Causes and Treatments for Your Night Headaches
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Headaches toward the end of the day — after dinner, right before bed, or even waking you in the night — can be surprisingly common. Unfortunately, they can also make it hard to get a good night’s sleep, which means you feel groggy and irritable the next day. There can be a few reasons you’re experiencing night headaches, so we chatted with Audrey Wells MD, founder of Super Sleep MD, for some expert insight. Read on for potential causes of night headaches, and what you can do to prevent them.
Note: The content on Sleepopolis is meant to be informative in nature, but it shouldn’t be taken as medical advice, and it shouldn’t take the place of medical advice and supervision from a trained professional. If you feel you may be suffering from any sleep disorder or medical condition, please see your healthcare provider immediately.
Causes of Night Headaches
“Nighttime headaches are less common than daytime headaches,” Wells tells Sleepopolis. Factors like stress, exposure to environmental triggers, prolonged screen time, hormonal changes, caffeine withdrawal and dehydration can all increase the likelihood of headaches during the day; however, those symptoms can also trigger a headache as the day comes to an end.
Night headaches generally fall into specific categories, including tension, hypnic, migraine and cluster. There are no diagnostic tests to confirm what type of headache you have, but signs and symptoms can be a clue into what’s going on.
Tension headaches are one of the most common headache types. According to the American Migraine Foundation, two out of every three adults in the U.S. are affected.
Tension headaches have a few specific symptoms:
- Mild to moderate pain that can range from dull to aching on both sides of the head or across the forehead
- Tenderness in the neck, scalp and shoulders
- A feeling of pressure or tightness in the head
This common type of headache is often triggered by muscle tension, stress or fatigue, which is why they often occur at the end of the day. However, you can get a tension headache at any time of day. Poor posture and insufficient sleep are also contributors, says Wells, along with eyestrain, anxiety, dehydration and grinding your teeth.
Regular exercise, proper posture, adequate hydration and relaxation techniques are recommended for reducing some of the triggers that can lead to tension headaches. But in some cases, over-the-counter pain relievers like acetaminophen or ibuprofen may be required to relieve pain so that you can fall asleep comfortably.
“Applying heat or cold packs to the affected areas may help relieve muscle tension,” says Wells. “In chronic or severe cases, prescription medications like muscle relaxants or tricyclic antidepressants may be indicated.”
Hypnic headaches are unique because it’s the only headache that develops exclusively during sleep, and usually around the same time of night. It’s been called the “alarm clock” headache because it wakes the sleeper.
Considered a true headache disorder, hypnic headaches tend to develop more than 15 days per month and occur on average 15 minutes to four hours after waking. While rare, they are most common in people who are older than age 50. Symptoms include:
- Mild to severe pain that occurs on both sides of the head (which distinguishes this type of headache from a cluster headache)
- Migraine-like symptoms such as nausea
At this time, experts don’t know what causes hypnic headaches. Some speculate that it’s related to an issue in the parts of the brain that manage pain, melatonin production, or REM sleep.
Hypnic headaches can be difficult to treat and require an evaluation by your doctor. The first-line treatment method for hypnic headaches is a bedtime dose of caffeine. And while you might think that this would interfere with sleep, that’s not the case! The sleep quality of those who experience hypnic headaches doesn’t seem to be affected.
Other treatment options include lithium and a nonsteroidal anti-inflammatory drug called indomethacin.
If you’ve never had a migraine before, consider yourself lucky. It’s a severe type of headache that can last from several hours to several days, with all kinds of unpleasant symptoms. The American Migraine Foundation estimates that these extreme headaches affect at least 39 million Americans. “Migraines usually start during the day, but some people may wake up with a migraine headache,” says Wells.
