What You Should Know About Morning Headaches?

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 prevalent and often debilitating condition affects 5% to 8% of the general population. Women experience morning headaches more often than men. The prevalence is also higher among individuals aged 45 to 64 years.¹

What Are the Causes of Morning Headaches?

The causes, related factors, and patient medical history can be a practical approach to identifying potential treatments for headaches.

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 (a functional tissue in the brain) disease.

Causes of Primary Headaches

The following are among the few common causes of primary headaches:

• Hormonal fluctuations
• Side effect of medications wearing off overnight
• Movement from a lying to a standing position
• Sudden/vigorous physical activity can also trigger a morning headache
• Obstructive sleep apnea (OSA)
• Circadian disruption
• Poor sleep hygiene

Secondary Morning Headaches

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 Headaches

The cause of primary headache is often related to over activity or problems with the pain-sensitive structures in the head. Genetics and lifestyle factors, such as, lack of sleep, and certain foods, can trigger them. Following are some common types of primary headaches.

Migraine Headaches

Migraines are a common issues that significantly impact daily life. Morning headaches are pretty common in migraine patients. Studies reported that about 60% to 70% of migraine patients experience morning headaches, suggesting that these two conditions are closely related and often share common underlying causes.²

Several mechanisms may explain the connection between migraine and headaches in the morning, such as:

• Changes in blood vessels, such as constriction and dilation
• Hormonal changes, especially in women due to menstrual cycles, pregnancy, or menopause, play a crucial role in the relationship between these headaches.
• Specific genetic factors may contribute to both morning headaches and migraines.
• Hypersensitivity and inflammatory responses may also contribute to their simultaneous occurrence.

Cluster Headaches

Cluster headaches (CH) are a rare but severe headache disorder characterized by excruciating, one-sided pain, typically around one eye or temple. These headaches often occur at the same time each day, predominantly in the early morning hours.
Previous studies reported that about 80% of patients with CH had headache awakening, and these patients reported nighttime sleep as a trigger of attacks.
This has been linked to disruptions in the body’s internal biological clock. Which regulates circadian rhythms, plays a critical role in the patho-physiology of CH.
³Treatments aimed at regulating circadian rhythms, such as:

• Melatonin supplementation or chronotherapy
• Use of continuous positive airway pressure (CPAP) therapy in patients with comorbid sleep apnea could 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 headaches and is often characterized by a tightening pain.⁴

Research indicates that up to 40% of individuals with TTH experience morning headaches. They share common contributing factors such as muscle tension, stress, and poor sleep quality.⁵

Chronic tension-type headache treatment is critical for developing comprehensive treatment strategies. These include:

• Underlying issues, such as sleep hygiene
• Stress management
• Muscle relaxation

Secondary Morning Headaches

A secondary headache occurs as a symptom of an underlying health problem or as a side effect of medication. Following are some common types of secondary headaches.

Intracranial Pressure Headache

Morning headaches can sometimes be associated with changes in intracranial pressure (ICP), a condition characterized by low or high cerebrospinal fluid (CSF) pressure.

One previous study showed 62% of patients with idiopathic intracranial hypotension (low blood pressure) have headache with awakening, and 73% of patients reported daily headache.⁶

There are different reasons of intracranial pressure-related headaches, such as:

• Intracranial hypertension can worsen headache in the morning because, during sleep, particularly in a lying down position, blood flow to the brain can increase, leading to a slight rise in ICP.
• Hormonal changes and fluid retention during lying down while sleeping can also contribute to increased ICP.
• Positional or orthostatic headaches, which typically worsen when upright and improve when lying down

High Blood Pressure Headaches

According to the International Classification of Headache Disorders (ICHD)-3, headache due to arterial hypertension is classified as a secondary headache disorder of hemostasis (internal body environment control).

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

Such headaches are linked to abruptly elevated blood pressure (systolic blood pressure 180 mmHg or higher, or diastolic blood pressure 120 mmHg or higher).

Brain Tumor Headaches

Brain tumors are rare but serious causes of secondary morning headaches. Nearly 32.2% to 71% patients with brain tumors report headaches in the morning, often accompanied by various neurological symptoms.⁸

These are one of the characteristic signs of brain tumors, presenting as a worse headache in the early morning upon waking. Tumor headaches are often exacerbated by lying down or bending, coughing, exercise, or straining.

Nausea or vomiting is another common accompanying symptom; however, the clinical characteristics of tumor headache are not well-defined.

Factors associated with headache in patients with brain tumors are uncertain, but large-sized brain tumors and tumors with increased ICP showed a higher prevalence.

A few medications to alleviate headaches related to brain tumors include:

• Corticosteroids such as dexamethasone
• Non-steroidal anti-inflammatory drugs
• Opioids

Take Away

In conclusion, morning headaches are a common condition that significantly impacts an individual’s quality of life. There are many complex factors contributing to morning headaches, necessitating a multidisciplinary approach to both diagnosis and treatment.

Sources

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2. Lin YK, Lin GY, Lee JT, et al. Associations between sleep quality and migraine frequency: a cross-sectional case-control study. Medicine (Baltimore). 2016;95(17):e3554. doi:10.1097/MD.0000000000003554 ↩︎
3. 1Barloese M, Lund N, Petersen A, Rasmussen M, Jennum P, Jensen R. Sleep and chronobiology in cluster headache. Cephalalgia. 2015;35(11):969-978. doi:10.1177/0333102414564892 ↩︎
4. Im HJ, Baek SH, Yun CH, Chu MK. Time preference of headache attack and chronotype in migraine and tension-type headache. Chronobiol Int. 2019;36(11):1528-1536. doi:10.1080/07420528.2019.1658202 ↩︎
5. Im HJ, Baek SH, Yun CH, Chu MK. Time preference of headache attack and chronotype in migraine and tension-type headache. Chronobiol Int. 2019;36(11):1528-1536. doi:10.1080/07420528.2019.1658202 ↩︎
6. Hong Y, Kang MK, Kim MS, Mo H, Cox RC, Im HJ. Morning headaches: an in-depth review of causes, associated disorders, and management strategies. Headache and Pain Research. 2025;26(1):66-79. doi:10.62087/hpr.2024.00231. ↩︎
7. Ohayon MM. Prevalence and risk factors of morning headaches in the general population. Arch Intern Med. 2004;164(1):97-102. doi:10.1001/archinte.164.1.97 ↩︎
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   Valentinis L, Tuniz F, Valent F, et al. Headache attributed to intracranial tumours: a prospective cohort study. Cephalalgia. 2010;30(4):389-398. doi:10.1111/j.1468-2982.2009.01970.x ↩︎