Waking Up With A Migraine: Everything You Need To Know

Why do you wake up with a migraine?

Wake-up headaches are a common occurrence among those diagnosed with migraines. 

According to the National Headache Foundation,¹ this is because your body doesn't produce enough natural painkillers — such as endorphins and enkephalins — between 4:00 AM and 8:00 AM, as it does throughout the rest of your day.

It's also likely due to medications wearing off overnight or being unable to take your medication at the onset of the migraine due to sleeping when early symptoms arise. 

There can be several reasons you wake up with a migraine, especially since different lifestyle choices and other factors can trigger a migraine. Here are some common examples. 

Sleep patterns

Sleep can play a substantial part in morning headaches. If you have poor quality sleep due to sleep disorders — sleep apnea, insomnia, or teeth grinding — or simply haven't slept enough or slept too much, it's a common trigger for a headache. In fact, the American Migraine Foundation (AMF)² reports that those with migraines are 2 to 8 times more likely to have a sleep disorder.

Mental health conditions

Mental health conditions such as anxiety, depression, and stress have long been associated with migraines. One study³ found that stress and anxiety, in particular, had a strong association with the condition. Participants with migraines reported the following symptoms that could be related to anxiety:

• Not being able to stop or control worrying

• Trouble relaxing

• Feeling nervous, anxious, or on edge

• Worrying too much about different things

Hormones and medications

Other key factors to consider as the cause of morning migraines are hormones and medications. For women — who are three times more likely⁴ to have migraines than men — the chronic headaches can be triggered by hormonal changes during menstrual periods or certain hormonal contraceptives. In fact, one study⁵ found that combination oral contraceptives, in particular, can:

• Cause de novo migraine in individuals who didn’t have a history of the condition 

• Worsen a migraine condition

• Change the pattern of an existing condition 

Furthermore, another study⁶ reported that migraine sufferers are more sensitive to hormonal fluctuations, with results finding that a decline in estrogen was linked to the onset of a migraine. 

Adverse reactions to certain medications can also trigger migraines, particularly in cases where medication overuse⁷ causes headaches. 

Genetics

Genetic factors have also been studied in association with the risk for migraines. Many studies⁸ found that migraines have a strong genetic component and that when you have a stronger family history of migraines, you are more likely to have them yourself. This was found to be particularly true for migraines with aura. 

Dehydration and caffeine withdrawal

According to AMF, approximately 1/3 of migraine sufferers signal dehydration as one of their triggers. Although there hasn't been enough research to make a strong association yet, studies — like the ones done in 2012⁹ and 2021¹⁰ — link dehydration to worsening migraines and increased water intake to migraine improvements. 

As for caffeine, it has been linked as a trigger and cure for migraines in different studies. Caffeine withdrawal is particularly linked as a trigger, with one study¹¹ not being able to connect it to long-term effects on migraines but identifying 'abrupt withdrawal' as a 'potent trigger' for migraines. 

Symptoms

Although there are cases where people have had morning headaches without any warning, and the attack ends with sleep, there are cases when the symptoms in the experience are much more than the attack itself. In these cases, there are at least three phases of migraine.

Note that the migraine symptoms you may experience depend on the phase you're in. Here are the symptoms as they relate to each phase. 

Prodrome Phase

The prodrome phase encompasses the warning signs that migraine attacks are coming on. It often includes:

• Fatigue 

• Depression

• Irritability

• Food cravings

• Euphoria 

• Neck pain or stiff neck 

• Sensitivity to light, sound, and smell

• Constipation

• Yawning more often 

• Increased urination 

Aura Phase

In the aura phase — which can occur right before or during migraine attacks —  you may experience neurological symptoms such as:

• Seeing bright lights, dots, zigzags, or double vision (Loss of vision is not often associated with migraine. See a doctor as this could be a more serious condition)

• Tingling or numbing sensation

• Speech impairment 

• Muscle weakness

According to The Journal of Headache and Pain,¹² 98–99% of people who experience aura symptoms have visual aura symptoms, while 36% experience sensational disturbances and 10% experience language difficulties.

These symptoms typically last between 20 and 60 minutes. You can visit your healthcare provider for a neurological exam for further examination.

Attack Phase

• Throbbing headaches that intensify

• Nausea 

• Vomiting

• Sensory sensitivities (i.e., sensitivity to light, sound, and smell)

• Skin sensitivities (otherwise known as allodynia)

• Muscle tenderness

It's possible that after these phases, you will feel exhausted and weak and may require some rest. This is normal since your body went through so much while battling the severe pain.

How do you know if your headache in the morning is turning into a migraine?

A morning headache, also known as awakening headaches, doesn't necessarily mean you will have a migraine. However, if you have a history of headaches turning into migraines in the morning, there is a higher chance it will happen. 

This risk, combined with migraine attacks being more common early in the morning, could increase your odds.

Since there are at least three other types of headaches (sinus, tension, and cluster headache), it can sometimes be challenging to differentiate them from a potential migraine. However, the best thing you can do is compare your symptoms to common migraine symptoms and those that may be from another type of headache:

• Sinus headache. It involves sinus pressure, nasal congestion, and cold symptoms.