Symptoms of migraines can vary from one person to the next, but these are often experienced:
- Moderate to severe head pain to the point that it’s hard to endure. Can occur on one side of the head or both, or behind the eyes and cheeks
- Throbbing, pounding, pulsating sensation in the head
- Worsens with physical activity or even movement
- Sensitivity to light, noise or scent
- Nausea and/or vomiting
- Vision issues, like flashes of light or blind spots
Migraine pain is thought to be the result of activated nerve fibers in the membrane layers that protect the brain and spinal cord; however, triggers that jumpstart migraine attacks can vary and are highly individual. According to the American Migraine Foundation, triggers include:
- Sudden changes in the weather or environment
- Missing meals
- Low blood sugar
- Insufficient sleep
- Strong odors or loud noises
- Motion sickness
- Depression and anxiety
- Hormonal changes
- Certain medications
Treatments for migraines are generally intended to relieve symptoms and help prevent future attacks. They might include napping or resting in a quiet, cool room; using an ice pack or cool cloth on the forehead; and staying hydrated. That’s especially important if someone is vomiting.
“Over-the-counter pain relievers (such as NSAIDs) can be effective for mild migraines,” says Wells, who clarifies that prescription medications are often used to treat more severe migraines. “Stress reduction, regular and sufficient sleep patterns, maintaining hydration, and identifying and avoiding triggers can also help manage migraines.” Wells notes that in some cases, complementary approaches like acupuncture or biofeedback therapy may be considered.
As the name suggests, cluster headaches are characterized by headaches that occur in cyclical patterns. “The pain comes on and leaves abruptly, and is usually located on one side of the head,” says Wells. “People tend to be very restless during the episodes,” which can be as short as 15 minutes and as long as several hours.
Cluster periods, which describe rounds of frequent headache attacks, can be quite prolonged and last from weeks to months with remission periods in between. Cluster headaches are among the most painful kinds of headache and often awaken people in the night.
Cluster headaches tend to come on quickly and without warning, though migraine-like symptoms of nausea and aura sometimes happen first. Symptoms can include:
- Excessive pain in; behind; or around one eye, which can radiate to the rest of the face; head; and neck
- Pain on one side of the face
- Tearing, redness and droopiness in the eye on the affected side
- Runny or stuffy nose on the affected side
- Facial sweating on the affected side
“The cause of cluster headaches is unknown, but because of the daily reoccurrence over weeks to months, the circadian clock may play a role,” says Wells. Another theory is that cluster headaches are related to the sudden release of serotonin or histamine in the body. According to John Hopkins Medicine, other triggers may include drug and alcohol use, foods high in nitrates, exercise, exertion, bright light, changes in altitude, or heat.
If you’re experiencing what appear to be cluster headaches, it’s a good idea to speak to your healthcare provider about options for treatment, especially since they strike suddenly and often at night. “Treatments focus on reducing the intensity and duration of the attack and also preventing future episodes,” says Wells. That can include inhaling oxygen through a mask, which can bring relief in about 15 minutes, or injectable or nasal spray medications.
How to Prevent Night Headaches
Being mindful of what’s happening throughout your day can help stop night headaches before they begin. That includes staying hydrated, managing stress, and generally leading a healthy lifestyle. “Preventing nighttime headaches can involve a combination of lifestyle adjustments, establishing healthy sleep habits, and addressing underlying causes or triggers,” says Wells. She notes that certain conditions, including sleep apnea, insomnia, nocturnal high blood pressure, low blood sugar in those with diabetes, alcohol use, medication withdrawal, and sleep loss of any cause, are often associated with nighttime headaches, so addressing them is an important first step.
Wells also advises a healthy approach to sleep to help keep night headaches at bay. Here’s what she suggests:
- Maintain a consistent sleep schedule. Establish a regular sleep routine by going to bed and waking up at consistent times. This helps regulate your body’s internal clock and promotes a healthier sleep-wake cycle.
- Create a sleep-friendly environment. Make sure your sleep environment is comfortable, quiet, and conducive to restful sleep. Consider factors such as room temperature, lighting, noise levels, and the comfort of your mattress and pillows.
- Practice good sleep hygiene. Adopt healthy sleep habits, such as avoiding caffeine and stimulating activities close to bedtime, limiting exposure to screens, and creating a relaxing pre-sleep routine to signal your body that it’s time to wind down.
