What to Do If You Get Headaches at Night

Headaches at night are common and can have many causes and triggers, such as neck tension, sinus pressure, or sleep disorders.

Treatments vary based on the the type of headache—such as tension headache, migraine, or hypnic headache—but often include a combination of medications and prevention strategies.

This article covers the basics of nighttime headaches, including their causes and what you can do to treat and prevent them.     

Causes of Nighttime Headaches

While mornings are the most common time of day people have headaches, many occur at night. While the exact mechanisms of nighttime headaches aren’t fully understood, they’re likely related to the activity of the hypothalamus, a brain region associated with both pain perception and your natural sleep-wake cycle, known as your circadian rhythm.

As this region changes activity throughout the day and night, it can spur both nighttime headaches as well as those when you wake up.  

As a result, there’s a distinct connection between sleep and headaches, with disruptions of the former leading to the latter. This can arise due to sleep apnea, sleep disruptions or disorders, migraines, teeth and grinding, among other causes.   

Many headaches at night arise due to primary headache disorders, which are those that occur independently of other symptoms and are not caused by another medical condition. Primary headache disorders include tension headaches, migraines, hypnic headaches, and cluster headaches.

Tension Headache

By far the most prevalent headache, tension headaches are a common cause of nighttime headache. They can last anywhere from 30 minutes to a week.

Symptoms

Tension headaches cause:

• Duller pain that is not pulsating
• Headache on both sides of the head
• A feeling of pressure, like a vice grip, on both sides
• Pain that's sharper in the scalp, temples, back of the neck, and sometimes the shoulders  

Tension headaches are caused by the contraction of muscles in the scalp and neck. They can also be set off by a number of triggers, including:

• Physical and emotional stress
• Muscle tension and stiffness in the neck
• Holding your head in an awkward position for a long time
• Sleep interruptions; not getting enough sleep
• Sinus infections, common cold, and flu
• Teeth grinding or tooth misalignment
• Alcohol use, smoking, and/or caffeine (excess or withdrawal)
• Eyestrain
• Physical fatigue; being over-tired

Treatment

Over-the-counter (OTC) analgesics, such as Tylenol (acetaminophen) and non-steroidal anti-inflammatory drugs (NSAIDs) like Aleve (ibuprofen) and Bayer (aspirin) are typically the first line of treatment for headaches, including tension headaches. The use of these drugs should be monitored, especially in chronic cases.

In more difficult or chronic tension headache cases, medications may be prescribed if OTC drugs aren’t yielding results. These include muscle-relaxers, such as Flexeril (cyclobenzaprine), and tricyclic antidepressants like Elavil (amitriptyline) and Palemor (nortriptyline).

Migraine

Migraine is a recurring type of headache that is moderate to severe in intensity. Migraine is a relatively common headache disorder that represents about 30% of all headache cases. Attacks of this condition go through stages and last anywhere from four to 72 hours.

Symptoms

Migraine doesn't just cause head pain; its typical symptoms can include:

• Throbbing or pulsing head pain, often on just one side of the head
• Nausea and vomiting
• Light or sound sensitivity
• Fatigue
• Restlessness
• Changes in mood
• Visual disturbances (auras), such as seeing angular lines or flashes prior to onset

There are several different kinds of migraine, and specific symptoms can vary from person to person.

In some cases, migraine can set on while you’re asleep and wake you up. They most often arise towards the tail end of your sleep cycle, coming on between 4 and 9 AM. While the exact causes of nighttime migraines are not known, poor sleep and sleep disorders can trigger attacks, and they can also be the result of medications wearing off overnight.

