What to know about waking up with a migraine

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Migraine is a neurological disorder that people usually inherit. Migraine episodes can have numerous causes, including slight blood vessel narrowing in the brain, mild inflammation, or both.

Migraines cause severe throbbing or pulsing pain in the head. People with migraine headaches often experience other symptoms, such as nausea, vomiting, and sensitivity to stimuli such as light, sound, and smells.

Migraines are more than just headaches, although headaches usually occur as part of a migraine. They involve four distinct phases, each with its own set of symptoms.

Below are the phases of a migraine headache.

Prodrome

This stage occurs before the onset of a migraine headache and usually lasts for about 24 hours, but it can also last for a few days. Symptoms are subtle and may include:

• a stiff neck
• mood changes
• craving sweet foods
• excessive thirst
• tiredness

Aura

Not everyone experiences aura, which refers to sensory sensations that occur during migraine headaches. Auras typically cause visual disturbances, although they may also affect other senses.

Examples of aura symptoms, which do not usually last more than 60 minutes, include:

• difficulty speaking
• hearing sounds
• tingling, or pins and needles, sensations
• seeing shapes or lights
• temporary partial loss of vision
• weakness or numbness of the face or body

Attack

This stage involves severe, debilitating pain that can last for several hours or days. Symptoms include:

• throbbing or pulsing pain on one or both sides of the head
• nausea
• vomiting
• sensitivity to light, sounds, smells, or motion

Postdrome

This is the recovery stage, where people may feel:

• confused
• drained
• exhausted

Symptoms of migraines can be severe and impact a person’s quality of life. Not everyone will experience all stages of a migraine.

According to the American Migraine Foundation (AMF), early morning is the most common time for migraine headaches to occur. Non-migraine headaches also tend to be most severe at this time of day.

Migraines most commonly appear around 4–9 a.m., which may indicate a relationship to sleep and circadian rhythm.

Many factors can contribute to the onset of a migraine headache in the early morning.

Factors may include:

Sleep problems

There is a well-known relationship between migraines and sleep disorders. Research indicates that people with insomnia have an increased risk of migraine headaches and other types of headaches compared with people without insomnia.

Other sleep-related factors that may trigger migraines include:

• lack of sleep
• too much sleep
• poor quality sleep, which may be due to sleep apnea, teeth grinding, or snoring
• irregular sleep patterns, which may be a result of shift work
• jet lag

Dehydration

Waking up dehydrated may trigger migraines in some people. According to the AMF, up to one-third of people claim that dehydration is a trigger, even if it is mild.

Other signs of dehydration upon waking include dry mouth, dizziness, and confusion.

Medication, alcohol, and caffeine use

Migraines may commonly occur in the early morning in people who are using over-the-counter (OTC) or prescription pain medications. These medicines typically wear off within 4–8 hours, which can trigger a medication withdrawal migraine.

Caffeine withdrawal can also occur after several hours without caffeine, which may trigger a migraine.

Finally, alcohol is a common cause of migraine. Drinking alcohol, especially wine, before bed may result in a morning migraine.

Depression and anxiety

Depression and anxiety can contribute to migraine onset, as these mental health issues affect sleep and increase stress, which is another migraine trigger.

Some research links chronic morning headaches to depression and anxiety.

Hormonal changes

Hormonal changes in the early hours may cause migraines and other headaches. At around 4–8 a.m., the body produces fewer endorphins, which are natural pain-reducing compounds. Therefore, migraines may feel more severe upon waking.

Additionally, the body produces more of the hormone epinephrine at this time of day. Epinephrine may contribute to migraine attacks.

Other hormonal changes also cause migraines, including the estrogen changes that take place before or during menstruation, pregnancy, and menopause.

Other migraine triggers

Many other triggers can cause migraines at any time of day, including:

• certain foods, such as aged cheeses and foods containing monosodium glutamate, which is a food additive
• changes in weather or barometric pressure
• bright lights
• strong smells
• loud noises
• stress
• intense physical activity
• some medications, such as hormonal birth control

A person with migraines may want to consider the following treatments:

OTC medication

These include pain relievers, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin IB), and aspirin.

Migraine relief medications are also available for the treatment of mild migraines. Excedrin Migraine is one example. These contain caffeine, aspirin, and acetaminophen.

Prescription medication

Prescription drugs for migraines include:

• triptans, such as sumatriptan (Imitrex, Tosymra) and rizatriptan (Maxalt), which block pain signals
• dihydroergotamines, which are nasal sprays or injections that alter blood vessel constriction in the brain
• opioids, which are very strong pain relief medications that rarely benefit people with severe and chronic migraine attacks
• antinausea drugs, which doctors prescribe to address the symptoms of nausea and vomiting

Home remedies

People who are experiencing a migraine can try the following home remedies alone or in combination with drug treatments:

• lying down in a dark, quiet room
• sleeping or resting
• applying warm or cold compresses to the head and neck
• taking a bath or shower
• drinking caffeine
• practicing yoga or meditation to reduce pain levels

Medications and behavioral changes can help prevent migraines.

Medications

People with migraines can take preventive medications regularly, such as:

• certain blood pressure medications
• some types of anti-seizure medications
• tricyclic antidepressants, such as amitriptyline
• Botox injections

Self-care tips

Self-care habits can go a long way toward reducing the frequency and severity of migraines. Here are a few things a person can do:

• Identify and avoid triggers: Keep a journal to determine migraine triggers and avoid or limit these where possible.
• Practice sleep hygiene: Go to bed and get up at the same time each day, if possible. Avoid caffeine, nicotine, and alcohol before bed, as these can negatively affect sleep quality.
• Stay hydrated: Drink plenty of water and other fluids throughout the day to prevent dehydration upon waking.
• Exercise regularly: Moderate exercise may reduce migraine frequency and severity in some people.

A person should seek guidance from a doctor if they regularly wake up with migraines or other headaches, especially if their headache patterns or symptoms change suddenly.

It is important to seek immediate medical attention if any of the following signs and symptoms occur:

• headache after a head injury
• an abrupt, severe headache
• neurological symptoms of weakness, vision changes, or sensory changes
• a headache accompanied by a fever, confusion, seizures, or difficulty speaking
• chronic headaches that get worse during exertion, straining, or sudden movement
• new headache pain in those aged over 50

Waking up with a migraine is a common occurrence. It may result from medication or caffeine withdrawal, poor sleep, or natural hormonal changes, among other triggers. If a person has morning migraines, they can have migraines at other times of day too.

People who experience regular or severe migraines should consult a doctor. Treatments include medications and home remedies. Preventive strategies include self-care habits and medications.

Read this article in Spanish.