Morning Migraine Again? How to Wake Up Pain-Free

One of the most common migraine patterns many of us experience is going to bed feeling fine then waking up with debilitating headache pain. Migraine attacks in the morning are especially perplexing because it seems like nothing out of the ordinary happens during the night, or even the night before, to cause the severe symptoms. Some call it “migraine upon waking,” or “early morning awakening headache,” and it has some evil cousins, like the "Saturday syndrome" or “weekend migraine.”

So why is this happening? How can you prevent another morning headache surprise this week?

Why Do I Wake Up With a Headache?

The reason for morning headaches and nausea is still largely a mystery.

Sure, we know there are plenty of risk factors for migraine. The National Headache Foundation, for example, lists the following risk factors as potential migraine triggers:

• Bright lights
• Excessive noise
• Family history
• Sleep deprivation, sleep problems, or sleep disorders

Also, we know that about one-fifth of people with migraine experience aura symptoms, which typically include visual disturbances like sensitivity to light, wavy lines, flashing bright lights, or blind spots that begin about 20 minutes to one hour before the migraine begins.

In addition, we know that migraine is often misdiagnosed as sinus or tension headaches (sometimes called a tension-type headache).

Still, the reasons for morning migraine attacks aren’t well understood. Here are 4 theories to help explain why you woke up with a headache again this morning:

1. Your Sleep Is Not as Good as You Think

As Christine Lay, MD, FAHS, neurology professor and the founding director of the headache program at the University of Toronto, explained during a Migraine Again podcast episode, “We’re finding now in migraine patients what we call ‘fragmented sleep.’ Patients wake up several times at night. They may not have sleep apnea. They may not actually have restless legs, but their sleep is poor quality.”

According to a 2018 study in Headache, 4 out of 5 people with migraine have a sleep disorder or problems with sleep quality. Sleep disturbances and snoring are risk factors for an increase in chronic headaches or in migraine turning chronic. Sleep disorders linked to migraine can include:

• Insomnia
• Snoring and obstructive sleep apnea
• Restless legs
• Circadian rhythm disorders
• Narcolepsy

2. You’re Rebounding

Your brain is not only smart but also cyclical. If you took medicine the day before, such as a triptan that typically lasts for 24 hours or Excedrin that lasts for 6, the relief you gained may have worn off during the night. While occasional use doesn’t pose a great risk of rebound attacks for migraine sufferers, using acute medications 10 to 15 times or more per month can cause a condition called medication overuse headache.

Caffeine withdrawal is another common reason for waking up with migraine symptoms. If it’s 9 a.m. and your brain expects its usual shot of java at 8 a.m., it may trigger a migraine attack that’s waiting to greet you when you wake up. Also, some pain medications contain as much caffeine as what’s in a cup of coffee, so keep that in mind when you’re trying to cut back on caffeine.

3. You’re Out of Natural Painkillers by Morning

A night of interrupted sleep or poor sleep quality primes your brain to experience more severe head pain and release fewer natural painkillers, according to researchers at the University of California, Berkeley.

“Sleep loss not only amplifies the pain-sensing regions in the brain but blocks the natural analgesia centers, too,” says Matthew Walker, a professor of neuroscience and psychology at UC Berkeley and author of the book Why We Sleep.

4. You’re Still Processing Yesterday’s Stress

In an article in the journal Headache, E.L. Spierings, MD, PhD, founder of MedVadis Research at Boston PainCare, states, “The headaches which developed during the morning or afternoon were preceded by increased tension the previous days.”

That’s consistent with the stress letdown effect, confirmed in other research, that can produce a migraine attack on the first day of vacation, for example. Your brain may still be painfully processing whatever happened yesterday.

Cracking the Code on Morning Migraine Attacks

Let's assume for a minute that one or more of these theories is true for all of us who wake up with a morning migraine. How might it play out in real life?

Maybe it's Tuesday, an intense workday. You come home and unwind by watching back-to-back episodes of your favorite crime series while munching on a chocolate cookie.

You go to bed a little later, at midnight, and wake up at 2 a.m. because there's a loud thunderstorm outside, and then drift off again. You find yourself waking up with a headache and nausea at 4, 5, or 6 a.m. on Wednesday morning.

You hit the snooze button and sleep a little longer while you try to figure out just how bad the pain is and how you're going to deal with it — again!

Notice any migraine triggers in there?