• Cluster headache. It occurs suddenly (compared to migraines that often have warning signs) and includes symptoms like a runny nose and watery eyes. 

• Tension headache. It’s caused by stress and eye strain. Tension headaches are more common and primarily affect the back of your head and forehead. 

• Hypnic headache. Although many people report migraine-like symptoms, hypnic headaches are a rare, recurrent headache that happens overnight while you're sleeping. It can last anywhere from just 15 minutes to four hours per night. 

Treatment

If your migraine headaches are severe enough that they are debilitating and decrease your quality of life, you should meet with a healthcare provider who specializes in internal diseases or a headache specialist.

They will have the best insight into effective prevention, diagnoses, and treatment. 

Their treatment recommendations will likely differ from person to person since everyone is different. However, you will be considered for one or more of the following treatment plans. 

Prescription medication

The type of drugs prescribed to you will depend on several factors: what you have already tried in the past (what worked/what didn't), your preference, affordability, and medical limitations (i.e., other medicines you're taking, allergies, etc.). 

With that being said, either one of these medication options can be your first-line treatment, depending on your case:

Pain medications 

Pain medications are given for all types of pain, including different kinds of headaches.

Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line treatments for people with migraines who only experience mild to moderate pain and symptoms. These drugs are often offered over-the-counter, but you may be prescribed medications stronger than the traditional Advil or Aleve.  

Triptans

Triptans are used for the treatment of headache/migraine only.

Triptan drugs are the most commonly prescribed class of drugs for migraines. These include sumatriptan, frovatriptan, rizatriptan, almotriptan, eletriptan, naratriptan, and zolmitriptan. 

They may be prescribed as a first-line treatment for those suffering from severe headache pains but is often a second-line treatment for those who don't respond well to traditional pain relievers. It is not a preventive treatment, nor does it help with any other pain besides migraines. It is available as nasal sprays, pills, injections, and patches.  

Narcotic pain medications

Opioid pain relievers like Vicodin, Percocet, and OxyContin can be prescribed but aren't typically recommended. 

Stephen Silberstein, MD, FAAN, FACP, FAHS, director of the Headache Center at Jefferson University Hospital, told the American Headache Society,¹³ "The problem we have is that many physicians treat the symptoms and not the disease. So if you have a pain of any type, they're treated with an opioid [even though] evidence strongly suggests that opioids are not as effective as medicine like triptans."

Second or third-line treatment options can also include antiemetics and dihydroergotamine for some migraine sufferers with a refractory migraine — a medication overuse headache. 

Home remedies

Before participating in any home remedies to treat your headache pain and symptoms, you should always discuss it with your doctor to ensure it is safe for you to proceed. 

That said, some home remedies many people use or have tried include:

• Heating pads

• Warm baths or showers

• Adequate sleep, i.e., creating/sticking to healthy sleep habits to increase your sleep quality overnight

• Avoid foods that have been linked to triggering migraines, such as alcohol, chocolate, aged cheeses, fermented and pickled items, yeast, and processed meats.

Another study¹⁴ recommends the following home remedies to reduce headache intensity, although it does note that there's limited research to support it:

Yoga

Some research supported a positive effect on blood sugar, blood pressure, high eye pressure, and the regulation of your breathing.

Aerobic exercise

Although the frequency of morning headaches and other headaches did not reduce in all observations, the intensity of pain did decrease significantly. One study¹⁵ recorded a decline in headache frequency, duration, and severity. 

Sometimes home remedies are enough to get you through your migraine attacks — or at least some of them — but more often than not, a pain reliever or specific migraine medicine is required due to the severe head pain. When this is the case, consult your doctor about the best treatment plan for you and your specific experience. 

When to visit a doctor

You should seek medical advice from your primary care doctor if:

• You currently suffer from migraines, have not been diagnosed, and have experienced a decrease in quality of life.

• You are considering changing your treatment plan or trying something new at any time. You should also discuss the pros and cons of your current treatment, whether it's working for you, and some changes (if any) you would like to see moving forward. Your doctor will know the best preventative measures and treatments for you.

• You experience severe or worsening symptoms.

The lowdown

Waking up to a migraine is common among those who experience migraines. This is because mornings are the optimal time for an attack due to sleeping through the early signs, being off pain relievers overnight, and a decrease in natural pain relievers your body produces. Factors that can also play a part include unhealthy sleep patterns, mental health issues, hormonal or medication changes, genetics, dehydration, and caffeine withdrawal. 

It is always a good idea to look closely for common migraine signs. Remember, the sooner you take medication, the better. For instance, you may experience warning signs in the prodrome and aura phase before the onset of your attack.

If not, monitor the start of a migraine attack so you can treat it promptly. 

Treatment for migraines differs from person to person. While home remedies work for some — such as exercise, warm baths, and adequate sleep — others may need to take more proactive measures like pain relievers or triptans.

Either way, you should always discuss treatment options with your doctor before proceeding and never make any changes unless your doctor tells you to.