3 Causes of Early Morning Headache One Cannot Afford to Miss

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.

Hypertension

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.

Sleep apnea

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.

Pseudotumor cerebri

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 can be done which removes 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.

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Comments

View Comments (28)
  • JRudolphAuthor
    5 months ago

    Thank you for this article. It was because of this i was able to talk to my doctor and yeah, as it turns out, i have primary intracranial hypertension.

  • maria.deleon moderator author
    5 months ago

    JRudolphAuthor..Wow! I am so glad that i was of help and that you got the right diagnosis so that you can start feeling better soon..Many blessings.Maria De Leon/author/patient advocate/moderator

  • Jo
    12 months ago

    I have been waking up 4-5 nights a week at 3:00am with a crushing migraine. I have had Rheumatoid Arthritis so that complicates my migraines. I have to take medication to help the RA but I believe increase my migraines 10 fold. I have had migraines since childhood but now that I am 61 they are the worst. I can’t stop the RA meds all my joints will fall apart and I would be crippled. It’s a guessing game between me and my doctors. My Rheumatologist says it’s a side effect of the meds and my body will get used to it. It’s been way too long – I can’t take it!

  • maria.deleon moderator author
    12 months ago

    I am truly sorry..I know living with a chronic illness can affect all aspects of life …may want to get second opinion or discuss alternative treatments for RA..many new ones available which may not exacerbate your headaches…best wishes and merry Christmas Jo- Maria /author/moderator

  • Katyb
    12 months ago

    I, too, wake up with severe migraines around 2:30-3:00am! I found my problem is MOH! UGH! I sometimes have to take *something* during the day for migraine starting at work and I really want to just tough it out. But, I’m at work and can’t. Soooo, at night, I go to bed without a headache and wake up to a horrible migraine after sleeping soundly. It’s so frustrating. If I take nothing for days, I will have zero nighttime migraines. There really is some truth to this MOH theory and you will have rebounds that wake you up. I’m 64 and was told migraines would get better as I age. Right. Didn’t happen and I avoid all triggers.

  • paulaper
    12 months ago

    Developing “alarm clock” headaches, those that wake you up in the middle of the night, led to my discovering a very simple treatment that has greatly reduced the number of migraines that I get at any time of the day. I read online that drinking caffeine in the evening could actually avert the midnight headaches and tried it. Caffeinated coffee kept me awake, but I found that distributing the 2 cups of caffeinated coffee daily that my doctor said to limit myself to throughout the day worked like a charm. Specifically, I have a cup of caffeinated coffee in the morning, a cup of caffeinated tea in the late afternoon, and a cup of caffeinated tea after dinner. It’s worked like a charm for me, reducing my number of migraines from about 15 a month to 4 of less. I want to spread the word since it’s such a simple fix and might just work for someone else. Good luck to all!

  • SusanZ
    12 months ago

    Thank you for posting this. I’m going to give it try. My doctor finally convinced me to give botox a try ad,a treatment and so far that hasn’t worked very well. I’ve gone from an all day migraine everyday to an off and on migraine everyday. So, some improvement? UGH! We keep on going, right?

  • maria.deleon moderator author
    12 months ago

    Paulaper, thanks for sharing. Yes it’s true that migraines do improve as we age so if your are still bothered by them especially if we’re better and have gotten worse need to rule out other causes as above.merry Christmas feel better

  • maria.deleon moderator author
    11 months ago

    paulaper, how are headaches going?
    maria de leon/author/moderator/ patient advocate

  • Deb
    12 months ago

    Thanks, Maria, for this article. I’ve been waking up almost every morning with major migraines. Once that horse is out of the barn, he’s hard to reign in. My headache specialist has recently added an increase in my daily propanerol to help fight this. I am also taking Amitriptyline, Diazepam, and Tizandine at night. I have found Fioricet and a cup of coffee in a.m. help reign in the migraine. I am now going to try your idea of a second cup of coffee and cup of tea in evening. Here’s to hoping it will work fir me too. Thanks again!

  • maria.deleon moderator author
    11 months ago

    good luck Gubs, keep me posted.

  • jcollup
    12 months ago

    Amitrptyline not only made my headaches worse, I would experience a severe black mood before the attack. Sometimes, you have to adjust meds, or discontinue them altogether…

  • maria.deleon moderator author
    12 months ago

    Good morning, paulaper ..I am so glad that caffeine works for you and it does for many people with migraine symptoms to why many of the old medicines like midrin and esgic as well as excedrin migraine otc have very high doses of caffeine as their main active product; however I must caution that most of us having increase caffeine can induce migraines or worsen them…also having increased caffeine can increase heart rate and blood pressure. So talk to doctor before deciding if increasing caffeine intake maybe a good solution. Thank you for sharing .happy holidays to everyone

  • paulaper
    12 months ago

    Thanks for your response, Maria. I agree with you about caffeine and just want to emphasize that I didn’t increase my caffeine intake when addressing my “alarm clock” headaches-I stick to the 2 caffeine drinks a day limit that my neurologist established-I just distribute the caffeine throughout the day. Also, I should add to the first post that I also take 120 mg. of Vermapamil a day as a headache preventative.

  • maria.deleon moderator author
    12 months ago

    Litoria76
    Th am you for sharing your story and i am so very sorry that though are going through such rough times…a couple of things I found in. Y personal experience that worked or might again discuss is ..1) don’t know if tried topamax ..it helps with diabetes, also bipolar disease and headache prevention., lamictal also except no effect on diabetes
    2) sometimes although calcium Chanel blockers like diltiazem are used as preventive therapy it can in some people like it did me worsen migraines 3) also if not sleeping well can cause worsening migraines …so perhaps treating rls may also help you and decrease headaches 4)finally don’t know how much Botox u used or how many sites but my personal to 75units of Botox
    Best of luck …hope you feel better soon
    Author/ moderator/ patient advocate

  • litoria76
    12 months ago

    Tried topamax without success and lamictal gave me migraines (tried it for bipolar). I tried botox 3 times, probably 20 injections each time. I’m planning on getting a referral to a headache specialist since my neurologist has given up on me.

  • litoria76
    12 months ago

    Unfortunately Botox didn’t work for me. I take losartan (Cozaar) in the am and diltiazem at bedtime. I’m limited in what I can take because of potential fatal interactions with lithium which is the only drug that helps control my bipolar disorder. I had a sleep study which found that i have restless leg syndrome and a circadian rhythm sleep disorder. I’m also diabetic and have neuropathy which is treated with lyrica. I’m unemployed so I usually wake up around 6 or 7am to take my am meds and go back to sleep until 11am or so which is when I wake up with the unilateral eye-stabbing migraine…

  • AudreyB
    1 year ago

    Thanks for publicizing the link between migraines and sleep apnea. When I was diagnosed with apnea I came home and did a little research to find out if it was related to any of my other chronic conditions. Depression? Check. Obesity? Check. ADHD? Check. Asthma? Check. IBS? Check again. Since being treated for the apnea, I’ve lost 40 pounds and am starting to slowly eliminate some of the supplements I’ve been taking to improve my health. Next, I’ll see if I can reduce some of my daily meds. It’s amazing what a little oxygen can do.

  • Purplelady63
    1 year ago

    I do have these type of migraines, but my BP can be low one time and to high another, strange I know but I have an arrhythmia and this may cause some of the issues, however, I have started using an Essential oil made for migraines by Forces of Nature, if I catch a migraine when my aura starts, the oil has stopped it from becoming a full-blown migraine, I do not always have an aura, so with this type of a migraine it has not stopped yet, but it is the first real hope of getting some relief I have had since the migraines became severe in 2012. the Essential oil made for migraines by Forces of Nature is a great beginning for me, and hopefully ending sometime in the future. It is worth a try, but give it time to work, the rule of thumb is if it took 10 yrs to get to this point with the migraines it will take 10 months to really get help with the oil. I am willing to try, nothing else is working, I take morphine 15 mg 2xs a day and oxycodone 10 mg 4xs a day, not much help; I have tried everything else there is on the market.

