Almost half of all migraine attacks occur between 4 am and 9 am.[i]
Morning migraine or headache is common. When you wake up with an attack can be an important clue in finding the appropriate treatment and prevention.
You can be awoken by a migraine at any time.
Contents
Causes
There are a number of factors which may cause or trigger an attack. Like migraine triggers generally, some of these factors alone may be enough to cause you to wake up with a migraine.
In other cases, it may be a combination of factors that push you over your ‘migraine threshold’, a concept that is discussed in greater detail in our Trigger Guide section.
Triggers that affect you may not affect others so the challenge is to uncover which of the below causes may be affecting you and potentially contributing towards your attacks.
From personal experience, triggers rarely work in isolation. They are almost always accompanied by several other triggers when problems begin to arise.
1. Poor Sleep Habits
Poor sleep is a common migraine trigger.
Adequate sleep is an essential part of migraine management. It’s also a restorative brain function which influences many other aspects of the body.
Sleep, headache and mood all share common neurotransmitters. Neurotransmitters are the brain’s messaging system.[i] Inadequate sleep increases the chances of headache and changes in mood.
Sleep loss also amplifies the physical and emotional experience of pain. In other words, sleep loss lowers the pain threshold. Fortunately the reverse is also true. Restful sleep improves your pain threshold and lifts your mood.[i]
Any of the following can be a sleep-related migraine trigger:
- Too little sleep
- Too much sleep
- Disrupted sleep
- Poor quality sleep
- Irregular sleep routines (i.e. shift work)
- Dramatic shifts in sleep routine (i.e. jetlag)
If you have a headache disorder like migraine chances are you have a sleeping disorder too. A study of 1,283 migraine patients found that over half had reported difficulty getting to sleep and maintaining sleep at least occasionally. [ii]
The same study also found that sleep disturbance triggered migraine attacks in 50% of patients.
For those with chronic migraine or headache you’re at least twice as likely than the average individual to have a sleep disorder. Some sources suggest up to eight times more likely.[i]
Adults in general are poor sleepers in today’s fast-paced society. The US Center for Disease Control (CDC) said “insufficient sleep is a public health problem”.
The National Sleep Foundation found that 60% of adults reported having sleep problems a few nights a week or more.
Sleep may be an issue when you:
- wake up tired
- get sleepy during the day and feel the need to nap
- have difficulty falling asleep
If you are woken regularly or even daily with a headache or migraine it is referred to as “awakening headache”. These may share symptoms with migraine, tension type headache or other type of headache such as cluster headache.
As the name suggests, an awakening headache tends to occur shortly after waking in the morning.
Research has found that 71% of migraine patients reported awakening headache during the study period. [ii]
2. Sleep Disorders
Sleep Apnea
Sleep apnea occurs when breathing is interrupted temporarily whilst an individual is asleep. It triggers a gasp for breath and often disrupts sleep quality without fully waking the individual.
Many people with apnea do not realize they have it and 80% of people have not been diagnosed.[iii] It’s often the partner, wife or husband who alerts them to the problem.
Sleep apnea is often associated with migraine but researchers still debate the strength of its association. [iv]
Snoring is a potential symptom of sleep apnea. It’s often the first sign of abnormal breathing but does not always indicate obstructive sleep apnea.
Insomnia
Insomnia is the most common sleep issue for those with headache. [i] It includes difficulty falling or staying asleep, nonrefreshing sleep or early morning awakenings.
Total sleep time with insomnia is often less than six hours per night for an adult.
Insomnia is likely to lead to anxiety or depression in those who experience it.
Migraine or headache combined with poor sleep and mood issues reduces quality of life and daily function. It can also lead to a negative feedback loop of increased attack frequency.
3. Medication Overuse Headache
Medication overuse headache (MOH) may be one of the most commonly underdiagnosed headache disorders that exist in those who experience daily headache or migraine attacks.
Studies have shown that up to 80% of patients presenting at a headache clinic overuse acute medication or already have MOH.[v]
MOH frequently causes daily headache or migraine attacks. It often develops over time and is the result of using acute medications too frequently.
For those who overuse medication, if a dose is administered throughout the day or night, medication levels within the body typically fall whilst the individual is asleep. Over time this leads to a dependence which can cause future attacks if the medication is withdrawn. MOH is frequently referred to as rebound headache for this reason.
Click here for a detailed review of MOH including prevalence, symptoms, and treatments.
4. Caffeine
Caffeine is a drug that can develop dependence within a week. Once dependent, if you do not get your regular “hit” of caffeine you may experience a withdrawal headache or in those susceptible, migraine.
High caffeine consumption is a risk factor for progression to chronic migraine.[vi]
If you have chronic migraine or headache, doctors often advise patients to avoid caffeine.
Some treatments for migraine may include caffeine (such as Excedrin) because caffeine can enhance the effect of the treatment. These treatments should be used cautiously to avoid contributing to MOH.
If caffeine is an important part of your life then keeping caffeine levels regular and consistent is helpful to prevent caffeine withdrawals.
5. Stress
Stress is another common cause of sleep problems.
According to the Anxiety and Depression Association of America, one in three adults report persistent stress or excessive daily anxiety. 70% of the same group admit to having trouble sleeping.
Stress or anxiety can make it difficult to fall asleep with ‘racing thoughts’ and sleep difficulties which often exacerbate stress and anxiety.
Have you lied in bed worrying or getting frustrated about not getting to sleep when you really needed it?
This emotional stress can create a negative feedback loop of stress fuelling sleep issues and sleep issues fuelling further stress.
Make Sure Your Sleep Is Not A Trigger With This Migraine Specific Sleep Checklist
6. Jaw Clenching or Grinding
Grinding or clenching teeth can occur without the individual even realizing it. You may have a morning migraine or headache but not notice symptoms from the jaw.
Clenching throughout the night can lead to fatigue and exhaustion of jaw muscles.
Individuals may notice a stiff jaw, aches in the temples and even damaged teeth. Extreme forces can occur in individuals who grind or clench during sleep. This is often several times more forceful than teeth clenching whilst awake during the day.
See 17 treatments for clenching or grinding-related headache.
7. Diet
Let’s be honest with ourselves. Many of us could be eating better. As a broad population, we generally do not eat as much healthy fresh food as we should.
