- Causes
- Diagnosis
- Treatment
- Warning signs
If you’re experiencing migraine every night, it could also be a tension, cluster, or hypnic headache. See your doctor to determine the headache type and get the right treatment.
Maybe they start after dinner, just as you’re winding down for the night. Maybe they happen just before your head hits the pillow. Maybe they even wake you up in the middle of the night. Regardless of their timing, headaches at night are frustrating.
When they interfere with sleep, nighttime headaches can lead to additional problems the next day, such as grogginess and irritability.
Read on to learn about the potential causes of a headache at night and what you can do about them.
What causes a headache at night?
Tension headaches
Almost everyone experiences a tension headache at some point. The pain associated with them ranges from mild to severe.
Experts aren’t sure about the exact cause of tension headaches, but they’re often triggered by stress, exhaustion, and muscle tension. These can all pop up at the end of a long day.
For some, teeth grinding also triggers a tension headache. If the headache is severe enough, it could wake you up.
Additional signs of a tension headache include:
- dull, aching, or squeezing head pain
- pain on both sides of the head or forehead
- tenderness in your neck, shoulders, and scalp
- a sense of tightness or pressure around your head
Cluster headaches
Cluster headaches are an extremely painful type of headache that occurs in clusters.
People who get them report feeling like they have an ice pick jammed in their eye. They’re called cluster headaches because they tend to occur several times within the span of several weeks or months before disappearing for a while.
For many, cluster headaches often start at night, usually a few hours before going to bed. Other symptoms include:
- excruciating head pain, usually around one eye
- headaches that happen repeatedly at the same time of day
- pain that begins on one side of the head but radiates outward
- redness, swelling, drooping, or tearing in the affected eye
- a stuffy or runny nose on one side
- pale skin or flushing
- trouble sitting still during the attack
No one’s sure what causes cluster headaches, and they don’t appear to have any triggers. Read more about cluster headaches.
Migraines
Migraines cause severe attacks of head pain accompanied by other symptoms.
Other symptoms of a migraine include:
- nausea or vomiting
- seeing flashes of light
- extreme sensitivity to noise and light
- blurred vision
Not sure if your symptoms point to a migraine or a headache? Learn more about the differences between the two.
Migraines are often triggered by certain things, including:
- hormonal changes around your period, pregnancy, or menopause
- changes in the weather and barometric pressure
- certain foods and food additives
- changes in sleep patterns
- stress
- sensory stimuli, like smells, sounds, or lights
If you’re not sure what’s triggering your migraine, try keeping a log of every time you experience one. Note the time of day, what you were doing, the weather, and any other information that might help you narrow down your triggers. Try to keep an eye out for these triggers.
Hypnic headache
A hypnic headache is the only type of headache that occurs exclusively at night. It’s often called an alarm clock headache because it only happens when someone is sleeping. They also tend to happen at the same time every night.
Hypnic headaches are rare and typically begin after age 50.
Pain can range from mild to severe and usually occurs on both sides of the head. Other symptoms include:
- waking up with a headache more than 10 nights per month
- a headache that lasts for 15 minutes to 4 hours after waking up
- nausea and vomiting, in some cases
Like cluster headaches, experts aren’t sure what causes hypnic headaches, and they don’t have any known triggers.
How do I know which type of headache I have?
While some headaches have unique features that make them easy to diagnose, most headaches aren’t that straightforward.
If you regularly get headaches at night and you’re not sure why, it may be worth making an appointment with your doctor. They can help you narrow down the type of headache you have or rule out any underlying conditions that might be causing them.
To do this, they’ll likely ask you a series of questions. These might be about:
- The severity of your pain: Do your headaches wake you up at night? Do they keep you awake? How much sleep are you losing due to headaches? Is it the worst pain you’ve ever experienced?
- The type of pain you experience: Is the pain dull and aching? Sharp and stabbing? Does it feel like your eye is burning? Is it throbbing, pulsating, or steady?
- The location of your pain: Does it affect one side of your head or both? Does it affect the forehead only, or the back and sides of your head too? Does the pain radiate to your neck or shoulders? Is the pain focused around one eye?
- Any accompanying symptoms: Do you experience nausea or vomiting? Do you feel dizzy or extra sensitive to light and sound?
