Waking up with a headache is a terrible way to start the day. If it happens often enough, getting to the root cause of the problem will likely become a top priority. The first question? Is it a sleep problem or a headache problem?
If you have a history of chronic headaches, you might decide that a headache disorder could be to blame for your morning misery. But what if poor sleep is contributing to your headaches?
If you’re a person who rarely gets enough sleep, you might suspect that sleep deprivation is causing the headaches. But what if it’s your aching head that’s keeping you from getting the sleep you need?
Getting caught up in this loop of uncertainty, one thing becomes clear: you’re dealing with a sticky issue. One way to approach this type of chicken-and-egg problem is to focus on each issue separately.
But considering the foundational importance of sleep to overall wellness — and the significant cognitive, physical, and emotional repercussions attributed to sleep deprivation — the first order of business should be adjusting your daily habits to improve your sleep.
In this article, we’ll explain how lack of sleep can contribute to pain and headaches, and we’ll share tips for improving sleep hygiene to get the sleep your body needs. We’ll also explore the specific types of headaches, sleep disorders, and other medical issues associated with early morning head pain.
Sometimes called awakening headaches, morning headaches can have more than one contributing factor. Some of the main categories include:
Before we delve into the details of morning headaches, it’s important to note that the association between headaches and sleep problems is bidirectional. Headaches can disrupt sleep, and sleep disturbances can precede, trigger, or worsen headaches. The good news is, anything you do to treat or improve one may also have a positive impact on the other.
If you’re looking for a way to upgrade almost every aspect of your life or just feel better and enjoy yourself more often — improve your sleep. Or if something feels off and you’re just not feeling or performing at your best, poor sleep is probably playing into that in one or more ways. And your health and wellbeing are certainly affected. Let’s take a look at sleep’s role in pain and morning headaches.
Sleep loss increases the production of proteins that cause chronic pain in the body. Because sleep deprivation reduces pain tolerance, it can make what might have been minor cranial discomfort register as a full-blown headache. And insomnia is a risk factor for higher headache frequency .
The mechanisms of sleep are not fully understood, but we do know that sleep supports proper functioning of the glymphatic system, which helps clear the brain of protein waste products and is most active during sleep. That’s why sleep can have a therapeutic role in terminating a headache, and getting sufficient sleep — and keeping sleep debt low — is protective against headaches.
Sleep debt is the amount of sleep you owe your body — as compared to the sleep your body needed — over a 14-day period. Paying it down and keeping it low to reduce the risk or severity of headaches starts with good sleep hygiene.
Sleep hygiene is the upkeep of behaviors that impact the way you sleep. Here are some guidelines for improving yours:
People who experience frequent headaches are more likely to be diagnosed with a sleep disorder than those who do not. And sleep loss associated with most sleep disorders has the potential to cause headaches. But headaches that occur in the morning are especially common with sleep apnea.
A sleep disorder characterized by repeated pauses in breathing during sleep, sleep apnea can cause snoring, morning headaches, and excessive daytime sleepiness.
In obstructive sleep apnea (OSA), the most common form of sleep apnea, the throat muscles relax intermittently and block the airway during sleep, thereby reducing the amount of oxygen in the blood and the brain. When oxygen levels drop, the correlating increase in carbon dioxide causes the blood vessels in the brain to dilate. The pain caused by that dilation is usually experienced as a morning headache.
Doctors treating OSA may recommend lifestyle changes to help you lose weight or quit smoking. In more severe cases, patients may use a continuous positive airway pressure (CPAP) machine to help them breathe more and snore less.
According to the National Headache Foundation, migraines, cluster headaches, and tension-type headaches often strike in the early morning in part because of hormonal fluctuations: “Between about 4 a.m and 8 a.m., the body tends to produce less of its natural painkillers, the endorphins and enkephalins, than at other times of the day.” (But keep in mind, this time frame may be true for many people, but it won’t be true for all people since there are different chronotypes.)
And because adrenaline, which affects blood pressure and the regulation of blood vessel dilation and contraction, is released in larger quantities during the early morning hours, it’s not uncommon to experience a headache upon waking. Let’s take a look at the types of headaches most likely to strike when you wake up.