Personally, I don’t think perfection is realistic, but making progress and rewarding ourselves with modest indulgences is a realistic balance.
We need to consider that food is information. Not merely fuel. It can be our poison or our medicine.
For migraine or chronic headache patients this can be particularly challenging when otherwise ‘healthy food’ can trigger attacks. See the best diet for migraine.
Certain foods may be triggering attacks without you being aware. Some people with migraine may not respond well to gluten, dairy or soy amongst other things.
Again, this is highly individual. The only way to really find out is through an elimination diet and a diary. Click here for a list of potential problematic foods or ingredients >>
8. Low blood sugar
Blood sugar concentration refers to the amount of glucose (sugar) in our bloodstream. The body tightly regulates blood sugar levels to keep our metabolism in balance.
Levels often rise after meals for an hour or two and then drop. After dinner, our blood sugar levels drop and continue to fall throughout the night.
Hypoglycemia refers to a condition where the blood sugar levels drop too low. Symptoms include lethargy, impaired mental function, irritability, shaking, twitching, weakness, pale complexion and sweating.
In severe cases, seizures and loss of consciousness may also occur. In the most severe cases, hypoglycemia can be fatal.
9. Dehydration
Dehydration is not likely to surprise many as a migraine trigger but many people don’t appreciate how easy it is to become dehydrated due to sometimes mild or subtle symptoms.
Dehydration can occur throughout the night which can trigger migraine attacks or headaches.
10. Alcohol
Alcohol is a depressant which may help initiate sleep, but it can also prevent deeper sleep states required for restorative rest.
In addition to sleep quality, alcohol can also shorten sleep duration. [vii] These factors combined may account for why so many people experience a migraine in the hours or days following alcohol consumption.
It is possible that the compromised sleep following alcohol may be a greater trigger than the actual alcohol itself.
Intoxication has become so common that we might easily forget that alcohol is a toxin and should be avoided in any significant quantity for those with chronic migraine or headache disorders.
11. Hormones
Dr Anne MacGregor reveals “More than 50 percent of women who suffer from migraines are more prone to them around the time of their menstrual period.”
This is due to changes in the levels of female sex hormones. Men do not experience the same fluctuations. This difference may help explain why females are three times more likely to experience migraine than men.
To read further about menstrual migraine, treatments and prevention click here >>
Another hormone that could be playing a role is melatonin. Melatonin production decreases with age. [viii] Melatonin has been shown to potentially help with migraine prevention although further high-quality studies are required.[ix]
12. Cluster Headache
Cluster headache is considered to be one of the most painful headaches. They are often referred to as “suicide headaches” due to the severe pain.
Some people may awake at night due to cluster headache.
Typical symptoms include pain that centers around the eye and/or in the front part of the head. It is not typically throbbing pain like migraine but rather a stabbing pain or hot poker in the eye. What characterizes cluster headache so distinctly is the restless agitation which makes it very difficult to lie still.
According to Dr Deborah Friedman at the 2016 Migraine World Summit, “80% of cluster patients have what we call episodic cluster headache, they’ll get these bouts that lasts for weeks and months, and then they’ll go for periods of months, or sometimes years without having cluster headaches.”
13. Hypnic Headache
Hypnic headache syndrome is a rare headache disorder that occurs exclusively at night. The cause is still unknown. Hypnic headache:
- Rare
- Begins from 40 – 50 years old
- Occurs often between 1 am – 3 am
- Typically lasts 30-60 minutes but can last up to 6 hours.
- In some cases can also occur when napping during the day.
This type of headache is often called the “alarm clock headache” as it occurs at the same time. In a small study of 19 patients 68% experienced this headache more than 4 nights per week. [x]
It is not considered to be a migraine although it can share similar features such as unilateral pain (one side of the head), throbbing and in rarer instances sensitivity to light and sound.
14. Allergens & Chemicals
The living and breathing environment of our home can play more of a role than most people might think.
Allergens such as dust mites living in bed sheets and mattresses can cause sinus congestion and consequent headache or even migraine attacks.
Mold in the bedroom from the roof, floor or other damp areas could also lead to a range of symptoms including headaches although there is a lack of scientific evidence supporting this theory.[xi]
Chemical exposure or scents from certain products such as air fresheners, cleaners, deodorants and perfumes may also be playing a role in headaches.
If you think sinus may be playing a role use this symptom checker for sinus vs migraine.
15. Intracranial hypotension
Intracranial hypotension is often referred to as a ‘positional headache’ where sitting upright in the morning triggers head pain. In normal conditions the brain is supported by the cerebral spinal fluid. The cerebral spinal fluid in effect carries the bulk of the weight of our brain. The remaining weight is held by pain-sensitive structures. When the volume of cerebral spinal fluid is below it’s normal levels it is thought that the brain places pressure on these pain-sensitive structures which lead to pain. There is also some evidence that vasodilation may play a role. [xiv]
The nature and location of the headache can vary widely but it is often made worse from laughing or coughing and does not respond to typical painkillers. Patients may also experience nausea, vomiting, anorexia, neck pain, dizziness, changes in hearing, light sensitivity, difficulty concentrating, facial numbness or weakness and other symptoms. [xiv] Many of these symptoms overlap with migraine so the helpful distinguishing feature is that relief is experienced by simply lying down in a supine position.
Intracranial hypotension can be caused by:
- A cerebrospinal fluid leak:
- This can occur following a spinal tap (lumbar puncture)
- A defect in the spinal tube covering (the dura). This can be spontaneous or occur due to injury, congenital weakness or from surgery.
- Following a shunt procedure.
Intracranial hypotension usually resolves with conservative management and bed rest. Lying down flat (supine) is believed to reduce cerebral spinal fluid pressure at the site of leakage and facilitate healing. For ongoing cases, if the site of the leak can be found then procedures to repair the leak are usually very effective. [xiv]
16. Rare Serious Conditions
There are rare serious conditions for which you should immediately see a doctor. Two of them are brain tumors and giant cell arteritis.
Brain tumors can cause patients to wake during the night. Increased pressure from within the skull is a common first symptom. Often the headache becomes more frequent until it is constant. Learn more about the similarities of brain tumors and migraine here >>
Giant cell arteritis is an inflammation in the lining of your head arteries. It’s also known as temporal arteritis for this reason. It can occur elsewhere in the body. The most common symptoms are severe head pain and tenderness as well as fever, fatigue, jaw pain, vision loss and double vision.
