When I was practicing, I often saw patients with this complaint in migrainer’s and non-migrainer’s alike. The key was recognizing a change of pattern for those who had existing history of migraine. Either they were beginning to wake up with severe headache or the frequency and intensity of early morning headaches had somehow changed. These headaches can be so severe they often awaken people from sleep. This was the case for me as well. I have had migraines since childhood as I mentioned previously but never really had early a.m. headaches much less awaking me from sleep due to throbbing pain.
When this began occurring, I took notice immediately. I had to find the answer and put a stop to the problem.
Mine turned out to be one of the most common causes of early morning headaches. I had developed high blood pressure during pregnancy and it was not going away postpartum as we had hoped. The result was severe migraines with nausea, vomiting, light and noise sensitivity but unlike my usual headaches these were global not unilateral and were much worse laying supine in bed. Sure enough my blood pressure was skyrocketing in early hours in the morning due to the normal rise in cortisol levels. This is also the reason why most strokes occur in the wee hours of the morning. Once I started antihypertension medication- voila! No more waking up with a throbbing headache.
This is another common cause of severe headaches waking people up from sleep. These commonly occur in people with other underlying medical problems like Parkinson’s and other neurodegenerative disorders. Sleep apnea occurs in the elderly and obese population as well as in those who have anatomical defects of the septum or who have enlarged tonsils. These patients aside from above, complain of severe fatigue and daytime sleepiness. Also a bed partner may indicate heavy snoring and even note periods of breathing cessation. The way to diagnose sleep apnea is via a sleep study.
This is a condition in which there is too much cerebrospinal fluid in the brain causing increased pressure within the brain cavities. This occurs due to scarring of the cells responsible for uptake of the fluid for recycling due to prior trauma, infection (e.g. Lyme Disease), excess use of vitamin A, chronic use of steroids, intake of birth control pills (most common cause in this age group), and use of certain antibiotics like tetracycline. Although, this can affect anyone including children it is most common in women who are overweight and of child bearing age. The headaches are accompanied by visual problems- typically double vision due to effect the increase pressure puts on the lateral eye muscles. One may also experience flashing lights, blurred vision and even briefly have episodes of blindness, along with dizzy spells, nausea, vomiting, ringing in the ears and neck, shoulder (all of these symptoms are not unlike those in typical migraines) and back pain. If left untreated, permanent vision loss can occur. A lumbar puncture could occur which is also treated by removing excess fluid. Sometimes medications like Diamox have to be initiated and even a shunt is needed to remove excess fluid from the brain when there’s no response to other treatments.
The key to treatment
These three types of headaches are treatable and preventable by identifying underlying problems and treating the source. So if you experience any changes as mentioned above or have increase in frequency and severity of early a.m. headaches as I did, take note and talk to your neurologist ASAP.