Starting your day with pain of any kind is truly miserable. When you have a migraine headache every morning, it can be debilitating, depressing and demoralizing. It’s especially hard to distract yourself from pain when it’s coming from your head.
On the bright side of this bleak condition, waking with a migraine attack each morning often has specific clues to help you and your doctors figure out what is triggering the attacks. Once that is figured out, there are strategies that can help minimize morning migraines.
Let’s take a look at the top reasons why some people are plagued by morning migraine headaches and what can be done for relief.
** While Migraine Strong writes about the latest in migraine treatments, this is not medical advice. We are patient educators and all information you read should be discussed with your doctor.
Why am I waking up with migraine headaches every morning?
Experts believe migraine is due to a combination of hereditary factors. The 7 main reasons for the daily pattern suggest what is triggering the pain and other symptoms.
In general, the migraine brain likes consistency and routine. It’s less tolerant of change and tends to be overly responsive to factors that people who don’t have migraine brain never even notice.
Understanding the main reasons for daily morning migraine headaches starts with knowing what to look for so you can put actions in place to break the cycle and find lasting relief.
1- Medications that may have you waking with headache each day
Prescribed and over-the-counter drugs that we take for headaches and other conditions are a double-edged sword for some people. It may seem hard to believe, but medications for headaches and migraine can actually contribute to morning migraine headaches.
Morning migraine is often rebound
It’s hard a hard pill to swallow. Please pardon the pun. I was adamant with my headache specialist when he was quite blunt with me about my experience with rebound. Fortunately, he was right and I improved with his help.
Many headache specialists working at major headache centers will confirm that one of the biggest problems they see is rebound or medication overuse headache, now called medication-adaption headache. It is common for these doctors to see patients who were treating episodic migraine attacks and headaches with medications that stopped working like they used to.
Over time the need for medication increases and transforms from infrequent attacks to headaches often occurring every morning. Often there is little or no relief.
Sometimes, the medications that we take for headache and migraine actually contribute to worsening condition. This is especially common when someone is not working with a skilled neurologist who knows how to minimize risk for rebound and when to intervene with better acute medications and/or a preventive regimen.
Most neurologists will consider a person at high risk for rebound if the patient is waking up with migraines while frequently taking medications. The doctor will usually try to address the triggers, break the cycle and find a preventive regimen that will reduce the need for acute medications.
The topic of rebound is so important to the community of people with frequent and chronic migraine that we have several articles dedicated to it including frequently asked questions and how to get rid of rebound headaches.
The below graphic summarizes how to reduce your risk for rebound and may provide some clues as to why you have migraine headaches every morning.
Undertreatment of a headache disorder
While overuse or adaptation to medication is a risk factor for rebound and worsening morning migraine, people are taking the medications for relief. They just want to be able to function and live their lives.
Sometimes waking up with a headache every day, or morning migraine attacks, needs stepped-up care from a doctor skilled in diagnosing and treating headache disorders. The American Migraine Foundation has this handy tool to help you find expertise in your area. If you don’t have a certified headache specialist in your area or the wait is too long, this review of Neura Health may help you get the support you need.
2- Sleep disorders, poor sleep and inconsistent sleep times can worsen headaches and migraine
You are probably getting less sleep than you need. According to a National Institute of Health publication regarding insufficient sleep and public health, inadequate sleep has been linked to 7 of the 15 leading causes of death in the U.S., including heart disease, cancer, stroke, car accidents, type 2 diabetes, septicemia, and hypertension.
Migraine isn’t listed there as it isn’t a cause of death but it’s the third most prevalent disease on Earth. Migraine robs us of our vitality. Most people with frequent migraine report poor quality sleep. And, many neurologists put quality sleep at the top of the list for improving other neurological conditions. Sleep is vital to health especially when you are prone to migraine headaches or “just” tension headaches.
Sleep is probably the most overlooked and underrated migraine treatment. That’s right. Sleep should be looked at as an important treatment for migraine. When sleep is compromised, especially chronically, the proverbial wheels fall off. Lousy sleep could be the main reason you have a migraine headache each and every morning.
The glymphatic system- your nightly detox
The glymphatic system was discovered in 2012 so it’s not discussed in many medical text books or on the tips of the tongues of many doctors. Simply put, this is the “waste disposal system” for the brain. It’s responsible for taking out the trash each night.
Why at night? Researchers don’t know exactly, but the glymphatic system is suppressed by 90% during wakeful hours. It’s in full swing when our brains are in sleep mode.
We need sleep as it’s the main time when toxins are cleared from our brain. There are other lifestyle factors that impact the glymphatic system, but sleep is the main factor.