Here's what could be happening in your personal pain code: a tiny dose of caffeine + poor-quality, off-cycle sleep + low natural painkillers + work/violence stress exposure + weather trigger = morning migraine.

A few things we do know for sure: Triggers are additive. And people with migraine tend to have highly individualized responses to the same environmental stimuli.

Finally, doing nothing almost guarantees history is going to repeat itself. In fact, treating it the same way you always have increases the chance of another morning migraine as you rebound.

9 Tips to Avoid the Morning Migraine Pattern

1. Make Sleep a Top Priority

Go to sleep at the same time and wake up at the same time, even on weekends. Make sure your bedroom is cool and quiet. Limit your exposure to screens and light for a few hours before bedtime.

Journal your ideas out of your head before bed. Try our favorite sleep technique if that doesn't work. You need 7 to 8 hours of good sleep, period. Healthy sleep habits are critical to avoid morning headaches.

2. Name Your Stressors and Limit Them

You may not have the same response to a work conflict, scary movies, and overdue bills as someone else. That's okay. Compile a list of what makes YOU tense. Empty your brain of that stress before bedtime in a journal: inlclude what you're grateful for, and what you need help with to manage. If a friend, job, or home is your top stress trigger, you might consider giving them up for a while and see if your migraine attacks improve.

3. Try Melatonin Before Bed

Andrew Charles, MD, professor of neurology and director of the UCLA Goldberg Migraine Program, recommends the supplement melatonin to his patients who frequently find themselves waking up with morning headaches, or severe pain and nausea.

4. Learn How to Manage Conflict Better

Few of us love conflict. You can either avoid it or learn how to resolve it. Your brain doesn't need to keep processing something that's already handled. It can rest like it needs to.

5. Consume Caffeine Very Carefully or Not at All

Weaning yourself off caffeine isn't easy, but it can be done over time. Just know that consuming any caffeine 6 hours before bedtime can affect your sleep quality. Delaying morning consumption by even an hour can also trigger morning headaches.

6. Eat a Light Bedtime Snack

But make sure your snack doesn't turn into a meal. Dr. Charles explains, "Generally speaking, we don't like to advise people to eat a lot before bed, but try a bedtime snack and see if that's helpful." A blood sugar crash in the middle of the night could be contributing to morning headaches and a lack of restful sleep.

7. Build Up a Stress Defense System

If you feel the need to unwind, you're stressed out. Life is packed with stress, and people with migraine have to build up a better defense against it. Take a walk outside, breathe deeply, talk to a friend, have sex, laugh out loud, pet your dog, make art, do yoga — whatever calms you or transports you to a happy place.

8. Accept What You Can't Control

Examples include other people, time, weather, and your monthly cycle. Control what you can and let go of the rest.

Menstrual cycles and incoming storms are two major triggers for many that are pretty unavoidable. What you can do is limit exposure to other triggers during these times. Take extra-good care of yourself if you know they're coming.

9. Hydrate More Effectively

You wake up cotton-mouthed because you breathe out moisture all night and process your food and drink into urine. Mild dehydration can bring on poor quality sleep and morning headaches even among those who don't have migraine. It is especially important to stay hydrated to avoid triggering a migraine attack.

To learn how much fluid you should be drinking every day and to monitor how well you're doing, check out this handy hydration calculator.

Other Headache Disorders That Could Cause Waking Up With Head Pain

There are other headache disorders that can wake people from sleep, including hypnic headache and cluster headache.

Hypnic headache is a rare type of primary headache disorder that is related to sleep. These non-migraine headaches usually occur between 2 a.m. and 4 a.m., waking a person from sleep. The pain can be mild to severe, and is most often described as being on both sides of the head.

Cluster headache, often known as "suicide headaches" due to the severe head pain, also tend to occur in a circadian pattern. Though not typically occurring in the morning, cluster headache may also awaken people from sleep.

Final Thoughts

You may have already made some of these lifestyle changes, with or without success. Giving up caffeine and a stressful job you love is really hard. Don't get discouraged. Consistency is key.

Just try one change at a time and celebrate your progress! It's worth it if you're frequently waking up with a migraine attack and nausea.

Whatever the true reason for your repeated morning migraine, good prevention can reduce the odds of it happening again tomorrow. It may not be long before one morning you'll wake up and realize, "Hey, I don't have a headache when I wake up anymore!"