How to prevent migraine or headache attacks that wake you
Develop good sleep habits
Restful sleep delivers a refreshed feeling in the morning, improved mood, cognitive function, physical energy and perhaps most importantly for chronic migraine patients – an increased threshold for pain. [i]
To improve your sleep hygiene consider some or all of the following to start experiencing the benefits:
- Setup a sleep routine: have consistent bed and wake times.
- Avoid stimuli before bed: this includes LED lights which contain stimulating light and can negatively affect melatonin production. The TV, phone and computer all emit this light.
- Temperature control: Keep the bedroom cool. The body falls asleep easier when the body temperature cools.
- Eat a few hours before bed: give your body time to empty your stomach. Avoid eating sweets or sugary foods before bed that cause large spikes in your blood sugar levels.
- Exercise during the day.
- Keep your room dark and quiet.
Insomnia
According to Dr Jeannetta Rains, Clinical Director of the Center for Sleep Evaluation – “The treatment of choice for insomnia is behavioral sleep therapy.” Dr Rains also suggests speaking to your health care professional about “pharmaceutical grade L-tryptophan, 5-HTP or melatonin”.
Other options from sleep specialists or psychologists include:
- Cognitive therapy
- Relaxation training
- Sleep behavior modification
Low blood sugar
A light balanced snack before bedtime can help to keep blood sugar levels more stable whilst you sleep and prevent night time hypoglycemia. Look for low GI foods or combinations and avoid sugary sweets which can spike blood sugar levels.
Dehydration
Drinking a large glass of water right before bed is only likely to wake you during the night and disrupt your sleep.
Instead maintain good hydration levels throughout the day to help prevent dehydration whilst you sleep.
Stress
There are many ways to better manage stress:
- Exercise is a great way to relieve stress and improve your stress threshold.
- Practice relaxation training such as mindfulness meditation.
- Avoiding unnecessary stress.
- Adapt. When you cannot change the stressor, perhaps you can change how you react to it. Manage your expectations and put it in perspective. Will this really matter 10 years from now?
- Accept the things you can’t change.
Jaw Clenching
Clenching or grinding is typically diagnosed by a dentist. The dentist can provide an occlusal splint, a small mouth guard to prevent teeth damage and disable the jaw from fully contracting. This dramatically reduces muscle strain and tension resulting from clenching or grinding.
Breaking the habit itself of clenching can be challenging. Stress management techniques may also be helpful. See 17 treatments for clenching and grinding-related headaches.
Cluster Headache
There are several types of treatment strategies for one of the most painful types of headache. Treatments can be directed at treating the headache itself, trying to shorten the cluster period and for long-term prevention.
In treating the attack, high-flow oxygen at 10-15 litres a minute in a non rebreather mask is effective in around 80% of patients according to Dr Deborah Friedman.
Hypnic headache
Interestingly, caffeine is the recommended initial treatment for hypnic headache. A recommended treatment, for example, is having caffeinated tea or coffee around bedtime. This goes against some of the healthy sleep habits outlined above, but studies have shown this can be helpful and straightforward to self-administer for this particular type of headache. [xiii]
The other most helpful medicinal treatments are lithium, indomethacin, and flunarizine according to a systematic review of the research literature published in Neurology. [xiii] These treatments are taken preventatively [lookup in glossary] at bedtime.
Some of these treatments have common side effects which are not suitable for certain patients. Your doctor will be able to advise you whether they are appropriate or not.
Allergens & Chemicals
Minimise dust mites in your bed by using allergy-proof pillowcases, mattress covers, and duvets designed to minimize exposure to mites.
Wash your sheets more often and consult an allergist about your potential exposure to chemicals or irritating scents which may be affecting your home environment.
Use this symptom checker to find out if you may have sinusitis or migraine.
Conclusion
Waking with migraine or headache is a common and challenging problem. There may be multiple factors involved and it can be challenging to uncover which triggers are at work and address each of them.
Poor sleep, diet, and stress levels have become so commonplace today that they are often ignored, but this may be where we can find our most sustainable results.
Let me know in the comments what factors could be waking you up with an attack?
HOW TO USE SLEEP TO PROTECT AGAINST MIGRAINE
Make Sure Your Sleep Is Not A Trigger With This Migraine Specific Sleep Checklist. For a limited time, we are emailing a copy of this one-page checklist to every reader.
Article Sources
[i] Rains, J. Sleep. Amercian Migraine Foundation. 2016 https://americanmigrainefoundation.org/understanding-migraine/sleep/ Last accessed 14 Jul 2017.
[ii] Kelman, Leslie, and Jeanetta C. Rains. “Headache and sleep: examination of sleep patterns and complaints in a large clinical sample of migraineurs.” Headache: The Journal of Head and Face Pain 45.7 (2005): 904-910.
[iii] Sleep Apnea for Clinicans. https://www.sleepapnea.org/learn/sleep-apnea-information-clinicians/ Accessed Jul 13 2017
[iv] Kristiansen, Håvard Anton, et al. “Migraine and sleep apnea in the general population.” The journal of headache and pain 12.1 (2011): 55-61.
[v] Sances, G. Ghiotto, N. et.al. ‘A CARE Patheway In Medication Over-use Headache: The Experience Of The Headache Centre In Pavia.’ J Headache Pain 2005; 6: 307-9.
[vi] Scher, Ann I., Walter F. Stewart, and Richard B. Lipton. “Caffeine as a risk factor for chronic daily headache A population-based study.” Neurology 63.11 (2004): 2022-2027.
[vii] Palmer, C. D., G. A. Harrison, and R. W. Hiorns. “Association between smoking and drinking and sleep duration.” Annals of human biology 7.2 (1980): 103-107.
[viii] Sack, Robert L., et al. “Human melatonin production decreases with age.” Journal of pineal research 3.4 (1986): 379-388.
[ix] Peres, M. F. P., et al. “Melatonin, 3 mg, is effective for migraine prevention.” Neurology 63.4 (2004): 757-757.
[xi] Dodick, David William, A. C. Mosek, and J. K. Campbell. “The hypnic (“alarm clock”) headache syndrome.” Cephalalgia 18.3 (1998): 152-156.
[xii] Friedman, Deborah I., and Timothy De Ver Dye. “Migraine and the environment.” Headache: The Journal of Head and Face Pain 49.6 (2009): 941-952.
[xiii] Evers, Stefan, and Peter J. Goadsby. “Hypnic headache Clinical features, pathophysiology, and treatment.” Neurology 60.6 (2003): 905-909.
[xiv] Paldino, Michael, Alon Y. Mogilner, and Michael S. Tenner. “Intracranial hypotension syndrome: a comprehensive review.” Neurosurgical Focus 15.6 (2003): 1-8.
My sleep and sleep pattern is horrible. Has been for almost 2 years. An obvious trigger for me. I will lay in bed and with everything being quiet and still- all I can focus on is pain. I get so restless I just get up. I will go over 24 hours without sleep, Because I don’t want to nap and mess up going to bed that night. It’s a mess. My HAS is aware and I had a sleep study done.
Results were no sleep apnea, no oxygen problems, no restless legs. Also I had no R.E.M. Sleep and no N3 level sleep ( just before R.E.M.) and I actually thought I had a good nights sleep compared to most night. I woke up all night in pain. Great!
Follow up with MD, I already take melatonin, Benadryl, diazepam, magnesium, meloxicam, Remeron at night.
They could not offer any more tips. They said I need better pain control. To this I responded "no sh** Sherlock "
I have added turmeric milk, no blue lights and filter as much as I can on all my electronic devices.
It’s a battle-
I went cold turkey with all my migrain medication, I told my husband to take them back to pharmacy, as I was so ill most of the time, my head hurt so much I wanted to smash it against the wall, I was vomitting nothing but bile and phlem. I would have taken the lot to be out of it all together. Regretted it for a few days as the withdrawl effects had to be tackled. NEVER LOOKED BACK, SAW A BRILLIANT NEUROLOGIST, she was trained in Sweden , after MRI and the usual checks my bloodtest showed my vitamin B12 level to be Low, not below the UK standard of 140 but Low to her standards! Started the loading doses of Hydroxocobalamin injections straight away, it took only a month or 2 for migraines to stop but about 6 month for the rest of my neurological symptoms to get better. I no longer have problems with remembering or being anxious and short tempered.I sleep fitfully again. Vertigo is also much improved but all my previous symptoms come back as soon as my level of Vitamin B12 drops.Now with the regular injections, I have my feelings back in my left leg and can walk unaided, I started exercising again and can use my treadmill again. It’s not a miracle cure, I have to manage myself carefully, a good balance with all my Vitamin B, I take folic acid regular and use a magnesium skin spray as I can not tolerate oral tablets for that. In winter I supplement vitamin D and also take vitamin K2 as you need that one to help to absorb the D. I avoid my triggers lemon, citric acid and Ascorbic acid also sulfites, I cook and bake myself from scratch. If I do get a migraine( not bedridden anymore) I put on sunglasses, take a suppository(paracetamol) plus 1 Ibuprofen, that is enough to get me through the day. Also before I forget, I drink water 2 litres a day. Have an odd cup of tea or coffee( yes I can do that again) and make sure I exercise at least 30 minutes a day, fast walk where I live. Or when it rains on the treadmill, uphill.
My injections should have been for life 1 every month, but my new GP has first put it 1 in 3 month and now after complaining stopped them all together. After 6 month I went downhill so bad again that I went to see a doctor in the Netherlands where I was living then and he gave me the injections straight away and when I require them. I also can self inject now. I hope that more people can benefit from my story, give it a go, go online on a site called HealthUnlocked, lots of us are there supporting each other.
Thank you for sharing your story Anke. It’s a great example of working with your doctor to find your individual solution. There is hope.
Hey Sarah, so many of us have trouble sleeping at night it. That’s a lot of medication to be taking. If you’re taking that every day and have been for over 3 months it may be worth checking if you have MOH. No.3 on the list.
Great information
Thank you Laurie! 🙂
Great information
Great article! I especially love that it specializes in nighttime migraines. I am going to try the nighttime mouth guard. I don’t think I clench or grind my teeth but it’s worth a try. I am constantly working on the diet, exercise and hydration. I have kept a diary but it just proves that weather is the culprit. So I guess the answer is to limit our own personal threshold sensitivities.
Sounds like a plan Pam, good luck and thank you for your feedback.
I took this sleep advice seriously many years ago and go to sleep always at the same time 1030 and rise at 7. I use an IPod shuffle with a relaxation file called A Trip To The Beach and also a progressive muscle relaxation
Letting Go of Stress
Audio CD
Steven Halpern Emmett Miller
I use the shuffle with only these two items on it so messing with it is minimal. This and a 3mg melatonin and I am sleeping in 15 minutes. I once was an insomniac for years until my pharmacist told me that I needed to learn how to sleep again. So I did. It works. Google how to learn how to fall alseep and follow it.
Sounds guidance Donna. I think many of us need to learn that. We can always improve how we sleep.
Shift work is a major factor for me. I always wake out with at least one migraine during night shifts.
Shift work is a major challenge Sarah with no easy answers. I can’t remember where I read that the body does not adjust to shift work.
You might need to evaluate the cost and benefits of trying something else.
Thank you for the information, I’m hoping it will help my daughter and I. As for myself, I have suffered from insomnia since I was a child and have tried numerous medications and tactics but none have proven effective (without at least some sort of side effect that is almost as bad) My insomnia is not a constant issue, so I have learned to deal with it and I don’t believe it is a major factor in my migraines. As for my daughter, we are still tracking her migraines looking for possible triggers, this article has certainly helped shine a light on a few.
Glad to have helped Michaela, good luck to you and your daughter.
The trend tends to be the earlier you can get migraine under control particularly in youth, the more likely it doesn’t become a significant issue long term in their lives.
Get your daughter into good habits whilst she is still developing them!
This was a very interesting article as my worse migraines occur between 3 and 5 am. I don’t have a problem falling asleep, most likely due to all the sedative meds I take for various conditions. I follow most of the recommendations except that I find I cannot give up caffeine completely, so I have cut my intake down. The low blood sugar did catch my eye, as I don’t eat large quantities due to GERDand IBS. I think I will try a small snack before bed. I am also guilty of not exercising. Partly due to foot issues partly because frankly I hate it! I know I need to try harder.