Treatment 

Migraine treatments focus both on managing symptoms and developing ways of preventing attacks. If OTC medications, such as ibuprofen or acetaminophen, aren’t yielding results, you may be prescribed triptans, such as Imitrex (sumatriptan) and Zomig (zolmitriptan), among others. In addition, for more difficult cases, several drugs work to prevent attacks. These include:

• Tricyclic antidepressants
• Anticonvulsants, including Neurontin (gabapentin) among others
• Monoclonal antibodies like Aimovig (erunumab) and Vyepti (eptinezumab)
• Beta-blockers, such as Lopresor (metoprolol) and Inderal LA (propranolol)
• Botox injection (for difficult cases)
  

Hypnic Headache

Hypnic headaches are rare and occur exclusively at night, waking people up from sleep. Attacks frequently recur 10 or more times a month and last anywhere from 15 minutes to four hours.

It’s sometimes called an “alarm clock headache” because symptoms tend to arise at the same time at night.

Symptoms

Though hypnic headaches can be severe, they are generally milder than other kinds.  

The main feature is waking up during the night due to a headache at least 10 times a month for at least three months.

Symptoms may include:

• Recurrent headaches only occur at night
• Dull or throbbing pain affecting one or both sides of the head
• Nausea
• Sensitivity to light or sounds
• Runny eyes or nose

Treatment

A common approach to treating hypnic headache is caffeine, as in a cup of coffee or black tea, before bed. While caffeine can sometimes cause insomnia, it doesn't seem to interfere with a good night's sleep for most hypnic headache patients.

That said, this condition is notoriously difficult to treat. Several other medications and supplements may help provide relief:

• Melatonin
• Sibelium (flunarizine)
• Tivorbex (indomethacin)
• Topamax (topiramate)
• Lithium carbonate
  

Cluster Headache

Considered the most severe and debilitating of the primary headache disorders, cluster headaches can also arise at night. As the name suggests, they arise in “clusters”—periods of time with multiple attacks in a day—that can last for weeks or even months. These are then followed by significant periods of remission.

Symptoms

Cluster headache symptoms include:

• Unilateral (one-sided), very sharp headache
• Pain typically behind one eye, before moving to the forehead and other parts of the head
• Drooping eye
• Facial swelling
• Facial sweating
• Restlessness and jitteriness

Treatment

Cluster headaches, like other primary headache disorders, can be challenging to treat. Several treatments take on attacks, including:

• Oxygen therapy: Often the first line of cluster headache treatment, inhaling oxygen from a canister using a respirator can effectively relieve pain. Most cases resolve within 20 minutes of this therapy.
• Triptans: Triptans for cluster headaches typically take the form of nasal sprays or under-the-skin patches rather than tablets. These medications help reduce the duration of attacks. They can also be used for migraines.
• Dihydroergotamine: Injections or nasal sprays of dihydroergotamine may also help with cluster headaches.
• Lidocaine: Nasal drops of lidocaine can also help after cluster headaches have come on. A second dose can be taken after 15 minutes, but you shouldn’t take more than that.

As with migraine, some drugs may also help with prevention. Evidence suggests Verelan (verapamil), lithium carbonate, and Topamax may help reduce the frequency of attack.

Diagnosis

To help determine the type of headaches you're having and potential causes, your healthcare provider will ask a series of questions about your headaches, such as:

• How frequently they occur
• How long they last
• The severity, such as dull and achy or sharp and piercing
• Whether it is one or both sides of your head

Your healthcare provider will also take a detailed personal and family medical history and ask you about any known health conditions.

In some cases, and especially if your headaches are severe or you have other symptoms, your healthcare provider may order additional tests, such as:

• Blood and urine tests can help identify infections, blood vessel damage, or toxins that affect the nervous system.
  
• Diagnostic brain imaging, such as magnetic resonance imaging (MRI) or computed tomography (CT scans), can look for irregularities in blood vessels and bones, certain brain tumors and cysts, brain damage from head injury, bleeding in or around the brain, inflammation, infection, and other brain issues. 
• Spinal tap to look for bleeding in the brain or infections

Coping and Prevention

Prevention strategies are often a key part of an overall treatment plan to help reduce or minimize the frequency and intensity of headaches at night. This may include relaxation strategies, lifestyle changes, complementary therapies, and medical devices.