- Manage stress. Stress can contribute to headaches, including nighttime headaches. Stress management is an active process and can include relaxation exercises, deep breathing, meditation, or engaging in activities that help you unwind. Explore progressive muscle relaxation, guided imagery, or biofeedback therapy.
- Identify and avoid triggers. Keep a headache log to track potential triggers, such as certain foods, beverages, or environmental factors. Note the timing, duration, location and severity (scale of 1-10) of your headache. If you notice specific triggers, try to avoid or minimize exposure to them, especially closer to bedtime.
- Address sleep disorders. If you suspect a sleep disorder, such as sleep apnea, consult with a healthcare professional for proper evaluation and treatment options. Treating the underlying sleep condition may alleviate associated headaches.
- Stay hydrated. Dehydration can contribute to headaches, so make sure to drink enough water throughout the day. However, avoid excessive fluid intake close to bedtime to prevent sleep disruptions.
- Maintain a healthy lifestyle. Taking care of your body includes regular exercise, a balanced diet with mostly unprocessed or minimally processed foods, and managing any chronic health conditions.
“Headaches are unique to each individual, and what works for one person may not work for another,” says Wells. “It may take time and experimentation to find the best strategies and approaches to manage and prevent nighttime headaches.”
When to Consult Your Doctor
Though it might feel easiest to simply “push through the pain” that comes with headaches, it’s important to know when to say when.
“Headaches that affect your sleep or daily life need attention,” says Wells. She advises seeing a doctor if headaches persist despite making lifestyle changes, and keeping a headache log with symptom descriptions, potential triggers, a pain scale, and timing. “Testing may be indicated and treatment will focus on pain relief and prevention,” she says.
Why do I get tension headaches at night?
Nighttime tension headaches can be the result of tension that builds throughout the day. Issues like poor posture, tight muscles, fatigue, and stress can culminate in a tension headache in the evening.
Is sleeping with a headache dangerous?
“Sleeping with a headache is generally not dangerous,” says Wells. “In fact, for many people sleep can provide relief from headaches. However, if a headache is accompanied by other concerning symptoms or a recent history of physical trauma, a person should get medical attention before going to sleep.”
The Last Word From Sleepopolis
Going to bed or waking up in the night with a pounding head isn’t uncommon, but neither is it a great experience. By addressing potential triggers and causes, prioritizing healthy daytime habits and establishing a consistent bedtime routine, you may be able to prevent nighttime headaches. If these interventions aren’t helping, or you find that night headaches are impacting your ability to function well, it’s time to see a doctor.
Dr. Audrey Wells. Personal interview. June 2023.
American Migraine Foundation. Tension-Type Headaches. 2023. https://americanmigrainefoundation.org/resource-library/tension-type-headache/
Khalili, Y. et al. Hypnic Headache. 2022. https://www.ncbi.nlm.nih.gov/books/NBK557598/#:~:text=The%20exact%20etiology%20of%20HH,melatonin%20production%2C%20or%20REM%20sleep.
American Migraine Foundation. Hypnic Headache. 2017. https://americanmigrainefoundation.org/resource-library/hypnic-headache/
National Institute of Neurological Disorders and Stroke. Migraine. https://www.ninds.nih.gov/health-information/disorders/migraine
American Migraine Foundation. What is Migraine? 2021. https://americanmigrainefoundation.org/resource-library/what-is-migraine/
American Migraine Foundation. Migraine with Aura: Types, Symptoms & Treatments. 2023. https://americanmigrainefoundation.org/resource-library/understanding-migraine-aura/
American Migraine Foundation. Acupuncture and Migraine: Finding a Combination that Sticks. 2017. https://americanmigrainefoundation.org/resource-library/understanding-migraineacupuncture-and-migraine-finding-a-combination-that-sticks/
Mayo Clinic. Cluster Headache. 2022. https://www.mayoclinic.org/diseases-conditions/cluster-headache/symptoms-causes/syc-20352080John Hopkins Medicine. Cluster Headaches. https://www.hopkinsmedicine.org/health/conditions-and-diseases/headache/cluster-headaches