Thank you for your honest self assessment Linda. We’re often too hard on ourselves. Exercise not only helps migraine it also helps you live longer and be happier. Start small with short walks or swims if your foot is an issue and aim for progress not perfection.
To comment about mold being a trigger, when I lived in the Smokey Mountains for 5 years in my early 20’s, is when my chronic migraines and cluster headaches began. I suffered all year there it was so moldy in the air conditioned house and outside. In Missouri now only my worst migraines are mostly in spring and fall, although I have them all year. My Botox helps. I also have insomnia, stress, and depression. I plan to come to the conferences sometime!
It’s easy to attend the Migraine World Summit, it’s mostly an online event so you can watch from your couch.
It sounds like you have a few areas that might help your migraine condition if you were to improve. Perhaps you can pick a few priorities first rather than overwhelm yourself trying to tackle everything at once. Good luck!
Kerry York, England
Hi Carl. Thanks for this article! Having suffered with chronic migraine for over twenty years I’m glad to know that waking during the early hours in pain is classed as normal! Like a lot of migraine sufferers I have a lot of neck pain and often wake in great discomfort, I’ve had physio with no affect and would like to know what treatments others use to help with this.
Also having read your articles I’m definitely going to use magnesium and was wondering if it’s more beneficial to use alone or with other natural treatments such as feverfew.
Kind regards
Hey Kerry, my neck was a problem for me for a long time. I saw physio’s, chiro’s and the like but no real improvement until bought a $10 book on amazon with great reviews and it suprisingly really helped. This is the book if your curious https://www.amazon.com/Steps-Pain-Free-Life-Rapidly-Shoulder/dp/0142180696/ref=sr_1_1?s=books&ie=UTF8&qid=1501204139&sr=1-1&keywords=neck+back+and+pain
As to whether one vitamin will help you or not will depend on your personal situation. It might be worth going to a nutritionist to test your levels and check. Or you can simply try taking it and see how you feel. Beware that some vitamins you can take if your planning a pregnancy and there may be other side effects too.
Why isnt there any mention of deficiënty of vitamines , B12,B6, B9, Vitamine D and minerale like magnesium. I myself have finaly after years and years of unnecessary suffering been diagnosed with VitB12 deficiency. After loading doses with Hydroxocobalamin injections and now regular once when I need them, I have got my Life back. You have to make sure the balance with Folic acid and B12 and vitD and magnesium is Very important. If I need to supplement with vitD3 then I also take vitK2 so the vitD gets absorbered better.
That’s a good point Anke. I tried to limit this article to issues that specifically lead to waking up with a migraine rather than looking at all the causes for migraine generally.
I have no idea of causation. I’ve explored all the suggestions. But you don’t mention necks. I only ever have migraines whilst I sleep. And I’m up to 20 days a month. I always have bad neck pain with them. And can’t say if this is cause or effect. 😡
Hey Pen, see my above comment with Anke and Kerry Yok.
In addition, neck pain can be both a symptom and trigger for migraine. Telling the difference requires a diary.
Grateful for reference to / info on hypnic headache. I have been diagnosed with hypnic headache after being woken virtually nightly with severe headache for the past three to four years. So far nothing has helped – caffeine, melatonin, Indomethacine, various migraine medications, nerve block, and lithium (the latest bid to stop them). The next, and seemingly last option is vagus nerve stimulation.
It is hard to find any detailed information or studies into the condition – because it is rare – so I would very much welcome anything further you could offer.
I have been a migraineur since childhood, and the first ‘stage’ of the hypnic issue began with not being able to stay asleep about four or so years ago. That inability to remain asleep morphed into being woken by terrible headaches which at first I erroneously concluded was menopause (despite being on HRT for more than a decade – possibly closer to 15yrs – to deal with menstrual migraine).
Thank you for the Migraine Summit and subsequent info emails. Much appreciate it. Just wish I could get my bosses to be part of it – they may have a greater understanding then.
Hey Chris, thank you for your kind feedback. You’re right there isn’t alot on hypnic headache. Check these scientific articles in this link for more on hypnic headache: https://scholar.google.com.au/scholar?hl=en&q=hypnic+headache+treatment&btnG=&oq=hy
As a menopausal woman, I find that I am unable to get a decent nights sleep because of hourly hot flashes. These wake me up and sometimes I can’t get back to sleep. I am on HRT which helps but not enough. So when I read about how important it is to get a good night’s sleep it seems impossible for me. This has been going on for 11 years so far. I do not have sleep apnea as I have done the testing for that.
I do wake up with migraine, generally always around 2AM. Not every night but when I do it’s always around 2AM. Have spoken to the neurologist about that but she doesn’t think it is important.
I also do have chronic migraine and chronic daily headache. I did have a problem with medication overuse but got that under control about 3 years ago but still have the chronic daily headache.
Other than that I don’t seem to have any of the other problems listed above but don’t think I will ever get a good night’s sleep until I stop having the hot flashes.
Hi Janet, I also had daily chronic headache after chronic migraine and it turned out it was my lifestyle and dietary triggers that were causing the headaches. Specifically for me it was a high carb diet, bright lights, stress, computer screens and sedentary work environment.
None of the above 15 reasons are the reasons I wake up with a migraine headache. You may be like me. Moonlight, street lights and other night lighting, including LEDs in your bedroom, such as on a fire alarm, can give you a migraine while you are sleeping. You are especially vulnerable at night because the pupil is fully open when your eyes are shut. Add to the the havoc night lights may play on your iris and associated muscles, which are directly wired to the nervous system. And if the night lights don’t get you, the morning light may. That is why I cover my windows dark at night, even in hotels/motels, if necessary. If you want to get rid of your migraines, you need to wise up on lighting. Just my experience.
Thank you for sharing your experience John. Light and light sensitivity can certainly play a role. The treatment suggestion under Good Sleep Habits discuss the issues of light particularly around bed time.
Sometimes exposure therapy can be helpful for light sensitivities. We also might be worsening our own light sensitivity by wearing sunglasses inside excessively and therefore dark adapting our eyes. It’s not a straight forward challenge (like all things migraine) but one that is important to manage.
