Waking up with a headache: causes and what to do

Waking up with a headache is most often caused by migraine, medication overuse headache or tension-type headache. Less common causes include sleep apnoea, teeth grinding, cluster headache and hypnic headache. The cause can usually be found and treated, and the answer is rarely a new pillow or mattress.

When your day starts with pain, it affects everything you do. Below you can read the most common reasons for regularly waking up with a headache, and what you can do about each of them.

Why do you wake up with a headache?

A headache when waking up can have several causes. The three most common are migraine, medication overuse headache and tension-type headache. Rarer causes include hypnic headache, cluster headache and sleep apnoea. We discuss each of them below.

Can a migraine attack start while you sleep?

Yes. Migraine is an inherited brain condition in which the brain reacts more strongly to stimuli than usual. Migraine attacks can begin during the night while you are asleep, so you wake up with a headache that is already at full strength. That makes it harder to treat the attack early, while acute medication works best when you take it as early as possible.

Signs that a morning headache is migraine:

• Throbbing or pounding pain, often on one side of the head
• Nausea when you get up
• Sensitivity to light and sound: you would rather stay in a dark room
• Tiredness and brain fog that last all day

Not everyone has all of these symptoms. Migraine is individual, and your pattern may differ from someone else's. About 10 million people in the UK live with migraine.

Can painkillers cause morning headaches?

Yes. If you regularly take painkillers or triptans for headaches, they can themselves be the cause of your morning symptoms. Overnight, the level of the medicine in your blood falls, which can cause a rebound headache: you wake up with a headache because your body is asking for the next dose.

Medication overuse headache can develop when you take triptans on 10 or more days a month, or simple painkillers such as paracetamol or ibuprofen on 15 or more days a month, for more than three months. The headache then becomes part of the problem rather than the solution. The good news is that cutting back on the medicine (sometimes called withdrawal or a detox) often improves the headache considerably. Do this with guidance from your GP or a migraine specialist, because the headache can get worse for a while before it gets better.

Is it tension-type headache?

Tension-type headache is a common headache that feels dull and pressing, like a tight band around your head. Despite the confusing name, it is not caused by psychological stress, and its exact cause is unknown.

Tension-type headache is usually less intense than migraine and rarely stops you doing what you need to do. If you have a pressing headache every morning that lasts all day, chronic tension-type headache may be the cause.

What else can cause a headache when waking up?

Less common, but important to know:

• Hypnic headache: a rare headache that only occurs at night and literally wakes you up, mainly in people over 50.
• Cluster headache: extremely severe, stabbing pain around one eye. Attacks often occur at night, typically one to two hours after falling asleep.
• Sleep apnoea: if you repeatedly stop breathing during the night, the lack of oxygen can cause morning headaches. Consider it if you also snore and are extremely tired during the day, and mention it to your GP.
• Teeth grinding (bruxism): grinding or clenching your teeth at night can cause jaw pain and headache.

Can your pillow or mattress cause morning headaches?

It is unlikely to be the main cause. Regular morning headaches usually have a medical cause, such as migraine, medication overuse or a sleep problem. A different pillow or mattress rarely solves the problem.

How do you get rid of a headache when you wake up?

The most important step is finding out what causes it, because that decides the treatment:

• Keep a headache diary. Note when you wake up with a headache, what the pain feels like and how many medicines you use.
• Count your medicine days. Taking painkillers or triptans on 10 to 15 days a month or more? Discuss it with your GP or a migraine specialist.
• Treat migraine early. If it is migraine, take your acute medication as soon as you wake, rather than waiting to see if it passes. Some people keep it by the bed.
• Recognise migraine features. Throbbing pain, nausea, sensitivity to light? Then it may be migraine.
• Consider preventive treatment. If you have migraine on 4 or more days every 4 weeks, preventive treatment is an option. The gepants atogepant and rimegepant and the monoclonal CGRP inhibitors erenumab, fremanezumab and galcanezumab can considerably reduce the number of attacks.

Is a morning headache a red flag?

Usually not. Most people who regularly wake up with a headache have migraine, medication overuse headache or tension-type headache, all of which can be treated. A morning headache needs a closer look when it is new, keeps getting worse or comes with other symptoms.

When should you be worried about morning headaches?

See your GP if:

• you have recently started waking up with headaches and have not had them before;
• the headache gets steadily worse over days or weeks;
• it is worse when you lie down, cough or strain, or comes with vomiting;
• you need more and more painkillers;
• you wake up with a headache on more than 4 days every 4 weeks.

When to get urgent help

Call 999 or go to A&E if you have:

• a sudden, severe headache that reaches its worst within minutes
• weakness or numbness on one side of the body
• slurred speech
• loss of vision that does not return
• a first aura after the age of 50
• a headache with fever and a stiff neck

If you are worried but it is not an emergency, call NHS 111.

Find out what is behind your morning headache

Take the migraine test to see whether your symptoms fit migraine. At The Migraine Clinic a migraine specialist helps you find the cause and draws up a personal treatment plan with you. Our care is fully online, by video, and you do not need a referral. Read more about treatment or how to start.

Written by the medical team of The Migraine Clinic.