Headaches are among the most common health issues faced worldwide. According to the World Health Organization (WHO), about 50% to 75% of adults have at least one episode a year. Given how widespread this issue is, it’s little wonder that many complain of headaches at night.

What causes nighttime head pain and other symptoms? Many arise due to primary headache disorders, those that occur independently of other symptoms, including tension headache, migraine, cluster, and hypnic headache. This article covers the basics of nighttime headaches, including their causes and what you can do to treat them.     

Causes of Nighttime Headaches

While mornings are the most common time of day people have headaches, many occur at night. While the exact mechanisms of nighttime headaches aren’t fully understood, they’re likely related to the activity of the hypothalamus, a brain region associated with both pain perception and your natural sleep-wake cycle, known as your circadian rhythm. As this region changes activity throughout the day and night, it can spur both nighttime headaches as well as those when you wake up.  

Tension Headache

By far the most prevalent headache, tension headaches are a common cause of nighttime headache. Lasting anywhere from 30 minutes to a week, they cause:

• Duller pain that is not pulsating
• Headache on both sides of the head
• A feeling of pressure, like a vice grip, on both sides
• Pain may be sharper in the scalp, temples, back of the neck, and sometimes the shoulders  

Tension headaches are caused by the contraction of muscles in the scalp and neck. They can also be set off by a number of triggers, including:

• Physical and emotional stress
• Muscle tension and stiffness in the neck
• Holding your head in an awkward position for a long time
• Sleep interruptions; not getting enough sleep
• Sinus infections, common cold, and flu
• Teeth grinding or tooth misalignment
• Alcohol use, smoking, and/or caffeine (excess or withdrawal)
• Eyestrain
• Physical fatigue; being over-tired

Migraine

Migraine is a recurring type of headache that is moderate to severe in intensity. Migraine is a relatively common headache disorder that represents about 30% of all headache cases. Attacks of this condition go through stages and last anywhere from four to 72 hours. Migraine doesn’t just cause head pain; its typical symptoms can include:

• Throbbing or pulsing head pain, often on just one side of the head
• Nausea and vomiting
• Light or sound sensitivity
• Fatigue
• Restlessness
• Changes in mood
• Visual disturbances (auras), such as seeing angular lines or flashes prior to onset

There are several different kinds of migraine, and specific symptoms can vary from person to person.

In some cases, migraine can set on while you’re asleep and wake you up. They most often arise towards the tail end of your sleep cycle, coming on between 4 and 9 AM. While the exact causes of nighttime migraines are not known, poor sleep and sleep disorders can trigger attacks, and they can also be the result of medications wearing off overnight.  

Hypnic Headache

Hypnic headaches set on exclusively at night, waking people up from sleep. Attacks frequently recur 10 or more times a month and last anywhere from 15 minutes to four hours. It’s sometimes called an “alarm clock headache” because symptoms tend to arise at the same time every night. Though hypnic headaches can be severe, they are generally milder than other kinds.  

Cluster Headache

Considered the most severe and debilitating of the primary headache disorders, cluster headaches can also arise at night. As the name suggests, they arise in “clusters”—periods of time with multiple attacks in a day—that can last for weeks or even months. These are then followed by significant periods of remission.

Cluster headache symptoms include:

• Unilateral (one-sided), very sharp headache
• Pain typically behind one eye, before moving to the forehead and other parts of the head
• Drooping eye
• Facial swelling
• Facial sweating
• Restlessness and jitteriness

Treatment

There’s no singular cure for headaches at night, so treatment may require a combination of approaches. A great deal depends on the underlying headache disorder you’re having, and everything from over-the-counter medications to lifestyle changes and other treatments can help.

Over-the-Counter Pain Medications

Over-the-counter (OTC) analgesics, such as Tylenol (acetaminophen) and non-steroidal anti-inflammatory drugs (NSAIDs) like Aleve (ibuprofen) and Bayer (aspirin) are typically the first line of treatment for headaches. The use of these drugs should be monitored, especially in chronic cases.

Tension Headache Medications

In more difficult or chronic tension headache cases, medications may be prescribed if OTC drugs aren’t yielding results. These include muscle-relaxers, such as Flexeril (cyclobenzaprine), and tricyclic antidepressants like Elavil (amitriptyline) and Palemor (nortriptyline).