Great article. I too often wake up with migraines and have regular sleep pattern and have tried the mouth guard. I believe I may be guilty of overuse of acute medicine but as my migraines often last for 5 days, requiring hospitalisation I will do anything to make it go! A Catch 22! As we know if we wait too long the opportunity is missed . Going around in circles!!!! Help!!
Hey Donna, if that’s the case with your migraine attacks then prevention is the name of game. You need to be doing everything you can to prevent attacks which will almost definitely include natural prevention tactics and quite possibly daily medicinal treatment at least initially.
What struck my interest was the opening remark "The time of the attack can be an important clue in finding the appropriate treatment and prevention". Reading through the article I failed to identify where this comment was clarified. Am I missing something ?
My wife ( 64 years of age) is a migraine sufferer — and the vast majority of her headaches/migraines commence during sleep . In her case she often wakes up 2-4 hours after going to sleep with a headache and finds sitting up in bed reduces it. She then will sleep for a further hour or two but usually the process repeats itself . About 50% of the time she wakes up she is experiences hot flushes — but she is not hormonal .
Hey Philip, hypnic headache is particularly useful if you’re getting regular attacks between 1 and 3 am. Where as MOH is often shortly after you wake up for example.
If your wife’s migraines are affected by her position it could be Idiopathic intracranial hypertension or hypotension. They are rarely diagnosed and are directly affected by body posture often getting better or worse when sitting up or lying down.
I hope that helps.
My daily headaches begin about 1 hour after I wake up each day.
That sounds suspiciously like MOH Michelle. This articles goes into more detail about that: https://migrainepal.com/rebound-headache/
I’ve been waking up daily with a morning migraine for the past 10 years. I’ve investigated most of these I tems, but two items I hadn’t considered yet (at least specifically in relation to waking up with a migraine) is the dehydration and low blood sugar that occurs during the night. While I make sure to keep well hydrated and eat periodic light, health snacks during the day, obviously this doesn’t occur for the 7-9 hours I’m asleep during the night. And I do think the dehydration may play at least some role because sometimes I will wake up from a vivid dream in the night parched. I’m wondering if I should set alarms a couple times during the night to drink water and eat a snack to prevent hypoglycemia/dehydration during the night from triggering the migraine that I wake up with each morning. I would encorage other people with morning migraines to consider trying this as well. It’s worth a shot.
I would speak to a sleep specialist about setting alarms in the night to eat or drink. That sounds very disruptive to your sleep cycle.
I also don’t sleep well of a night & wake with headaches. I think my neck also contributes to my headaches. When my neck is sore I always seem to have a headache. Massage does help
Who doesn’t love a great massage? We should treat ourselves more 🙂
Thanks for the article. I wake up to a migraine every day. I used to take my meds/supplements in the morning but now take them after lunch. My thought is that the dosage will not be at its lowest level during the early morning and when I am waking up. My hope is that better sleep will be of more help to me during the day. Time will tell.
I have almost constant migraine. I take mostly silent migraine now and I am almost always in one stage of migraine or another. If I take an aura, then I know it is going to be a nasty one with pain.
My sleep pattern is leveling out, but, when I have a major migraine coming, it throws my sleep pattern all off. Usually, I can’t get to sleep until 4 – 6 AM when a migraine is building and sometimes afterwards as well for a few days. The main reason while I have a migraine or before the major symptoms hit, I just want to sleep and pretty much have to to manage it, and that, of course, throws my sleep pattern off.
I do wake up with migraine on occasion, usually during the aura, and those are the most painful migraines, with hours or even a day or two of pounding pain and usually a few days of recovery.
I am lucky in that caffeine actually helps my migraine. I find that having a cup or two of coffee or one energy drink helps minimize the symptoms. The reason I know that, is that I didn’t have anything with caffeine for 12 years or so. One day I had an energy drink and found that the daily symptoms were lessened. I started drinking a cup or two of tea, then changed to coffee, every day and it does seem to lessen the daily symptoms.
My main triggers are variations in light, or flashing lights; environment, meaning changing weather or changing seasons and I have impinged nerves in my upper back that are the main cause of the constant symptoms. I also have to use a feather pillow as any time I use foam, it irritates my neck and upper back, triggering migraine. I have tried the imitation feather pillow, and no dice, it has to be real feather.
For the environmental triggers, from late November, usually, until about the end of April is pretty much one long migraine. I realize that isn’t the case, but it is pretty much bad symptoms all through that time. In the summer, when it is hot, I am miserable, and with weather changing from hot to rain and back also causes a great deal of misery. At the moment, I have been fighting migraine for 2 weeks with only one day of feeling somewhat good.
I am currently on verapamil, which has eased the daily symptoms to some extent, but hasn’t stopped the migraines.
Leland with chronic daily migraine comes central sensitisation which can make us extremely sensitive to triggers like the weather and other changes. I’ve had a migraine from running late to a destination for example.
The challenge is using strategies to complement your medicinal preventative with other healthy habits that promote a healthy and happy brain.
It is possible to change your change your sensitivity to external factors. A good night sleep for example makes me far more resilient to stress and other factors.
I suffer with chronic daily migraine, hemiplegic migraine and SUNA headaches. I often have a headache lasting days or sometimes just a few hours. On a rare occasion when I go to bed without a migraine I will often wake during the night and my migraine has returned. I have various other conditions and have just found out that I have a vit d deficiency and have been put on medication. I often wake up in the night to use the loo several times even though I don’t drink anything after about 7pm so rarely get a good restful sleep. I’m currently on no regular migraine meds apart from general painkillers as my neuro is struggling to find something that works for me after my regular DHE treatment was stopped last year following a pulmonary embolus. I have suffered with migraine for over 20 years now and really feel like I am getting to the end of my tether what with having pain in the right side of my head from migraine and pain from up to 100 SUNA attacks daily on left side of my head.
You said you rarely get a good restful sleep. John the more you’re able to improve your sleep chances are the more good days you’ll have. I’ve personally found almost a direct correlation in the quality of my sleep and my migraine risk.
Thank you so much for these useful informations
My pleasure Archita, thank you.