Impaired sleep is associated with neurodegenerative diseases. Migraine is not considered a neurodegenerative disease, but I think we can all agree that it’s important to clear out toxins and have refreshed, balanced fluids in our brain.
For more info, the National Headache Foundation has a wonderful video interview with a neurologist about the glymphatic system and headache disorders.
It may seem obvious to you that something about sleep can explain your morning migraine pain each day. Let’s dive in and look at what it might be.
How sleep works – the sleep regulators
A fantastic book caught my attention a couple of years ago and has changed my understanding and approach to sleep. The book is called Why We Sleep, written by Matthew Walker, professor of neuroscience and psychology at UC Berkeley where he’s the Director of its Sleep and Neuroimaging Lab.
Dr. Walker says the sleep mechanism is controlled by 2 levers, our circadian rhythm regulated by natural production of melatonin and another natural, powerful chemical called adenosine.
The circadian rhythm is our “wake drive.” It’s peak is in the morning.
Rising levels of adenosine happen in the evening and create “sleep pressure” resulting in the feeling of drowsiness. Adenosine levels give you that feeling that it’s time for bed.
When “life is perfect,” and there is no sleep disruption, these 2 regulators work together and the adenosine-circadian rhythm is “normal and healthy.” Our goal is to figure out how to keep these 2 regulators in balance. Easier said than done, right?
Unfortunately there are several factors that disrupt these regulators:
– Sleep disorders
Did you know that “sleep apnea headache” has its own official diagnostic classification? When sleep apnea headaches are properly treated, most people have their symptoms resolve in 72 hours. If you think you have sleep apnea and are avoiding being tested because of the cumbersome contraptions like CPAP machines, check in with your doctors. Each year new devices are making sleep apnea treatment less cumbersome and more acceptable.
Insomnia is another disorder. People with insomnia have trouble falling asleep and/or staying asleep. There are wonderful resources to help improve your slumber that don’t involve more medications. The book mentioned earlier, Why We Sleep, has helpful information for those that struggle at night.
Some people are helped by natural supplements including melatonin. Taking melatonin for migraine has good support among some prominent headache specialists. Studies show that the amount is important.
These helpful tips can support optimizing sleep when you have a sleep disorder.
– Restless Leg Syndrome
Restless leg syndrome (RLS) and migraine are definitely associated. The conclusion of this study of 2385 migraine patients concluded: Restless legs syndrome is not only twice as prevalent but also more severe in migraine patients, and associated with decreased sleep quality.
What can you do about RLS? Make sure your doctor is aware to see if your medications can be tweaked. There are some helpful medications for RLS when it’s very disruptive. Ask your doctor to order a serum ferritin level. Iron deficiency anemia is associated with RLS as well as migraine. Correcting anemia often helps both conditions.
– Pain and discomfort
For many, acute migraine medications can bring on sleep, but this isn’t helpful when you have morning migraine headache. A large percentage of the population regularly loses sleep for a variety of different aches and pains or general discomfort.
As mentioned above, melatonin is sometimes helpful as it supports the ability to fall asleep and stay asleep, but it can also help reduce pain and general inflammation. It’s an antiinflammatory for the central nervous system and the rest of our body.
Discomfort is often what leads to a wrestling match with our pillows. If you are like many with migraine, you have tried a multitude of pillow varieties. Finding the best migraine pillow often takes a lot of trial and error but keep at it until you find the one that works perfectly for you.
– Your sleep routine and environment
Many of us have families and/or commitments that keep us busy in the evenings when we should be winding down. Some of us choose to wind down in ways that work against the natural sleep cycle that the brain needs.
Prioritizing your sleep and having nighttime routine that optimizes your chances of dwelling in dreamland is truly priceless.
There are many things you can do. You won’t be able to do them all as some just won’t fit into your lifestyle and phase of life. This is a wonderful resource with 15 good sleep habits to help you put strategies in place to get the rest you need.
3- Caffeine or lack of caffeine – Is it helping or hurting morning migraine?
You may wake with migraine every morning due to the waning effect of caffeine. Caffeine stays biochemically active in our system for a long time after we consume it.
For some of us with migraine especially morning migraine, caffeine is our good friend. For others it is a foe. It’s helpful to understand the controversial and practical relationship between caffeine and migraine.
How caffeine may effect morning migraine
It’s likely that caffeine works in a few ways to help those who are not triggered by it. First, caffeine may help morning migraine headache through vasoconstriction. Caffeine is like some other potent migraine medications that tighten blood vessels, it just comes in a more delicious and comforting form.
