Headaches that get worse at night can be caused by a variety of conditions. In some cases, the underlying cause may be obvious, while in others it may require a trip to the doctor to identify the source of the nighttime headaches.
Migraines
One of the most common causes of headaches that worsen at night are migraines. Migraines are recurring headaches that are moderate to severe in intensity. They are often throbbing or pulsing headaches located on one side of the head. Migraines can be accompanied by nausea, vomiting, and sensitivity to light and sound.
Many people find that their migraine attacks tend to start in the late afternoon or early evening hours. The pain often progressively worsens through the night. Sleeping is difficult and migraines that awaken people during the night can be especially exhausting.
The exact cause of migraines is not fully understood. They are believed to involve changes in brain chemicals and nerves. Migraines may run in families. Triggers for migraines can include emotional stress, sensitivity to light, hormonal changes, and certain foods and drinks.
Cluster Headaches
Cluster headaches are excruciating headaches that tend to strike in clusters, meaning the headaches come and go in cycles. Cluster cycles can last for weeks or months and then go into remission.
These headaches are characterized by severe burning or piercing pain located on one side of the head, often around or behind the eye. They typically strike at night and can wake someone from sleep. People describe the pain as feeling like a hot poker in the eye.
Cluster headaches occur more often in men and tend to begin when a person is in their 20s or 30s. The cause involves the trigeminal nerve and hyperactivity of the hypothalamus in the brain. Triggers can include alcohol use and high histamine foods.
Hypnic Headaches
Hypnic headaches are rare headaches that specifically occur during sleep. They tend to strike after the person has been asleep for at least an hour. The pain is usually mild to moderate, but can occasionally be severe.
These headaches typically affect older adults over the age of 50. The pain is often described as dull and widespread. It may occur on both sides of the head. Nausea is uncommon with hypnic headaches.
The cause of hypnic headaches is not known. Treatment focuses on preventive medications taken at bedtime. Caffeine taken before bed may also ease symptoms.
Sleep Apnea
Obstructive sleep apnea is a condition where the airway becomes blocked during sleep, interrupting normal breathing. This results in reduced oxygen levels and brief awakenings as the person struggles to breathe.
The constant awakenings lead to poor sleep quality and daytime fatigue. Headaches are a common symptom of sleep apnea. Headaches that get worse at night may be traced back to sleep apnea as an underlying cause.
Sleep apnea tends to occur in those who are overweight and have a narrowed airway. Treatment options include CPAP, mouthpieces, and surgery. Losing weight can also help sleep apnea in some cases.
Medication Overuse Headaches
Frequent use of certain pain-relieving medications can cause rebound headaches. Migraine sufferers are at particular risk of developing medication overuse headaches.
When taken too often, the pain medications actually start causing worsening headaches. The headaches often settle into a pattern where they occur nightly and first thing in the morning.
Common culprits include over-the-counter medications like ibuprofen, acetaminophen, aspirin, and Excedrin. Prescription opioids and butalbital combinations can also lead to rebound headaches.
Bruxism
Teeth grinding and jaw clenching, also called bruxism, often occurs during sleep. It can put pressure on the muscles and joints of the jaw, face, and neck. This can contribute to pain and headaches at night.
Bruxism may occur along with sleep apnea. Other causes include misaligned bites, anxiety, and certain psychiatric medications. Treatment involves mouthguards, Botox, and correcting causes of anxiety and sleep apnea when present.
Caffeine Withdrawal
Heavy caffeine consumption followed by an abrupt drop in intake can trigger headaches. Caffeine withdrawal headaches may start as early as 12 hours after the last caffeine intake.
Headache symptoms are often worst over the first two days. Withdrawal headaches tend to be throbbing headaches located across both sides of the head.
Gradually tapering caffeine intake over a period of several days can help minimize withdrawal headaches. Being consistent with caffeine intake daily can prevent the spikes and dips that can lead to symptoms.
Brain Tumor
In rare cases, progressively worsening headaches that consistently wake someone from sleep can be a sign of a brain tumor. The headache pain tends to be worse in the early morning hours.
Along with headaches at night, there may be nausea, vomiting, blurred vision, dizziness, weakness, seizures, or personality changes. Though brain tumors are a rare cause, new persistent headaches should always be evaluated by a doctor.
Other Causes
There are a few other causes that can contribute to headaches that intensify during the night:
- Hormone shifts – Headaches related to hormones may flare at night in perimenopausal women or those with menstrual migraines.
- Low blood sugar – Nighttime drops in glucose levels can trigger headaches in diabetics.
- Glaucoma – Increased eye pressure from this condition can cause eye pain at night.
- Trigeminal neuralgia – Nerve pain in the face that tends to be worse in the evening and night.
Diagnosing the Cause of Night Headaches
Identifying the cause of nighttime headaches usually starts with a detailed history, description of symptoms, and physical exam. From there, the doctor may order testing such as:
- Blood tests to check hormone levels, blood counts, and signs of infection.
- Neuroimaging like CT scan or MRI to visualize the brain.
- Sleep study if sleep apnea is suspected.
- Eye exam to look for increased ocular pressure.
- Jaw imaging if jaw alignment issues are suspected.
Keeping a headache diary can help identify patterns related to sleep, diet, and activities. This aids the doctor in making an accurate headache diagnosis.
Treating Headaches that Worsen at Night
Treatment depends on the cause of the nighttime headaches:
- Migraines – Preventive daily medications to reduce frequency, plus abortive medicines for acute attacks.
- Cluster headaches – Abortive therapy to stop acute attacks, preventive verapamil, and sometimes oxygen therapy.
- Hypnic headaches – Daily preventive medicines like lithium, caffeine, or indomethacin.
- Sleep apnea – CPAP, oral devices, surgery, and/or weight loss.
- Medication overuse – Detox and preventive treatment for underlying headaches.
- Bruxism – Dental mouthguards, Botox, and stress reduction.
- Caffeine withdrawal – Gradual tapering of intake before stopping.
- Brain tumor – Surgery, radiation, chemotherapy, or targeted drug therapy.
Adopting good sleep habits can help reduce headaches that disrupt sleep. Going to bed and waking up at consistent times, limiting electronics before bed, and creating a restful sleep environment are some examples.
When to See a Doctor
Consult a doctor promptly if you experience:
- New onset headaches that consistently wake you from sleep
- Headaches that get progressively worse and more frequent
- Headaches along with neurological symptoms like weakness or visual changes
- Headaches following a head injury
- Headaches that interfere with your daily activities
Keeping a diary of symptoms, triggers, and patterns can help the doctor make an accurate diagnosis. Many causes of nighttime headaches are treatable once properly identified.
Conclusion
Headaches that get worse at night can disrupt sleep and impair daily function. Migraines, cluster headaches, medication overuse, sleep apnea, and bruxism are some of the more common causes. It’s important to see a doctor for a full evaluation when new and concerning headache patterns emerge.
Treatment will depend on the cause, but can include both abortive and preventive medications for headaches disorders. Lifestyle adjustments to improve sleep quality and manage underlying medical issues may also be part of the treatment plan. Keeping a symptom journal and being observant of headache patterns can aid in getting the right diagnosis and treatment.
