Why do I wake up with a headache?

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Morning headaches have a number of causes. One of the common culprits is caffeine — or a lack thereof. (Photo: Envato Elements)
I often get headaches in the morning. They improve when I get up and have coffee, but I can’t seem to figure out how to prevent them. I have tried various pillows and sleeping positions. What should I do?اضافة اعلان

Morning headaches have a number of causes. One of the common culprits is caffeine — or a lack thereof. “Sometimes, the reason for the morning headache is that you’ve slept in and you’re late on your morning caffeine,” said Dr. Kathleen Mullin, a neurologist and headache specialist at the New England Institute for Clinical Research. It’s easy to tell if caffeine withdrawal is the cause of a headache because putting caffeine back into your system quickly cures it.

People usually experience caffeine headaches only if they regularly drink more than 200 milligrams of caffeine per day, Mullin said, which is the equivalent of about two to three 8-ounce cups of brewed coffee. To reduce such headaches, slowly taper your caffeine consumption, ideally to less than 200 milligrams per day, she said. (Beware that in the process, your headaches might increase for several days or even weeks before lessening.)

Another common cause of morning headaches is sleep apnea, which is often associated with snoring and frequent waking in the night, Mullin said. Once sleep apnea is diagnosed and treated, often with a continuous positive airway pressure device or a special mouth guard, headaches usually go away, she said.

Teeth grinding can also cause morning headaches. Mouth guards can prevent those, too, she said.

Medication overuse can cause headaches as well. That includes 15 or more days per month of over-the-counter pain drugs such as aspirin, acetaminophen, or nonsteroidal anti-inflammatory medications like ibuprofen, or 10 or more days per month of prescription pain drugs like opioids or triptans. “Patients don’t realize that medicines as simple as Advil, Tylenol, and Excedrin are really big culprits,” Mullin said. The best way to prevent these headaches is to cut back on the drugs if possible, taking them fewer than three times a week.

In rare cases, morning headaches are the result of brain lesions, like tumors, that cause pressure inside the skull, Mullin said. Lying down heightens this pressure, so these headaches often occur in the middle of the night or the morning. And the pain is typically so intense that it rouses patients from slumber. “A headache that wakes you up from sleep in the morning is something that, for most neurologists, sets off our ‘This is worrisome’ flags,” she said. Often, an MRI is the next step, to see inside the brain.

Migraines are also a common morning headache culprit, said Dr. Merle Diamond, the president and medical director of the Diamond Headache Clinics in the Midwest. In fact, for unknown reasons, she said, 40 percent of migraines start in the early morning. Many factors can set them off, including alcohol, dehydration, lack of sleep, too much or too little caffeine,  and eating too much or not enough the night before. Other triggers are cured meats, chocolate, aged cheese, and artificial sweeteners, as well as stress, hormonal fluctuations, weather changes, and bright lights. Even a change in routine can trigger a migraine, Diamond said, because “a migraine brain likes things to be really regular.”

Migraines are different from other headaches, Diamond said. They often throb or pulsate, and they can come with nausea or sensitivity to light or sound. They frequently occur on just one side of the head, and they can endure from four hours to several days if untreated, making it hard for people to go about their lives.

To prevent migraines, Diamond recommended keeping a headache diary — noting triggers and patterns associated with their onset — and then avoiding those triggers. Depending on the frequency and severity of your migraines, a doctor may also recommend prescription drugs that can prevent or treat migraines. Since 2018, the Food and Drug Administration has approved a handful of new migraine drugs, many of which have fewer side effects than older drugs.

Finally, Diamond said, it sometimes helps her patients to turn off digital devices at least a half-hour before bedtime and to stretch, meditate or practice yoga before going to sleep. When people commit to “relaxing before bed and clearing their minds,” Diamond said, they sometimes find that their heads feel better in the morning, too.

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