Migraine Medications

Migraine treatments focus both on managing symptoms and developing ways of preventing attacks. If OTC medications aren’t yielding results, you may be prescribed triptans, such as Imitrex (sumatriptan) and Zomig (zolmitriptan), among others. In addition, for more difficult cases, several drugs work to prevent attacks. These include:

• Tricyclic antidepressants
• Anticonvulsants, including Neurontin (gabapentin) among others
• Monoclonal antibodies like Aimovig (erunumab) and Vyesti (eptinezumab)
• Beta-blockers, such as Lopresor (metoprolol) and Inderol (propranolol)
• Botox injection (for difficult cases)

Hypnic Headache Medications

A common approach to treating hypnic headache is caffeine, as in a cup of coffee or black tea, before bed. This has been shown not to prevent you from getting good sleep. That said, this condition is notoriously difficult to treat and several other medications and supplements may also help:

Cluster Headache Therapies

Cluster headaches, like other primary headache disorders, can be challenging to treat. Several treatments take on attacks, including:

• Oxygen therapy: Often the first line of cluster headache treatment, inhaling oxygen from a canister using a respirator can effectively take on symptoms. Most cases resolve within 20 minutes of this therapy.
• Triptans: Triptans for cluster headaches typically take the form of nasal sprays or subcutaneous patches rather than tablets. These medications help reduce the duration of attacks. They can also be used for migraines.
• Dihydroergotamine: Injections or nasal sprays of the ergot alkaloid, dihydroergotamine, may also help with cluster headaches.
• Lidocaine: Nasal drops of lidocaine can also help after cluster headaches have come on. A second dose can be taken after 15 minutes, but you shouldn’t take more than that.

As with migraine, some drugs may also help with prevention. Evidence suggests Verelan (verapamil), lithium carbonate, and Topamax may help reduce the frequency of attack.

Relaxation Therapies

Since stress and tension are often at the root of headache problems, working on relaxation strategies is a common means of prevention and minimizing the intensity of attacks. Typically employed strategies include:

• Cognitive behavioral therapy: This is a talk therapy that focuses on developing coping strategies, while working to change your perception of your condition.
• Biofeedback: This therapy involves using wearable devices to detect physiological signs of tension and stress, while learning relaxation strategies to prevent and proactively manage attacks.
• Meditation: Meditation, mindfulness, and other relaxation can help ease stress, a common migraine trigger.

Lifestyle Changes

A big part of headache treatment involves making significant changes in your lifestyle, while being strategic about how to practically manage your condition. This can involve:

• Getting regular and consistent exercise
• Ensuring you are eating healthy meals and aren’t skipping meals
• Getting enough sleep and going to bed, and waking up at consistent times
• Take part in relaxing activities, such as yoga, gardening, or others
• Avoiding dietary and other types of triggers for migraines

Complementary Therapies

Some evidence has shown some complementary therapies that can accompany other treatments to help with headaches. Stretching-oriented activities like yoga, meditation, and acupuncture are all options. Additionally, the supplements riboflavin, magnesium, or co-enzyme Q10.

Medical Devices

In chronic, difficult to manage headache cases, neurostimulation is another option to manage pain. This involves using magnetic fields or mild electrical shocks to stimulate nerves associated with pain perception. Overstimulating these nerve pathways blocks pain perception, and, in some cases, prevents headaches. Among these devices are:

• Trigeminal nerve stimulators, like Cefaly
• Single-pulse transcranial magnetic stimulators, such as eNeura
• Remote electrical neuromodulation device (transcutaneous electrical nerve stimulation, or TENS) , such as Neurivo

When to Seek Medical Attention

While headaches can be very debilitating, not all of them require medical attention. However, especially if you live with a condition like a migraine, cluster, or hypnic headache, it’s important to know the signs that you do need help. Get emergency help if you experience:

• Loss of consciousness following an impact to the head
• Very rapid onset of headache
• Pain that is unusually severe
• Headache getting worse for 14 or more hours

It’s also important to get help if you experience any of the following alongside headaches:

• Vision problems
• Severe pain or redness in one eye
• Problems with limb coordination
• Loss of balance, vertigo
• Fever and neck stiffness
• Trouble chewing and/or swallowing

Summary

Nighttime headaches can arise due to a range of disorders and health issues. In particular, this issue can be a feature of tension, migraine, and cluster headaches and is the primary symptom of hypnic headache. While the exact causes aren’t known, they’re linked to the activity of the hypothalamus.

Nighttime headache symptoms vary depending on the headache type. Tension headaches cause duller pain and pressure on both sides of the head. More severe migraine headaches focus on one side, with attacks also causing symptoms like nausea and vomiting, light and sound sensitivity, and visual disturbances. Cluster headaches arise as groupings of severe headaches within a short period of time (clusters). Lastly, hypnic are headaches that arise exclusively while you’re sleeping.

Treatments for nighttime headaches focus on managing symptoms, preventing attacks, and making positive lifestyle changes. OTC and prescription medications are available to ease pain after onset. Additionally, ensuring proper and healthy sleep, not skipping meals, and managing stress can also help.

A Word From Verywell

There’s no denying that nighttime headaches can be debilitating, causing not only physical pain but also a significant emotional and personal toll. Taking on this burden means being proactive about seeking out care, learning about your condition, and making meaningful lifestyle changes. If you’re struggling, it’s important not to give up hope; today’s treatments can effectively ease this weight, paving the way to better outcomes.