Its a viscous circle. I am awakened by a headache, so I can’t sleep, yet you state lack of sleep causes headache. I see a neurologist and take Gapapentin as a preventative. Seems to be not working anymore, does lessen the severity. I could go on and on about how many ways I have tried to improve my lifestyle and how many things I have tried to make myself painfree. My neurologist says some people are just headache people! This didn’t start til I was about 45. I had headaches as a teen but midlife …none. I am now 64. 20 years of this struggle. Sandy
This cycle is something that view others understand but it is truly horrible Sandy. That line from your neurologist is a sign of them losing hope. Sure some people might have a higher or lower threshold, but these are not permanent. Thresholds can change, improve or get worse.
It sounds like they are out of ideas. I’d start fresh with someone new.
Headache and migraine can be treated and managed.
I had brain surgeries 56 years ago and slowly my constant headaches developed so that I had to take butalbitaol. I have increase the pills over the last 45 years and now have chronic migraines which lead to MOH. I am age 70 now and spend a lot of time in bed missing life. I am too old to bear the pain of a withdrawal. I tried weaning and failed. I am in the Boston-Cambridge area and would like to know from anyone if there is an method of withdrawal . I need to reduce this prison of pain. Please contact Florence @flo_02472@yahoo.com Thanks.
less painful w
Florence, this website discusses medication overuse headache at length. For more answers and potential solutions check out the article. There are good options and high success rates, but you need to be working with a doctor who has experience with MOH.
Here is the article: https://migrainepal.com/rebound-headache/
Good luck!
Nice Post. Thanks for sharing.
It’s really interesting blog which helpful for everyone who suffers to migraines.
Thank you so much your kind feedback Albert! I hope it helps.
Mold in the bedroom from the roof, floor or other damp areas could also lead to a range of symptoms including headaches although there is a lack of scientific evidence supporting this theory.[xi]
—– Original Message —– Sickbuildings Yahoo group From: "erik johnson" <erikj@…> Sent: Thursday, March 09, 2000 1:59 AM Subject: Stachybotrys Chartarum & CFS >
I’m one of the ’85 Incline Village epidemic. I’ve been saying since day one with this illness that mold is primary in my illness. Drs. Cheney & Peterson disagreed and would not help me research it. I decided to trust my perceptions and conduct my life as if my symptoms of anxiety and depression and fatigue represented an exposure to toxic mold. In the 2 years since I’ve applied my mold avoidance strategy I have eliminated almost all of my long standing CFS symptoms. My recovery continues but at present I am finally able to work full time, have no headaches or cognitive dysfunction, no fatigue and if it weren’t for the reactivity I have to people and objects who come into my presence from contaminated buildings, I could live a completely normal life. I have been trying to tell doctors and CFS patients about this but despite seeing my recovery, nobody thinks it could possibly apply to them. While they tell me this, I’m shaking with the reaction I get to their clothes. I see now after the 48 Hours special that some people want to look into this but find little information and so far, no feedback from CFS patients with this experience. I have been diagnosed by the famous doctors Cheney and Peterson as the perfect case of CFS and yet I have told them about this mold and my recovery, yet they are completely uninterested. Even if Stachybotrys is not the primary cause of CFS, I believe that there must be a connection between the illness and an extreme reactivity to mold.
https://www.youtube.com/watch?v=q6EZqrq2SjY&feature=youtu.be&list=UUJKjR0Okx8_luwzyuuu7uIA
We would all benefit from more scientific research in this area Erik. There is still so much we don’t know.
I have been going to sleep with an ice pack on my forehead and the back of my head for months which has reduced the amount of wake up headaches I used to get. Is this about inflammation? I am also convinced that many of my headaches come from my neck, under my chin. Just taking each day as it comes.
I’m not sure why that works so well. It could certainly be helping with sleep and relaxation. Cooling the body helps with sleep.
If you know your migraines are coming from your neck then perhaps some some physcial therapy to rehabilitate your neck might help or seeing a neck specialist to correct any potential issues there.
Neck is tricky – sometimes it’s a trigger, other times it’s a symptom and sometimes it’s both…
Obstructive Sleep Apnea (OSA) is accompanied by increased red blood cells / increased hematocrit.
"The severity of OSA is significantly associated with increased hematocrit"
Increased hematocrit is known to be accompanied by increased viscosity of the blood and increased viscosity of the blood is linked to migraines.
"hyperviscosity, that is now considered a crucial determinant in the pathogenesis of migraine"
"Phlebotomy was performed 5 times on the patient to improve microcirculation and cerebral perfusion."
Interesting finding Tom, can you share the name of the study?
I’m always well awake when I get a migraine. I go blind, my head painfully throbs, and I throw up. I start experiencing problems days before I get a migraine. I become angry and depressed. I am a guy, but I think some sort of hormone is released into my brain. My sleep patterns are fine or at the least stable. The only thing I have identified as a problem for me was Gatorade which triggers violent cluster headache that will last a few days.
The emotions are not "you" its the attack and chemical release which is actually common but important to be aware of. Sleep, exercise, diet, stress of all forms are super important considerations.
I would include autoimmune disease, especially thyroid disease as a cause for disrupted sleep and headaches. Also it’s very common in ME/CFS.
Interesting Frank, can you please share a reference for further reading? Thank you.
Fantastic blog. Really helpful and well laid out! Thank you. I was not aware of how common waking with a migraine is. I seem to get them when I have nightmares of swallowing things.
Thank you for your kind feedback Buddhajim. I’m glad it has helped.
If you are having a recurring nightmare it may be related to some type of ongoing stress in your life. Getting to the bottom of that stress and managing it may unlock better sleep, which in turn, may reduce the number of mornings you wake with migraine.
I’ve also personally found sleeping in an overly warm bedroom can lead to nightmares sometimes, so I keep my room cool at night and the stay under cosy bed covers.
Thankyou for such an insightful article. I’m now keeping a diary to try and pinpoint my never ending bout of night headaches triggers.
My pleasure Tiff, a daily diary really helped me. I keep an eye on the latest a greatest diaries- 2 I’d recommend in the app store Migraine Buddy and Curelator.