A migraine is a recurrent headache that can cause severe throbbing pain, usually on one side of the head. Other symptoms include disturbed vision, nausea, vomiting, and extreme sensitivity to light and sound. For some chronic sufferers, migraines can be debilitating.
In one large 2005 study, 71% of the participating migraine sufferers reported headaches awakening them from sleep. According to the American Migraine Foundation, early morning is the most common time for migraine attacks because most over-the-counter and narcotic pain medications (that may have been taken before bed) wear off in 4-8 hours, making people more vulnerable to the pain.
Cluster headaches are named for the cyclical patterns in which they typically occur. Bouts of attacks (that often occur daily or every other day), known as cluster periods, can last for weeks or months. And headache-free remission periods can last for months or years.
A rare but severe type of headache, a cluster headache commonly awakens sufferers in the middle of the night with intense eye pain on one side of the head, often accompanied by nasal congestion affecting only that side.
A tension-type headache is the most common type of headache and usually causes mild to moderate pain behind the eyes and in the head and neck. You may also feel pressure, like a tight band around your forehead.
Since stress and certain activities often cause the muscle contractions in the head and neck that characterize tension headaches, this type of headache often occurs during waking hours. However, lack of sleep can precipitate morning-onset tension-type headaches.
Hypnic headaches are sometimes called clockwise headaches or alarm clock headaches because they only develop during sleep and often wake the sufferer at the same time of night.
Hypnic headaches are rare, but those affected can suffer attacks 10-15 times per month, with each episode lasting 15 minutes to four hours.
A secondary headache occurs when a symptom of a disease or medical condition activates the pain-sensitive nerves in the head. It would be difficult to list all of the medical problems that could potentially cause morning headaches, but a few common conditions include sinus infections, ear aches, dental problems, bruxism (teeth grinding), and hypertension (high blood pressure). Although less common, a brain tumor or aneurysm could certainly cause a severe morning headache.
If you’re sick and tired of waking up with a pounding head, consider problematic substances that could be low-hanging fruit ripe for rethinking.
Drinking wine and other alcoholic beverages in excess and/or during the six hours before you go to bed can cause morning headaches, or part of what you may know as a hangover.
And alcohol is certainly not an effective sleep aid. Although its sedative properties may make it easier to fall asleep initially, alcohol has been shown to increase sleep fragmentation, sleep that’s sporadically interrupted by periods of wakefulness.
The disruption of normal sleep patterns and rapid eye movement (REM) sleep, which is important for learning and making and retaining memories, has been linked to some kinds of headaches.
Additionally, because alcohol is a diuretic — it stimulates your kidneys and causes more frequent urination — it can lead to dehydration, which causes your blood vessels to narrow as a way of maintaining adequate blood pressure. But because that narrowing also causes decreased blood flow to the brain, headaches sometimes follow.
Even without alcohol consumption, waking up somewhat dehydrated is normal after going 6-9 hours without fluids. To minimize the associated discomfort (which may or may not include head pain), stay well-hydrated during the day and drink a glass of water upon waking. Just be wary of excess fluid intake in the hours before bed, since frequent trips to the bathroom during the night causes sleep fragmentation.
The word “headache” makes frequent appearances on the side effects lists of a variety of over-the-counter and prescription medications. Some of the most common ones that may cause headaches include anti-anxiety medicines and pain relievers including opioids, acetaminophen, and NSAIDs, such as ibuprofen and naproxen sodium.
And because people suffering from severe headaches often reach for those very medications for relief, the risk of intensifying or prolonging a headache by using them is very real. Patients who develop a medication overuse headache (MOH) may not realize that what they’re taking for the pain is actually making it worse.
Medications that interfere with sleep are equally problematic, as sleep loss can worsen headaches, which can lead to yet more lost sleep.
As varied and numerous as the causes and types of morning headaches are, the treatments and therapies are equally plentiful — from stress management techniques and natural remedies to medications and supplements. Get a full medical exam and talk to your doctor about the best treatment options for you.
Thankfully, you don’t need a medical degree to address sleep problems, improve sleep hygiene, and reduce sleep debt. The RISE app gives you a clear picture of your sleep debt and circadian rhythm and can send you reminders for the sleep hygiene habits you want to adopt for better sleep, better days, and fewer headaches.
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