Second, caffeine helps reduce the effect of adenosine. In the above section on sleep regulators, adenosine was briefly mentioned as the natural, potent chemical our body makes to assert “sleep pressure” and drowsiness. For most people, the level climbs until peaceful slumber. So, most people think of adenosine as important and helpful. But, adenosine has a dark side.
It is beyond the scope of this article to explore the relationship between adenosine and headache disorders but there is good research that supports its potentially sinister role in our pain. Specifically, morning migraine headaches may point to an adenosine problem that is partially from a build-up of the chemical in the brain.
Poor sleep may not be allowing it to be cleared from the brain. Further several hours without caffeine to help blunt the negative effect of too much of adenosine may be causing morning migraine headaches.
Morning migraine and the caffeine conundrum
Since there are often many sources of caffeine in our day like coffee (including most decaf), tea, soft drinks, chocolate, etc., it’s important to note how much you are consuming and when.
People develop a tolerance for caffeine over time. Gradually decreasing your caffeine intake may ultimately help your sleep and fix your morning migraine headache. Then, your morning java (or other caffeine source) will be that much more enjoyable and perhaps banish any remaining traces of pain and fuzziness.
Personally, I live with the caffeine conundrum and go through spells of waking with the start of a migraine every morning. You’d think I’d know better, but my love of caffeinated beverages is unmatched! So, every few months I have to gradually taper my caffeinated coffee back to one, ~8 ounce cup in the morning and just a bite or 2 of chocolate in the evening.
Shortly after the coffee my head feels so much better. I won’t lie. Waking with the migraine headache takes a while to fade, but it happens. Some find that they do better eliminating caffeine completely.
4- The role of food and alcohol in morning migraine
Food can play a significant role in headaches and migraine. If you have frequent episodes, there is a good chance you have a small handful of food triggers. A tried and true migraine-oriented elimination diet may be helpful in identifying specific food triggers. It is best to attempt this only with the help of a dietitian or to avoid it entirely if you have a history of an eating disorder.
However, there are other ways food can contribute to waking with a migraine or headache every morning. During the early hours of the morning, some people have significant fluctuations in blood sugar. This could be normal, typically harmless fluctuation that is unacceptable to your migraine brain. The result may be waking with a headache or worse every morning.
There are two possible solutions that may help. First, see if there is improvement by having a snack that includes a little carbohydrate, protein and fat in the late evening. Peanut butter on celery is a favorite snack of mine. This may help prevent highs and lows in blood sugar.
The second possible solution is to limit sugar and simple carbohydrates in your overall diet to see if that is helpful. This often minimizes the ups and downs of blood sugar especially for those prone to diabetes or hypoglycemia. There is certainly a relationship between sugar and migraine. Limiting sugars and carbohydrates is often helpful for other medical conditions, too.
Alcohol and waking with migraine headache
Many of us learned the hard way about overindulging on alcohol-containing drinks leading to a terrible hangover and days-long migraine attack. If you have a headache every morning, it’s doubtful you are drinking a lot of alcohol, but it’s certainly possible that even one glass of wine or a single alcoholic beverage could be a problem. This guide to the best alcohols for migraine may be helpful for special occasions.
5- Your jaw – TMD, teeth grinding and clenching and how is can cause pain
Temporomandibular disorders (TMD) can be a source of headache, but there does not seem to be a connection between TMD and waking with a headache in the morning. In this video, Dr. Paul Matthew, a headache specialist at Harvard Medical School gives a brief overview of TMD as it relates to headache and migraine.
While it doesn’t seem common for TMD to explain why some have headaches each morning, teeth grinding (bruxism) and jaw clenching seem to be a factor for some people experiencing facial pain and tenderness. For those who tend to be prone to headaches and migraine episodes, this could be a factor. Anecdotally, in social media, we see many people who have been helped by mouth guards made by a skilled dentist.
Did you know that people who live with migraine may be more prone to dehydration than others? That’s right, we may need a glass or 2 more than the typical person.
Of course, you will need to find the balance between staying hydrated at night and not drinking so much that your sleep is very disrupted by needing to run to the bathroom during the night.
I would be remiss if I didn’t mention the possibility of a tumor causing migraine headaches every morning. Most often the reason is one of the other 6 categories discussed above. Tumors are NOT a main reason for morning migraine headaches. Since doing internet searches can be anxiety-provoking, do yourself a favor and make an appointment with your doctor.
Persistent headaches and migraine episodes should always be discussed with your doctor. Whether you wake with migraine headaches due to too much medicine, too little medicine, sleep issues or lifestyle, having a a good, helpful doctor on your team can make all the difference.