Waking Up with a Migraine

Have you ever had the unpleasant experience of waking in the morning with a migraine already underway? Or perhaps your head pain woke you in the middle of the night, leaving you tossing, turning, and deprived of a good night’s sleep. 

‍Migraine pain is no way to start the day. It typically manifests as an intense throbbing headache that starts on either the left or right side of the head and can spread to both sides, often accompanied by nausea, vomiting, sensitivity to light and/or sound, and fatigue. Migraine symptoms are more acute than those of cluster or tension headaches.

In a study on sleep patterns in people with migraine, 71% of respondents reported waking with migraine attacks. In fact, the American Migraine Foundation estimated that early morning — normally between 4-9 am — is the most common time of the day for migraine to occur. Other types of headaches also seem to worsen at this time of the day.

‍Why Am I Waking with a Migraine? 

Poor sleep quality, physical health factors and medical conditions tend to be prominent causes of migraine attacks during sleep.

‍Sleep Issues

‍Sleep disruption and sleep disorders

If you awaken with a migraine every morning, it may be due to your sleeping pattern or to a potential sleeping disorder, particularly if you’ve previously experienced migraine attacks. A study of migraine patients showed that 50% of migraine episodes that occur during sleep are caused by sleep disturbances. 

Your sleep-wake cycles function best when you achieve 7-8 hours of sleep per night. Lack of sleep can have a generally negative impact on your body, including increased sensitivity to pain. Sleep disorders — insomnia, sleep apnea, or circadian rhythm disorder  — can also result in sleep loss and a wake-up migraine.

‍Other sleep-related problems‍

Other sleep-related causes of migraine are muscle tension, neck stiffness and/or neck pain from poor sleep posture. Bruxism, or teeth grinding, can induce a migraine too, as pressure caused by the friction of teeth at night may result in muscle strain and jaw pain, leading to muscle tension. 

‍Physical Health Issues‍

• Dehydration: Thanks to lack of fluid intake while we sleep, dehydration is the most common culprit behind migraine episodes.
• Medication overuse: Medication overuse may also cause awakening migraines. Medication overuse headache (MOH) is a result of frequent acute medication use, often leading to drug dependency. Since medication levels in the body fall during sleep, as drug doses are not being administered, they can also induce a migraine.
• Diet and alcohol: A person's diet can severely affect their physical health and, consequently, their migraine intensity and frequency. Certain foods can be migraine triggers — they vary from person to person, so it’s important to understand yours. Alcohol consumption can increase the likelihood of migraine attacks in the morning, particularly due to poor quality of sleep and the hangover effect.
• Caffeine withdrawal and low blood sugar: Caffeine causes blood vessels to dilate, including those in the brain, so it can be useful in relieving tension and easing headaches. But lowering levels of caffeine overnight can cause caffeine withdrawal and thus worsen migraine pain in the morning. Blood sugar levels also drop when we sleep; if they go too low, they can spur wake-up migraine and, in extreme cases, hypoglycemia.

‍Medical Causes‍

• Genetics: Research suggests that migraine runs in families, indicating that a genetic factor contributes to migraine onset. Migraine is believed to be a dominant autosomal disorder, so there’s a high likelihood that it is passed down in families. A meta analysis of 375,000 people with migraine showed that 42% had a family member also affected by migraine.
• Mental Health: Mental health conditions like depression and anxiety not only can cause severe sleep disturbances (which, as mentioned above, lead to awakening migraine), but can also contribute to the onset of a migraine disorder itself.
• Hormones: Hormonal changes may also induce, or worsen, headaches. In early morning hours, our bodies produce less endorphins (a pain-reducing pleasure hormone) but more epinephrine (adrenaline), which may be a migraine trigger. Hormones linked to menstruation and/or pregnancy can also provoke a migraine.

‍Other Causes

• Stress: Studies of migraine repeatedly show a relationship between high levels of stress and migraine attacks. Migraine episodes themselves cause stress, creating a vicious cycle that increases attack frequency. Thus, stressing before going to bed can lead to migraine attacks during sleep, causing awakening headaches.
• Painkillers: Pain medications typically wane in approximately 4-8 hours. If you go to bed with a migraine and take painkillers to alleviate it, they may lose their effect by early morning, potentially leading to a morning headache.‍

‍Recognizing the Early Stages of Migraine

Knowing the signs of the early stages of a migraine attack may help you better prepare for it, so you’re less likely to awaken with a migraine the following morning. 

The first phase, prodrome, can manifest days to hours before the actual attack. Its symptoms, often described as "mild" or "unspecific," can include head tightness, neck stiffness and fatigue. For some people, prodrome is followed by an aura stage, when sensory-related symptoms like light and sound sensitivity appear. 

If you feel like you are experiencing prodrome or aura stages before bedtime, you may be likely to wake up with head pain. To minimize impact, get a better night’s sleep, and perhaps avert a migraine episode by avoiding loud noise and bright lights. De-stress before sleep with relaxation techniques, such as meditating or listening to calming music. 

Can Awakening Migraine be Prevented?

If you wake up with migraine daily, try writing down your symptoms and potential triggers in a migraine diary. The best way to prevent a migraine is to find these triggers and avoid them. Develop good sleep habits for better sleep quality. Lead a healthy lifestyle (including a healthy diet), drink plenty of water, and avoid excessive amounts of caffeine or alcohol. These steps may have a positive impact on the severity and frequency of your migraine episodes.

‍A Path Forward

Migraine attacks in the early morning are common, and there are a number of ways to identify, prevent and manage them. If you frequently awaken with migraine headaches and are not sure why, contact a headache specialist to discuss the best prevention and/or treatment for you. 

‍Mable can help you reduce your migraine days by matching you with treatment tailored to your DNA. Take our online quiz to see whether our DNA-based individualized treatment pathway is a good fit for you.

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