Relaxation Strategies

Since stress and tension are often at the root of headache problems, working on relaxation therapies is a common means of prevention and minimizing the intensity of attacks. Typically employed strategies include:

• Cognitive behavioral therapy: This is a talk therapy that focuses on developing coping strategies, while working to change your perception of your condition.
• Biofeedback: This therapy involves using wearable devices to detect physiological signs of tension and stress, while learning relaxation strategies to prevent and proactively manage attacks.
• Meditation: Meditation, mindfulness, and other relaxation can help ease stress, a common migraine trigger.

Lifestyle Changes

A big part of headache treatment involves making significant changes in your lifestyle, while being strategic about how to practically manage your condition. This can involve:

• Getting regular and consistent exercise
• Ensuring you are eating healthy meals and aren’t skipping meals
• Getting enough sleep and going to bed, and waking up at consistent times
• Take part in relaxing activities, such as yoga, gardening, or others
• Avoiding dietary and other types of triggers for migraines

Complementary Therapies

Some evidence has shown some complementary therapies that can accompany other treatments to help with headaches. Stretching-oriented activities like yoga, meditation, and acupuncture are all options.

Additionally, the supplements riboflavin, magnesium, or co-enzyme Q10 may be recommended by your healthcare provider.

Medical Devices

In chronic, difficult to manage headache cases, neurostimulation is another option to manage pain. This involves using magnetic fields or mild electrical shocks to stimulate nerves associated with pain perception. Overstimulating these nerve pathways blocks pain perception, and, in some cases, prevents headaches. Among these devices are:

• Trigeminal nerve stimulators, like Cefaly
• Single-pulse transcranial magnetic stimulators, such as eNeura
• Remote electrical neuromodulation device (transcutaneous electrical nerve stimulation, or TENS) , such as Neurivo

When to Seek Medical Attention

If your headaches at night wake you up from sleep or make it difficult for you to fall asleep, you should see a healthcare provider. You should also check in with a healthcare provider if you experience any of the following:

• Your headache lasts more than a few days.
• Your headaches change in pattern or intensity.
• You have headaches often and there is no known cause

While headaches can be very debilitating, not all of them require medical attention. However, especially if you live with a condition like a migraine, cluster, or hypnic headache, it’s important to know the signs that you do need help.

Get emergency medical care help if you experience any of the following symptoms:

• Loss of consciousness following an impact to the head
• Very rapid onset of headache
• Pain that is unusually severe
• Headache getting worse for 14 or more hours
• Headache is the worst you've ever experienced
• Repeated vomiting
• Vision problems
• Severe pain or redness in one eye
• Problems with limb coordination
• Loss of balance, vertigo
• Fever and neck stiffness
• Trouble chewing and/or swallowing
• Neurological symptoms, such as memory or speaking problems
• Personality or mood changes
• You develop a headache right after physical activities

Summary

Nighttime headaches can arise due to a range of disorders and health issues. In particular, this issue can be a feature of tension, migraine, and cluster headaches and is the primary symptom of hypnic headache. While the exact causes aren’t known, they’re linked to the activity of the hypothalamus.

Nighttime headache symptoms vary depending on the headache type. Tension headaches cause duller pain and pressure on both sides of the head. More severe migraine headaches focus on one side, with attacks also causing symptoms like nausea and vomiting, light and sound sensitivity, and visual disturbances. Cluster headaches arise as groupings of severe headaches within a short period of time (clusters). Lastly, hypnic are headaches that arise exclusively while you’re sleeping.

Treatments for nighttime headaches focus on managing symptoms, preventing attacks, and making positive lifestyle changes. OTC and prescription medications are available to ease pain when they occur. Additionally, ensuring proper and healthy sleep, not skipping meals, and managing stress can also help.

A Word From Verywell

When it comes to nighttime headaches, different causes of headaches have different treatments. Since the appropriate treatment can range from a simple cup of coffee to prescription medication, give your healthcare provider as much detail about your headache as you can so they can arrive at the right diagnosis (and the right treatment) for you as soon as possible.

— NICHOLAS R. METRUS, MD, MEDICAL EXPERT BOARD