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Morning headaches are characterized by mild discomfort to severe pain upon waking. It can have a profound impact on an individual’s quality of life.

This common and often debilitating condition affects 5% to 8% of the general population. Women are more likely than men to experience morning headaches. Prevalence is also higher among people aged 45 to 64 years.1

What causes morning headaches?

The cause, associated factors, and patient history can be a practical means of determining potential treatments for headache.

The causes of morning headaches are multifactorial and may include primary and secondary headaches.

Primary headaches include migraine and cluster headache (CH). However, secondary headaches include sleep disorders such as sleep apnea, hypertension, and parenchymal (functional tissue in the brain) disorders.

morning headache

Causes of primary headaches

Here are a few common causes of primary headaches:

  • hormonal fluctuations
  • Drug side effects disappear overnight
  • Movement from lying to standing position
  • Sudden/intense physical activity can also trigger morning headaches
  • Obstructive sleep apnea (OSA)
  • circadian rhythm disorder
  • poor sleep hygiene

secondary morning headache

The causes of secondary headaches can be serious and reflect an underlying health condition.

  • hypertension
  • Hemorrhagic stroke or changes in intracranial pressure (ICP)
  • Brain tumors.
  • psychological aspects, including anxiety and depression
  • substance overuse

primary morning headache

The causes of primary headaches are often related to overactivity or problems with pain-sensitive structures in the head. Genetic and lifestyle factors, such as lack of sleep and certain foods, may trigger these symptoms. Here are some common types of primary headaches.

Migraine

Migraine is a common problem that seriously affects daily life. Morning headaches are common among migraine sufferers. Studies report that approximately 60 to 70 percent of migraine sufferers experience morning headaches, suggesting that the two conditions are closely related and often have a common underlying cause.2

There are several mechanisms that may explain the link between migraines and morning headaches, such as:

  • changes in blood vessels, such as constriction and dilation
  • Hormonal changes, especially those that occur in women due to their menstrual cycle, pregnancy, or menopause, play a crucial role in the relationship between these headaches.
  • Certain genetic factors may contribute to morning headaches and migraines.
  • Hypersensitivity and inflammatory reactions may also cause them to occur simultaneously.

cluster headache

Cluster headache (CH) is a rare but serious headache disorder characterized by excruciating, unilateral pain, usually around one eye or temple. These headaches usually occur at the same time every day, mostly in the early morning.
Previous studies have reported that approximately 80% of patients with chronic hepatitis experience headache awakenings, and these patients report that nighttime sleep is a trigger for headache attacks.
This is related to the disorder of the body’s internal biological clock. It regulates circadian rhythm and plays a crucial role in the pathophysiology of CH.
3Treatments aimed at regulating circadian rhythms, such as:

  • Melatonin supplements or chronotherapy
  • Treatment with continuous positive airway pressure (CPAP) in patients with sleep apnea may help reduce the frequency and severity of CH episodes.

chronic tension-type headache

Tension-type headache (TTH) is one of the most common forms of primary headache and is often characterized by tightening pain.4

Studies show that up to 40% of TTH patients experience morning headaches. They share common contributing factors such as muscle tension, stress and poor sleep quality.5

Treatment of chronic tension-type headache is critical to developing a comprehensive treatment strategy. These include:

  • Potential issues, such as sleep hygiene
  • stress management
  • muscle relaxation

secondary morning headache

Secondary headaches are symptoms of an underlying health problem or a side effect of medications. Here are some common types of secondary headaches.

intracranial pressure headache

Morning headaches may sometimes be related to changes in intracranial pressure (ICP), a condition characterized by low or high pressure in the cerebrospinal fluid (CSF).

A previous study showed that 62% of patients with idiopathic intracranial hypotension (low blood pressure) experienced headaches upon waking, and 73% reported daily headaches.6

Intracranial pressure-related headaches have many causes, such as:

  • Intracranial hypertension can worsen morning headaches because blood flow to the brain increases during sleep, especially while lying down, causing a slight increase in ICP.
  • Hormonal changes and fluid retention while lying down while sleeping can also cause increased intracranial pressure.
  • Orthostatic or orthostatic headache, which usually worsens when standing upright and improves when lying down

High blood pressure headache

According to the International Classification of Headache Disorders (ICHD)-3, headache caused by arterial hypertension is classified as a headache disorder secondary to hemostatic (in vivo environmental control).

In a study on the prevalence and risk factors of morning headache in the general population, hypertension (11.0% vs. 7.2%) was one of the significant risk factors associated with morning headache.7

This type of headache is associated with a sudden increase in blood pressure (systolic blood pressure of 180 mmHg or more, or diastolic blood pressure of 120 mmHg or more).

brain tumor headache

Brain tumors are a rare but serious cause 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 hallmarks of a brain tumor, which can manifest as a headache that is worse when you wake up in the morning. Tumor headaches are often worsened by lying down or bending over, coughing, movement, or exertion.

Nausea or vomiting is another common accompanying symptom; however, the clinical features of neoplastic headache are unclear.

Factors associated with headache in patients with brain tumors are uncertain, but there is a higher prevalence of large brain tumors and tumors with elevated ICP.

Some medications to relieve headaches associated with brain tumors include:

  • corticosteroids, such as dexamethasone
  • NSAIDs
  • Opioids

take away

In summary, morning headaches are a common condition that can significantly impact an individual’s quality of life. There are many factors that contribute to morning headaches, requiring a multidisciplinary approach to diagnosis and treatment.

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