When to Worry About Morning Headaches: Symptoms, Causes, & Treatments

By Allon Mordel, MD
Medically reviewed
June 30, 2019

Morning headaches are common, and most of the time, there’s no reason for concern. However, if you find yourself waking up with an early morning headache, it’s important to pay attention to the type of pain you feel, and if you’re experiencing any accompanying neurological symptoms, so that you can take the right steps to treat your headache.

As an ER doctor, I have a quick procedure I follow to assess headaches and determine whether it is 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, some specific symptoms to watch for, and some general guidelines for when to see your doctor. 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.

The Two Categories of Morning Headaches: Pain vs Pain-Plus

So, you woke up with a headache. Despite the pain, you still need to go to work. What should you do? As an ER doctor, the first thing I ask patients is whether they’re feeling just headache pain (i.e., isolated pain) or pain plus neurological symptoms. Such neurological symptoms could include:

  • Dizziness
  • Balance and coordination issues, including an inability to walk in a straight line
  • Difficulties holding a pencil
  • 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 early morning headaches into two categories, which I’ve called Pain and Pain-Plus:

Pain: Isolated pain is far more common than “pain-plus” headaches. The vast majority are tension headaches, which present as isolated pain in the head and neck. They can be caused by many things, but two common reasons are stress and muscle tension. Symptoms include moderate pain in your neck and/or both sides or at the bottom of your head. Another common type of isolated pain headache is sinus headaches, which include facial pain and pressure under the cheeks and forehead. Sinus headaches normally include congestion and other cold-like symptoms.

This is the most common type of morning headache, and it’s the most common type of headache overall. These are typically sinus headaches or tension headaches, which present isolated pain in the head, neck, and face. They are usually caused by congestion, stress, or muscle tension. Symptoms include moderate pain in your neck and/or on both sides or at the bottom of your head. 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.

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Pain-Plus: 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.

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

As we’ve already established, if you have a headache when waking up in the morning, it’s most likely a tension headache which doesn’t require emergency care. What’s causing these tension headaches? These are caused by muscle contractions in your head or neck. Basically, anything that stresses your body can cause your muscles to contract, resulting in early morning headache pain. The following are possible causes:

  • Lack of sleep, including sleep apnea, snoring or teeth grinding
  • Dietary sensitivities
  • Stress
  • Anxiety or depression
  • Withdrawal from certain medications or from caffeine
  • Dehydration
  • Hangover
  • A mattress or pillow that is no longer supportive

Sinus Headaches in the Morning

Another common kind of morning headache is a sinus headache, which comes with pain caused by pressure built up by congestion in your sinus cavities. Notice whether the pain gets worse when you lean forward to help determine if you have a sinus 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:

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 there is a 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.

Brain Tumor

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

Sometimes called “Hypertensive Urgency,” extremely high blood pressure 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 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.


This occurs when part of an artery wall, which carries blood, gets weak and consequently narrows. These aneurysms can leak, which can cause 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 causes life-threatening pressure to build up.

Bleeding in the brain

When blood touched 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.

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Other Serious Morning Headache Symptoms to Watch for

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.

When to Go to the Doctor for Morning Headache Pain

The bottom line is that 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 with any symptom that feels “off” to you, your headache then falls into the Pain-Plus category, which means it’s best to see your doctor.

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. These symptoms are concerning until proven otherwise! This is because if your early morning headache is not a migraine, it could be a sign of a more serious illness.

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. These can also be good things to try if you wake up every morning with a headache because there may be something in your environment or lifestyle that’s causing tension headaches.

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 treatments 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. (You can chat about it with myself or a doctor on my team through the K app).

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.

Key Takeaways

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.

How K Health Can Help

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K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Allon Mordel, MD

Allon Mordel is the Medical Director at K Health. Dr. Mordel is a graduate of the University of Georgia and served as an EMT for the city and county services. He was accepted into residency at the NYU/ Bellevue Emergency Medicine Residency Program where he distinguished himself and became Chief Resident on his way to becoming an Attending Physician.

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