manifest as an inability to walk in a straight line or the feeling that your head is being pulled to the ground. Again, your neurological symptom(s) will depend on where the pressure has built up in your brain.
Extremely high blood pressure
Extremely high blood pressure, or hypertension, can push the brain’s blood vessels to their limit. This causes two things to occur: they can become damaged, which causes swelling, and they can leak fluid. Both of these things lead to swelling and since the skull doesn’t offer space to expand, this swelling puts pressure on the brain. This causes symptoms that may include headache, nausea, dizziness, weakness, confusion, seizures, and blurred vision. Receiving treatment to lower your blood pressure can improve and relieve symptoms, but must be done cautiously.
An aneurysm occurs when part of an artery wall, which carries blood, gets weak and consequently narrows. These aneurysms can leak, causing blood to seep into the brain. When blood leaks into the brain, it causes extreme, sudden pain (see below). It is very important to be vigilant if you ever experience such pain because a leaking aneurysm can turn into a ruptured aneurysm. If an aneurysm ruptures, that causes a lot of blood to pour into the brain, which can lead to life-threatening pressure build up.
Bleeding in the brain
When blood touches the very sensitive lining of the brain, called the meninges, it can cause headaches so severe that they are often described as “the worst headache of your life.” Importantly, because this lining is sensitive, the headache worsens very rapidly. Doctors will likely ask how quickly the pain came on. Since most headaches start gradually (even those that eventually become quite painful), a headache that reaches maximum intensity within one hour causes concern for bleeding in the brain. This is why headaches caused by bleeding in the brain are often called “thunderclap” headaches.
When to See a Doctor for Morning Headache Pain
The bottom line is that head pain combined with neurological symptoms, like those mentioned at the beginning of this article, are always considered abnormal until proven otherwise. Therefore, if you wake up with a headache and any symptom that feels “off” to you, your headache then falls into the Pain-Plus category, which means it’s best to see a healthcare professional.
This is especially true if you feel like you’re experiencing adult-onset migraines. In most cases, migraine sufferers start getting them in their teens or 20s. Therefore, if you’re already in your 30s, 40s, or older and start developing what you think are migraines, or if you feel unfamiliar neurological symptoms, consult your doctor.
Treatments for Morning Headaches
Treating Morning Tension Headaches
Tension headaches with no neurological symptoms have a wide variety of causes and treatments. Getting a massage, speaking to a nutritionist or therapist, addressing your snoring issues, getting more sleep, drinking more water, etc. are great ways to begin to address morning tension headaches, especially if you suspect a food allergy, are having sleep issues, or don’t drink enough fluids during the day. For headaches related to conditions like sleep apnea or bruxism, you may even need special equipment like a Continuous Positive Airway Pressure (CPAP) machine or a mouth guard.
Treating Morning Migraines
While there are a few theories on exactly how migraines work and what causes them, there is still a lot we don’t know. Most sufferers work with a doctor to become familiar with their own migraine triggers, symptoms, and the treatment options that are effective for them. For both tension headaches and migraines, there is a wide range of over-the-counter medications available that can bring relief. If you’re waking up every morning with a headache like this, it’s wise to talk to a doctor.
Treating Serious Morning Headaches
In the case of a serious headache with unusual neurological symptoms, seek immediate care. Your doctor will likely order a scan to determine what’s causing your symptoms and interventions can range from medication to surgery.
While morning headaches are usually common, they could also be a sign of something more serious. This is especially true if neurological symptoms occur simultaneously. Categorize your headache by noticing any neurological or unusual symptoms, and seek care accordingly.
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