- Any warning signs: Do you have symptoms — such as visual disturbances or mood changes — prior to your headaches?
- Possible triggers: Have you noticed that your headaches happen on nights that you eat certain foods? Do they happen during unusual weather? Do your symptoms coincide with any patterns in your menstrual cycle?
- The timing of your headaches: Do they happen only when you’re asleep? Do they happen at the same time every night?
- The duration of your symptoms: How long have these headaches been happening? When was the first one? Have you had headaches at any other point in your life?
- What helps and doesn’t help: Does anything make your headache feel better or worse?
Keeping these questions in mind, prepare a headache diary for your doctor. For about two weeks prior to your appointment, document every headache you have. Make sure to include all the details about pain characteristics, timing, triggers, and so on.
How are headaches at night treated?
Over-the-counter treatment
Treating headaches at night usually depends on the type of headache you have. If you’re not sure about the type of headache you have, start with an over-the-counter (OTC) pain reliever, such as ibuprofen (Advil) or acetaminophen (Tylenol).
If these don’t provide any relief, you can try a pain reliever that contains aspirin and caffeine. You can often find this combination in OTC migraine medications, such as Excedrin Migraine.
Caffeine is also one of the more common treatments for hypnic headaches. If you have symptoms of a hypnic headache, try taking a caffeine supplement or drinking a cup of coffee before bed. For people with true hypnic headaches, this usually doesn’t cause any sleep problems.
Taking a melatonin supplement at night might also help with hypnic and cluster headaches. Shop for melatonin online.
If you think you might be getting tension headaches, you can also try to add some stress-reduction techniques to your daily schedule. Try to set aside at least 5 to 10 minutes when you get home from work to do some controlled breathing or yoga.
Even a quick walk around the block can help to relieve stress and muscle tension.
Prescription treatment
If OTC pain relievers and relaxation don’t provide any relief, your doctor might prescribe additional treatment.
There are several oral medications you can take, which include:
- Triptans. These are medications that constrict blood vessels and block pain pathways to treat migraines. They can also help with chronic tension headaches and cluster headaches.
- Prescription pain-relievers. If you have intense pain, your doctor might suggest taking a stronger opioid-containing pain reliever.
- Ergots. These belong to an older class of medications that can help with chronic migraines.
- Beta-blockers and calcium channel blockers. These medications are commonly used to treat high blood pressure, but they can also help to prevent migraines and cluster headaches.
- Antidepressants. Although generally used for mental health conditions, antidepressants can also be effective for preventing migraines.
- Anti-seizure drugs. Some doctors recommend anti-seizure drugs to prevent chronic migraines, but they can cause many side effects.
- Lithium. This is another medication traditionally used for mental health conditions. It can also help treat or prevent hypnic and cluster headaches.
- Corticosteroids. These can provide short-term treatment during an intense period of cluster headaches.
- Indomethacin. This medication is a nonsteroidal anti-inflammatory that can help to prevent hypnic headaches.
There are also several injections that may help:
- Botox. Most often used to treat facial lines and wrinkles, Botox is also approved for the treatment of migraines. Learn more about how it works.
- Nerve blocks. These are injections of anesthetics and corticosteroids that can help to prevent migraines and cluster headaches.
- Octreotide. This is an injectable form of a synthetic brain hormone that helps to prevent cluster headaches in some people.
- Erenumab-aooe (Aimovig). The newest class of migraine medication, this medicine works to inhibit the role of molecules associated with migraines.
- Triptans. While there are oral triptans, an injectable form called Imitrex may help to treat migraines and cluster headaches.
For cluster headaches, your doctor may also recommend:
- Lidocaine. This is a local numbing agent that comes in the form of a nasal spray.
- Oxygen. Inhaling pure oxygen may help reduce the pain of a cluster headache.
Is it ever an emergency?
Headaches at night usually aren’t a sign of anything serious. However, it’s best to seek immediate treatment if your headache doesn’t feel like any other you’ve had before. You should also get immediate help if your headache is accompanied by:
- trouble speaking
- trouble seeing
- loss of balance
- confusion
- fainting
- high fever
- an unusually stiff neck
- numbness or weakness on one side of the body
