Personal Health

There’s a Reason You’re Waking Up with a Migraine

Migraine affects nearly 40 million people in the United States each year, and if you’re one of them, you know that there’s no such thing as a good time for one to appear. But there’s something particularly discouraging about waking up with one. Along with acute or throbbing head pain, a morning migraine can bring other symptoms, such as nausea and full-body fatigue, that make it difficult to get up and start your day.

Unfortunately, a 2005 study published in Headache found that waking up with headache and other migraine symptoms is common for people who have migraines. Here are some of the reasons experts believe an early-morning attack can happen, and how you can treat them when they do.

How do you know it’s a migraine?

Migraines and tension-type headaches can both cause throbbing pain that lasts for several hours. So how can you tell the difference?

“Migraine is more than just headache. For some people, the headache is not what really bothers them the most, if at all,” says Stephanie Nahas, a physician at the Jefferson Headache Center in Philadelphia. Pain on one side of your head, pain that throbs, pain that is moderate to severe, and pain that gets worse with physical activity are all indicators of a migraine. They also usually involve other symptoms, such as sensitivity to light and noise, vomiting, and nausea. Additionally, neck pain, sinus pressure, sweaty palms, visual disturbances, and dizziness are considered typical migraine symptoms.

“The pain of tension-type headache is most often diffuse and dull, and it is generally less intense than headache associated with migraine,” says Nahas. A tension-type headache typically may have one mild symptom in addition to head pain, but it typically has none.

Jan Lewis Brandes, who serves on the board of the National Headache Foundation and works as an assistant neurology professor in Nashville, Tennessee, points out that certain factors could put you in a higher risk category for migraine. In 2018, the CDC reported that women are more than twice as likely as men to have had a migraine within the last three months. Brandes also says that insomnia, snoring, restless leg syndrome, drinking alcohol often in the evening, and fasting for hours at a time can all make you more likely to have waking migraines.

Why do migraines happen in the morning?

“In migraine, attacks often strike in the early morning hours, just by the nature of the disease. Reasons for this are complex and not well understood, but it’s believed that the way the brain goes through the sleep-wake cycle has something to do with it,” says Nahas.

A 2017 review of 85 surveys found that sleep was the second-most common headache trigger for people with tension headaches and migraines. (Stress came in first, if you’re curious). An inconsistent sleep schedule, getting too much or not enough sleep for your body, and sleep-related health conditions like sleep apnea can all interfere with your sleep quality and be the reason you are waking up with a migraine.

In a large 2005 study of people with migraines published by Headache, people with chronic migraines (defined as having migraine symptoms 15 days or more during each month) tended to sleep for less time each night, and were more likely to have trouble getting to sleep. Migraine and poor sleep quality can feed off of each other and create a cycle of waking migraine and insomnia.

Researchers have established a strong link between certain mental health conditions and migraines. One study of 2,907 people showed that 63.8 percent of participants diagnosed with migraine had depression, and 60.4 percent had anxiety. The symptoms of these conditions can also mean that you are more likely to have difficulty getting quality sleep, resulting in morning migraines.

Early morning migraines can also be caused by the same things that trigger migraines during your waking hours, like your diet and being dehydrated. “Drinking too much caffeine during the day can lead to overnight caffeine withdrawal, which is a notorious trigger,” says Brandes. In that same vein, your body may get dehydrated or your blood sugar may drop during your sleep, which can trigger a waking migraine. “Someone who relies on pain or migraine medication too much during the day can wake with an attack as the medication wears off,” says Nahas.

How can you treat a migraine that happens in the morning?

If you wake up with migraine symptoms, Brandes says that taking an acute migraine medication as soon as you’re able to is an essential part of managing your pain. Brandes also recommends drinking water before eating a small breakfast that includes protein, along with six to eight ounces of caffeinated coffee (as long as caffeine isn’t a typical migraine trigger for you). “Caffeine helps more people with migraines than not, but should be used in limited quantities and earlier in the day. If caffeine is a clear trigger, avoid it, and always avoid caffeine overuse,” she says. Avoiding bright lights or strong sensory stimuli might help make symptoms more tolerable. If your symptoms are severe, 15 to 30 minutes of rest may help as a next step.

A migraine can slow down your body’s ability to metabolize medication, which is why it’s recommended that you treat one as soon as it appears. Of course, if it appears while you’re sleeping, that’s not really an option. “Treating morning migraine attacks may require medication that can get into your system quickly, like a rapidly-dissolving oral medication or a nasal spray,” says Nahas.

Preventative migraine treatments continue to expand, and newer medications that are specifically designed to reduce migraines are now on the market. According to the Mayo Clinic, monthly or quarterly migraine injections, antidepressants, blood pressure medication, and anti-seizure medications have all been used with some success to help treat migraines.

“If you have recurring headaches upon awakening that are interfering with your regular activities and that does not respond to self-treatment, that’s the time to see a doctor,” says Brandes. “Often, the key is prevention.”

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