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A morning headache is characterized by mild discomfort upon waking up to a strong pain. It can have a profound effect on an individual’s quality of life.
This common and often debilitating disease affects 5-8% of the general population. Women experience morning headaches more often than men. The prevalence is also higher in the 45-64 age group.1
What are the causes of morning headaches?
The causes, associated factors, and the patient’s medical history can be a practical approach to identifying potential headache treatments.
The causes of morning headaches are multifaceted and can include both primary and secondary headaches.
Primary headaches include migraines and cluster headaches (CH). However, secondary headaches include sleep disorders such as sleep apnea, hypertension, and brain parenchymal (functional brain tissue) disease.
Causes of primary headaches
The following are among the few most common causes of primary headaches:
- Hormonal fluctuations
- A side effect of medication that goes away overnight
- Moving from a lying position to a standing position
- Sudden/vigorous physical activity can also trigger a morning headache
- Obstructive Sleep Apnea (OSA)
- Circadian disorder
- Poor sleep hygiene
Secondary morning headache
The causes of secondary headaches can be serious and reflect an underlying medical condition.
- Hypertension
- Hemorrhagic stroke or changes in intracranial pressure (ICP)
- Brain tumors.
- Psychological aspects including anxiety and depression
- Substance abuse
Primary morning headache
The cause of primary headaches is often related to overactivity or problems with pain-sensitive structures in the head. Genetics and lifestyle factors such as lack of sleep and certain foods can trigger them. The following are some common types of primary headaches.
Migraine Headache
Migraine is a common ailment that significantly affects everyday life. Morning headaches are quite common in migraine sufferers. According to research, around 60-70% of migraine sufferers experience morning headaches, suggesting that the two conditions are closely related and often have common underlying causes.2
Several mechanisms may explain the association between migraine and morning headache, including:
- Changes in blood vessels, such as constriction and dilation
- Hormonal changes, especially in women due to the menstrual cycle, pregnancy or menopause, play a crucial role in the relationship between these headaches.
- Specific genetic factors can influence both morning headaches and migraines.
- Hypersensitivity and inflammatory responses can also contribute to their simultaneous occurrence.
Cluster headaches
Cluster headache (CH) is a rare but severe headache disorder characterized by excruciating, unilateral pain, typically around one eye or temples. These headaches often occur at the same time every day, mainly early in the morning.
Previous studies reported that approximately 80% of patients with CH had headache awakenings, and these patients reported that nocturnal sleep precipitated the attacks.
This has been linked to disturbances in the body’s internal biological clock. Which regulates circadian rhythms plays a critical role in the pathophysiology of CH.
3Treatments aimed at regulating circadian rhythms, such as:
- Melatonin supplement or chronotherapy
- The use of continuous positive airway pressure (CPAP) in patients with concomitant sleep apnea may help reduce the frequency and severity of CH attacks.
Chronic tension-type headache
Tension-type headache (TTH) is one of the most common forms of primary headache and is often characterized by throbbing pain.4
Studies show that up to 40% of TTH patients experience morning headaches. They have common contributing factors such as muscle tension, stress and poor sleep quality.5
The treatment of chronic tension-type headache is crucial in the development of comprehensive treatment strategies. These include:
- Underlying problems such as sleep hygiene
- Stress management
- Muscle relaxation
Secondary morning headache
A secondary headache occurs as a symptom of an underlying health problem or as a side effect of medication. The following are some common types of secondary headaches.
Intracranial pressure Headache
Morning headaches can sometimes be associated with changes in intracranial pressure (ICP), characterized by low or high cerebrospinal fluid (CSF) pressure.
A previous study found that 62% of patients with idiopathic intracranial hypotension (low blood pressure) have a headache upon awakening, and 73% of patients reported daily headaches.6
There are several causes of intracranial pressure headaches, including:
- Intracranial pressure can make headaches worse in the morning because during sleep, especially in the supine position, blood flow to the brain can increase, leading to a slight increase in ICP.
- Hormonal changes and fluid retention during supine sleep can also increase ICP.
- Postural or orthostatic headaches, which are typically worse when standing up and better when lying down
High blood pressure Headache
According to the International Classification of Headache Disorders (ICHD)-3, headache due to hypertension is classified as a secondary headache disorder of hemostasis (control of the internal environment of the body).
In a study on the prevalence and risk factors of morning headache, high blood pressure (11.0% vs. 7.2%) is one of the significant risk factors for morning headache.7
Such headaches are associated with a sudden increase in blood pressure (systolic blood pressure 180 mmHg or higher or diastolic blood pressure 120 mmHg or higher).
Brain tumor headache
Brain tumors are rare but serious causes of secondary morning headaches. Nearly 32.2% to 71% of brain tumor patients report morning headaches, often accompanied by various neurological symptoms.8
These are one of the typical signs of brain tumors, which manifest as a worse headache after waking up in the early morning. Tumor headaches are often made worse by lying down or bending over, coughing, exercising or straining.
Nausea or vomiting is another common symptom; however, the clinical characteristics of tumor headache are not well defined.
Factors associated with headache in patients with brain tumor are uncertain, but large brain tumors and tumors with elevated ICP showed a higher prevalence.
Some medications to relieve headaches caused by brain tumors include:
- Corticosteroids such as dexamethasone
- Non-steroidal anti-inflammatory drugs
- Opioids
Take Away
In summary, it can be stated that morning headache is a common disease that significantly affects an individual’s quality of life. There are many complex factors that contribute to morning headaches, requiring a multidisciplinary approach to both diagnosis and treatment.
Sources
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