My headaches probably include a combination of triggers you have suggested but are very often triggered by cool breezes on my shoulders,neck and head
The only way I can resolve this is through heat and often aggressive massage of muscles in the upper parts of my back alongside the spine
I haven’t heard of a cool breeze triggering migraine before. That is potentially manageable with beanies, hats, warm clothing and heat/wheat packs. Longer term you’d want to be thinking about what has made you so sensitive and lifting your migraine threshold or resilience.
Caloric testing can trigger vestibular migraine. That test involves pouring cold water in the ear canal. So it’s really not a big leap to imagine cold air having an effect. See the Daniel B. Hilton article on vestibular migraine at NIHdotGOV.
I haven’t seen that article but that doesn’t sound ridiculous to me.
I think it may have been worth mentioning idiopathic intracranial hypertension in your serious conditions section also. As headache I’m the morning is a red flag for this headache type. That’s because Cerebral spinal fluid is at its highest pressure in the head when a person is laying flat in bed, so pain often worse in the morning.
“as headache in the morning not I’m the morning”
Good suggestion Emma! Done.
Hi, have been getting migraines for over 30 years. I have a new neorologist. I see a chiro for overall adjustments, especially neck.
I take Deralin 40mg morning/ lunchtime and Endep 10mg and 25mg at night as a preventative. I still get migraines 2 to 4 weeks but not as severe, but would love to have less frequency attacks. I have heard of the Watson Headache Clinic who state alot of Migraine issues are from the neck. Any thoughts?
Hi Ros, lots of people have neck issues and don’t have migraine. The neck can be an important part of migraine. It is commonly where some people experience migraine first, then the pain travels up to the head. In this sense it’s a symptom of their migraine attack. For others it can be a trigger, where neck issues may trigger an attack. It may even be both a symptom and a trigger. The Watson Clinic may help with neck issues as they relate to migraine but it is not cheap and not a cure.
Great article! I have been waking up with a headache (migraine?) at the top and front of my head around 3 am every morning for maybe 6-8 months. I usually get up and take a couple Advil and tough it out until it goes away a few hours later. I sleep well, only take medication for hypothyroidism, have low(er) blood pressure, am generally in good health, and don’t have sleep apnea. At home we sleep with a fan on (pointed away from us), but when away from home we sleep with a fan app for background noise. As I am searching for causes I realized that I don’t wake up with a headache when away from home. So it must be environmental! – which I think is good news as it will be easier to figure out a cause. Things I am thinking that it could be are the fan (could it be stirring up something like dust mites?), my pillow…and that’s about all I can think of? I’d appreciate it if you could share your opinion – do you think I’m on the right track with my assessment and do you think there is anything else I should consider?
Hi Cathy, I’m not a doctor, so discuss all this with your personal doctor, but this is my thinking. Before you mentioned you don’t get the nightly 3am headache whilst elsewhere I thought it sounded a lot like no. (13) Hypnic Headache. That is characterized by regular, same time headaches in the middle of the night.
However if it’s only occurring at home then allergens could be playing a role. Is there mold in your house or room. Particularly black mold? How old are your pillows, mattress, dust, dust mites, mold spores, air quality might be involved. Dr. Vincent Martin speaks about these factors during his Migraine World Summit interview here.
The other factor could be that when you were traveling you were on holidays… maybe you were simply so relaxed that the hypnic headache didn’t arrive? I’m not sure if that affects hypnic headache or not but it’s something to investigate further. I hope that helps Cathy!
Hi,
I also have hypnic migraines which happen 99% at night (2-4am).I wonder what causes it and what to do to prevent it. If anyone has any input on this please let me know.
Thanks
Hi Luba,
There are some treatment options. According to the American Migraine Foundation, a bedtime dose of caffeine is the most common treatment. Strangely it does not to appear to prevent adequate sleep in patients with hypnic headache.
Indomethacin, lithium are other options but may have more side effects and should be taken under medical supervision and may involve regular tests. Topiramate is migraine preventive which is taken daily to prevent hypnic headache in some case study reports. Flunarizine and melatonin may also be helpful for some patients.
I hope this helps!
Very well explained, informative post.
Worth reading.
Thanks.
Hi Carl
I have had ‘morning’ headaches as part of the overall chronic migraine package for years. The head pain usually begins in the night but I can get interrupted sleep through it. It is often the worst on waking. I recently was recommended some vitamins by a chiropractor that he felt would help if it was due to fluctuating blood sugar levels. I was delighted to find that they have indeed worked. I either wake with a small head ache or no pain at all!!
Hi Kelly,
Great to hear about your improvement. Blood sugar levels may be regulated by diet for most people. Many of us underestimate the power diet plays. Thank you for your comment.
I have had 3-4 migraines a year starting maybe 8 years ago. (Age 44) I wake with it aaaaand vomiting. Nothing stays down. Including pain reliever and water. Takes almost the entire day and then a hangover feeling the next day.
Hi Janet, there are other options that can act fast that you don’t need to swallow. Eg. Sumatriptan using an injection pen. That’s one of the most effective options. There are also suppositories, devices and other options! Don’t lose hope.
“High caffeine consumption is a risk factor for progression to chronic migraine”
Could you post a link to the footnote you have at the end of that sentence? I’ve tried the link on both Chrome and Firefox to no avail.
I have a similar issue to Michelle (on July 26, 2017 at 4:33 am) where I get complex migraine symptoms a few hours after waking every day. Although I don’t consume medication daily/often nor have I consumed caffeine in quite a long time (in any form). Ironically, I feel the best right before bed/the furthest away from sleep.
Hi Zachary, here is the citation: Lipton, Richard B. “Tracing transformation: chronic migraine classification, progression, and epidemiology.” Neurology 72.5 Supplement 1 (2009): S3-S7. And the URL https://www.researchgate.net/profile/Richard_Lipton/publication/24014162_Tracing_transformation_Chronic_migraine_classification_progression_and_epidemiology/links/5abbb61ea6fdcccda655ead3/Tracing-transformation-Chronic-migraine-classification-progression-and-epidemiology.pdf
Sinus headaches are headaches that may feel like an infection in the sinuses (Sinusitis). You may feel pressure around your eyes.
With sinus headaches, you feel a deep and constant pain in your cheekbones, forehead, or on the bridge of your nose.
They happen when cavities in your head, called sinuses, get inflamed. The pain usually comes along with other sinus symptoms.