It jolts you from sleep like an alarm clock, but there's no noise—just the steady pounding in your head. You toss and turn for hours before giving up and starting your day … tired, groggy and sore.
Like its daytime sibling, nighttime headache can take many forms and crop up for any number of reasons. To prevent the pain, experts say it’s important to identify the specific issue that is keeping you awake and determine what may have triggered it.
Recognize Your Headache
The most common forms of nighttime (or nocturnal) headaches are the same ones that occur during the day: migraine and cluster headaches. Of the two, cluster headaches are a more frequent cause of nighttime headache, says Janine Good, MD, associate professor of neurology at the University of Maryland School of Medicine.
Cluster headaches are usually relatively short and intensely painful. They last between 30 minutes and two hours, and are often accompanied by other symptoms, such as red eyes, eye tearing, a running nose or droopiness of the eyelids. Migraines tend to last longer and manifest with different physical symptoms, such as nausea and sensitivity to sounds and light.
A third, less common type of headache is hypnic headache. These headaches, which occur exclusively during the nighttime hours, typically last 30 minutes to an hour and aren’t as severe as migraine or cluster headaches. But hypnic headaches, sometimes called “alarm clock” headaches, tend to become repeat offenders, turning up at the same time each night, sometimes for days on end.
“We don’t see them frequently in a headache clinic, but when we do, they are often in individuals older than 50,” says Ann Pakalnis, MD, professor of clinical pediatrics and neurology at The Ohio State University College of Medicine. Dr. Pakalnis also says hypnic headaches are more common among women.
Identify the Trigger
The cause of most nighttime headaches is still a mystery. In some cases, a sleep problem could be to blame. For example, sleep apnea, a sleep disorder characterized by abnormal breathing and often triggered by obesity, can prevent oxygen from getting to the brain, which, in turn, can trigger a headache.
Caffeine intake close to bedtime also could be a problem for some, as could overuse of painkillers. If you take several painkillers to fight headaches and then go to sleep, your body may begin to have withdrawal symptoms during the nighttime hours, thereby triggering another headache.
To help determine your nighttime headache triggers, keep a headache diary detailing when you got the headache, what type of headache it was and what actions you took before bed that could have triggered it.
If the headaches are recurring, and it’s unclear whether they’re migraine or cluster, Dr. Good says it’s important for doctors to rule out the potential for more serious conditions. In patients over age 50, additional symptoms, such as fatigue and pain while chewing, could point to inflammation in the arteries of the brain.
“Most of these headaches aren’t serious or life threatening,” Dr. Good says. “But if they are recurrent, we may need to examine the patient and screen with a blood test.”
The primary treatment for migraine and cluster headache is usually medication, in addition to good lifestyle practices, including adequate sleep and staying hydrated.
Doctors say hypnic headache can be treated with certain medications as well: For example, melatonin, which helps regulate sleep cycles, is useful in some cases. Dr. Pakalnis says studies have suggested that lithium, which is used to treat bipolar disorder, may be helpful for hypnic headache. And according to Arthur Elkind, MD, president of the board of directors of the National Headache Foundation and director of the Elkind Headache Center in Mount Vernon, N.Y, “Hypnic headache and other nocturnal functional may respond to low doses of tricyclic antidepressants.”
Of course, if you suffer from nighttime headaches, your first course of action should be trying to prevent them altogether. Limit your alcohol and caffeine intake, stay well hydrated, keep a regular sleep and wake schedule, and try relaxation exercises (including those with biofeedback techniques). And enjoy the shuteye when you can get it.
Want more information on nighttime headaches? Read this expert answer to a reader’s question on the subject.
In a recent poll on Headwisemag.org, we asked, "Do you suffer from nighttime headaches?" Here were your responses: