Why do I wake up with a headache?

An occasional morning headache usually has a simple explanation, like a drink the night before or a bad night's sleep. If you wake up with a headache most days, it's worth looking for a cause. Research links frequent morning headaches to insomnia, anxiety and depression, and sleep-related breathing problems, including sleep apnea.

How common are morning headaches?

The best estimate comes from a 2004 telephone survey of 18,980 people aged 15 and over in the United Kingdom, Germany, Italy, Portugal and Spain. Chronic morning headaches affected 7.6% of them, about 1 in 13. They were more common in women than men (8.4% vs 6.7%) and in people aged 45 to 64, at about 9%.

For many people they weren't a passing problem. The median duration was 42 months, and 1.3% of everyone surveyed said they had morning headaches daily.

The survey also looked at what morning headaches went along with. The strongest links were with anxiety and depression together, major depression, insomnia and circadian rhythm disorders. Sleep-related breathing disorders and high blood pressure were also linked. The author concluded that morning headaches are a good indicator of depression and insomnia, but are not specific to sleep-related breathing disorders. In other words, a morning headache can point to several different problems, and sleep apnea is only one of them. Heavy drinking and the use of anti-anxiety medication were also linked to morning headaches.

What kind of morning headache is it?

Cleveland Clinic suggests the type of pain is a useful first clue. It describes four kinds that often show up in the morning:

• Migraines usually feel like intense throbbing in one spot, often with nausea and dizziness.
• Tension-type headaches feel like a tight band squeezing the head, a steady pressure across the whole head.
• Cluster headaches cause severe pain on one side that goes away and comes back, and can last from 15 minutes to four hours.
• Hypnic headaches, sometimes called alarm clock headaches, are rare. They wake you from sleep, sometimes more than once a night.

Note which one sounds closest. It helps a doctor narrow things down, and it's one of the details worth keeping in the log described below.

Can sleep apnea cause a morning headache?

Sleep apnea can cause a morning headache. Mayo Clinic lists morning headaches among the daytime symptoms of obstructive sleep apnea, along with waking with a dry mouth or sore throat, excessive daytime sleepiness and trouble focusing.

The American Academy of Sleep Medicine also lists morning headaches among the common symptoms of obstructive sleep apnea, along with unrefreshing sleep, waking at night to urinate and difficulty concentrating.

Nancy Foldvary-Schaefer, a sleep medicine physician at Cleveland Clinic, says she thinks more than half of people with sleep apnea have headaches. She describes the typical pattern as waking up with a headache each day that goes away within four hours. People tend to describe it as a pressing pain on both sides of the head, which is different from the one-sided, pulsing pain of a migraine. According to her, the headaches typically go away once the apnea is treated.

The headache on its own isn't enough to tell. Look at what else is going on at night. Mayo Clinic lists these night-time signs of sleep apnea:

• Loud snoring.
• Pauses in breathing during sleep, often noticed by a partner.
• Waking during the night gasping or choking.
• Needing to urinate often.

If your morning headaches come with any of these, or with heavy daytime sleepiness, talk to a doctor. Our guide to snoring vs. sleep apnea explains the difference, and home sleep apnea tests covers one way doctors check for it.

What else causes headaches on waking?

Cleveland Clinic lists several other causes:

• Insomnia and poor sleep. Dr. Foldvary-Schaefer notes that insomnia can cause tension headaches, which in turn make sleep harder.
• Teeth grinding (sleep bruxism), which strains the muscles of the face and head.
• Alcohol. She says even one cocktail the night before can lead to a pounding headache the next day, partly because alcohol dehydrates you.
• Oversleeping, which can upset your body clock, especially when sleep quality is poor.

Cleveland Clinic's bruxism page lists headaches or facial pain, especially in the morning, as a symptom of grinding. It also notes that many people have both bruxism and sleep apnea, though it's unclear which causes which. If you wake with a sore jaw as well as a headache, mention it to your dentist. Cleveland Clinic says bruxism is usually diagnosed by a healthcare provider, often a dentist, from an exam and your symptoms, and that in more severe cases a dentist can make a custom mouth guard to protect your teeth.

Could caffeine or painkillers be involved?

Caffeine and painkillers are both worth ruling out as causes of morning headaches. If you drink caffeine every day, Sleep Foundation lists headache among the withdrawal effects you can get when you cut back, and suggests tapering down gradually rather than stopping suddenly. It also notes that regular users can feel sleepy in the morning until they've had their first dose.

The NHS lists taking too many painkillers among the common causes of headaches, along with drinking too much alcohol, not eating regular meals and not drinking enough fluids. If you reach for painkillers most mornings, tell your doctor or pharmacist, because the treatment may be feeding the problem.

What is exploding head syndrome?

Exploding head syndrome sounds alarming, but Cleveland Clinic describes it as a sleep disorder where you hear an imaginary crash or bang in the drowsy moments between waking and sleep. It's often painless, though some people feel a stab of pain in the head. Dr. Foldvary-Schaefer says it isn't well understood and may happen as the brain's wake systems shut down and sleep systems take over. If it's happening to you, mention it to your doctor.

What can you do about it?

To work out what's behind morning headaches, start by keeping a simple log for two weeks. Note when the headaches happen, how long they last, what you drank the night before and how you slept. If you share a bed, ask your partner whether you snore, gasp or grind your teeth.

Cleveland Clinic suggests a few habits that may help while you work out the cause:

• Go to bed and get up at similar times each day.
• Keep a headache journal by the bed or in your phone to spot patterns.
• Be mindful of evening alcohol, especially if your journal points to it as a trigger.
• Drink enough water through the day, including a glass first thing in the morning, and eat a balanced diet.

That record makes a doctor's appointment far more useful. Cleveland Clinic recommends seeing a doctor if you get morning headaches three or more times a week, and says a provider can also rule out other triggers like medication, diet or strained muscles. The NHS also advises seeing a GP if you regularly get headaches, or if you've tried treating a headache yourself and it isn't getting better.

When is a headache an emergency?

The NHS says to call 999 or go to A&E (911 or the emergency room in the US) if you have a headache and any of these:

• It started suddenly and is extremely painful.
• You've had a seizure.
• You have numbness or weakness in your body or face.
• You've had a head injury in the last 3 months.

It also lists difficulty speaking, balancing, walking or remembering things, drowsiness or confusion, loss of vision, a very high temperature, a stiff neck, or bright lights bothering you alongside a headache as reasons for emergency care.

The NHS says to ask for an urgent GP appointment, or call NHS 111, if a headache comes with vision or eye problems, is triggered or made worse by coughing, sneezing, bending down or exercise, comes with being sick, or comes with jaw pain when eating or a sore, tender scalp. A child with a headache that's getting worse or wakes them at night also needs to be seen urgently.

This article is general information, not medical advice. If you're worried about your headaches, see a doctor.

Read next

• Snoring vs. sleep apnea: how to tell the difference
• What is a home sleep apnea test?

* This content is for informational and educational purposes only and is not medical advice. It is not intended to diagnose, treat, cure or prevent any disease or health condition. Talk to a qualified healthcare provider about your health.