    I’am never actually without a headache, but the migraines are really getting old. The oil is starting to show great promise. I hope you have Good Luck with the oil.

  • pam bitterman
    1 year ago

    I understand the concern, however if these medical issues can be eliminated, one other cause I learned about recently is food sensitivities which can manifest as a waking migraine. This insight was from a doctor/ migraine sufferer in an online weeklong worldwide seminar on migraine,

  • maria.deleon moderator author
    1 year ago

    thank you for sharing Pam…will investigate further and keep that in mind..also increase blood sugars early am can cause this..
    have happy holidays everyone!

  • Traci
    1 year ago

    One other thing to consider would be MOH or rebound headache. When I was in that cycle, the pain was very bad when I woke up.

  • maria.deleon moderator author
    1 year ago

    yes..thank you traci- hope you are better

  • litoria76
    1 year ago

    I wake up with or have severe unilateral migraine almost every day. It always manifests as severe pain in my right eye to the point that I have to keep that eye shut for the duration of the migraine. It usually feels like someone is stabbing me in the eye with knitting needles along with the accompanying nausea, double or blurred vision, extreme light sensitivity, dizziness, fatigue, and sometimes confusion. My neurologist has given up on trying to find out why the migraines are happening. She did an MRI, didn’t see anything, and assumed that they are psychosomatic since I have depression, bipolar, PTSD, and anxiety. She gives me 30 Percocet per month(which she made me sign a contract for) and check ups every 6 months. I’m already on meds for hypertension (incl a calcium channel blocker) and it’s under control. I’ve had a sleep study and was diagnosed with restless leg syndrome and a circadian rhythm sleep disorder. Do I need to go to a pain specialist to find out if it’s the psuedotumor cerebri?

  • maria.deleon moderator author
    1 year ago

    sorry litoria76 that you are hurting since you have high blood pressure have you checked your BP during the headaches in early am? BP tends to spike in wee hours of the morning as i said before also have you had a sleep study to rule out sleep apnea? sometimes also chronic use of analgesics can lead to chronic daily headaches – if the other are ok may talk to doctor about changing BP med – i have found that although calcium channel blockers are often used for migraine prevention in some people these may actually cause headache- they certainly did me! Botox is always a good choice if not tried good luck!

  • Joleen1966
    1 year ago

    These three types of headache were ruled out for me. I had lumbar punctures a couple of times because my pressure was borderline. I lost 200 pounds which did away with my high blood pressure and sleep apnea. The cerebri pseudotumor was ruled out. Still wondering if we will ever find out what causes the chronic unilateral migraine that plagues me. 🙂

    Thank you for your article.

  • maria.deleon moderator author
    1 year ago

    you are very welcome joleen – as above have you had repeat sleep test since loss of weight and also do you check your BP early in am or late at night? was diamox ever tried for borderline pseudotumor? botox is a good alternative for recurrent migraines if not done in past- best of luck i feel your pain. take care

  • CherylB
    1 year ago

    I am 57 and have had migraines since my early 20s. While they are much more controlled now with Topomax, Botox injections , and Maxalt than the the horrid early days I developed the early morning headaches several years ago.

    Two different neurologists have just shrugged me off about them. They said they are just migraines. These migraines come and go. They will come for several weeks then leave and may be gone for months and then return although now they are becoming more often than not. The only thing I have found that may help is a bit of caffeine at night. Helps the morning headache not my sleep which I’m an insomniac also. Sometimes though if I do that for several nights it seems to break the cycle of them at least for a while and I can quit the caffeine but once my sleep is off it is off. What we headache sufferers deal with!

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