Everything You Need to Know About Waking Up With a Migraine

Dehydration, poor sleep, and stress are some of the many reasons why you could be waking up in the morning with a migraine. Read about the causes and symptoms of migraines, and, importantly, how to prevent and treat them.

Causes of Migraines

The exact causes of migraines are still being researched, though it’s thought attacks are caused by waves of hyperactivity in certain brain cells. This overstimulation releases serotonin and estrogen, two important hormones, causing blood vessels to constrict and leading to headache.

Migraine attacks are often associated with triggers, such as certain stimuli, foods, or other factors that bring on an attack. While triggers vary from person to person, the most common are:

• Emotional stress: People who experience anxiety and emotional stress are more likely to have migraine attacks. These conditions cause the release of hormones that dilate blood vessels and increase muscle tension, triggering a migraine.
• Certain foods: Substances in certain foods can also be triggers, such as preservatives (especially nitrates in bacon or cured meat), wine, aged cheeses, as well as pickled and fermented foods.
• Sleeping patterns: Irregular sleeping schedules, insomnia, sleep apnea, snoring, and other sleep disorders can bring on attacks. This is the reason that you may wake up with a migraine.
• Certain stimuli: Light is a common trigger. This includes sunlight, fluorescent lights, lights that are flashing or bright, as well as the glow of a monitor, TV, or other electronic screen. Smoke and certain odors are also commonly reported to bring on migraines.
• Caffeine: As found in coffee, certain teas, and some sodas, caffeine can bring on attacks in some people, while serving as a treatment for others. In those that regularly use it and suddenly stop, withdrawal leads to headaches.
• Hormonal changes: Menstrual periods and menopause are common causes of changes in estrogen levels, though hormone replacement therapy and certain forms of birth control can also affect them. Fluctuations in hormones are a common trigger.  

Additional triggers may include:

• The overuse of pain-relieving medications
• Changes in weather patterns
• Dehydration
• Physical overexertion

Headache vs. Migraine Symptoms

Headaches occur for a variety of reasons and range in location, severity, and duration. Aside from migraine, there are several other headache types, including:

• Sinus headache: This type arises from pressure in your sinuses, often due to congestion or illnesses like influenza or the common cold. It usually affects the face, nose, and cheeks.
• Tension headache: The most common kind of headache, tension headaches usually affect the forehead or back of the head. Stress, eye strain, and hunger are all causes of this type.
• Cluster headaches: These are very painful and occur daily—or even multiple times a day—for prolonged periods of time. These often arise when blood vessels serving the brain dilate. Common triggers include physical exertion, bright lights, and altitude.

Though headaches are the principal sign of migraines, they cause a range of other symptoms. There’s a good deal of variation between cases as well. Migraine attacks progress in stages, each with distinct characteristics:

• Prodrome: The initial phase, which lasts anywhere from three hours to several days, causes concentration problems, confusion, speech difficulties, nausea, sensitivity to light and smell, muscle stiffness, and sleep problems, among other symptoms.
• Aura: In some cases, prior to the onset of headache, migraines can cause visual disturbances, such as seeing flashing dots, sparks, or lines; temporary blindness; dizziness; changes in smell and taste; and numbness and tingling. The aura stage lasts anywhere from five minutes to an hour.  
• Headache: Lasting anywhere from four to 72 hours, full-blown migraine headaches cause throbbing, moderate-to-severe pain. Often affecting only one side of the head, the headache can affect the jaw, temples, or behind the eyes. This phase also causes severe nausea and vomiting, sweating and/or chills, severe sensitivity to light, sounds, or odors, loss of appetite, dizziness, and pale skin.
• Postdrome: A feeling of a hangover after a migraine, the postdrome phase can cause depression, inability to concentrate or comprehend things, fatigue, and euphoria. This stage can last for up to 24 hours.

Why Am I Waking Up with a Migraine?

There’s a close relationship between sleep and migraines. Disruptions in your natural sleep-wake cycle, or circadian rhythm, can trigger attacks, and, in turn, migraines can interrupt your sleep patterns. It’s little wonder that those with sleep disorders are more likely to experience this condition.

Disruptions in sleep due to several disorders can be at the root of your morning migraine, including:

• Insomnia: This disorder is characterized by an inability to fall asleep or stay asleep. This is because both insomnia and migraine may be due to the activity of some of the same brain regions and neurotransmitters.  
• Obstructive sleep apnea: Interrupted breathing while you’re asleep characterizes this condition. It can cause snoring, cold sweats, sudden waking, and excessive nighttime urination.
• Teeth grinding: If you grind your teeth at night, a condition called bruxism, muscular pain around the temporomandibular joint—the hinge that connects your jaw to the skull—can cause headaches to flare up.    

Though they can happen at any time of day, migraines most commonly arise in the morning hours, between 4 a.m. and 8 a.m. What’s behind your morning migraine attack? Several factors may be at play.

Interrupted Patterns

If you haven’t had a good night’s sleep or there’s been a disruption to your usual pattern of rest, migraine can set in. Not getting enough sleep causes problems, as does not going to bed and waking up at consistent times. Too much sleep can also bring on headaches.

Drug Efficacy

Some morning migraines occur because many over-the-counter (OTC) or prescribed migraine medications wear off within four to eight hours. Those that are using too much of a painkiller are prone to this kind of attack, also known as medical overuse headache (MOH).

A major key to migraine management is knowing your symptoms and being proactive about treating them. Since morning migraines can come on while you're still asleep, you may not be able to take medications in time.

Other Factors

Several other factors are known to play a role in morning attacks, including:

• Dehydration
• Caffeine withdrawal
• Stress and anxiety

Migraine Management and Prevention

Since there’s no cure for migraine, managing this condition usually requires multiple prevention and treatment methods. It may require pharmaceuticals, lifestyle changes, managing other health conditions, and therapy. Since individual cases vary, you’ll need to figure out what methods work for you.

Taking on Attacks

If you’re waking up to an attack, there are several ways of managing the pain and discomfort, such as:

• OTC medications: Over-the-counter painkillers like widely available pain-relieving and anti-inflammatory drugs, such as Tylenol (acetaminophen), Advil Migraine (ibuprofen), and aspirin all may ease the symptoms.
• Triptans: The most commonly prescribed class of drugs for migraine attack, triptans includeZembrace Symtouch (sumatripan), Zomig (zomitriptan), and others. Unlike some other drugs for migraine, these medications help with headache pain as well as other symptoms.
• Dopamine antagonist antiemetics: These are medications for nausea and vomiting, with some types helping manage this with migraine. Compazine (prochlorperazine), Thorazine (chlorpromazine), and Reglan (metoclopramide) are common types.  
• Opioids: Though they cause many side effects and can be addictive, stronger painkillers, such as butorphanol or codeine tramadol, can help with the pain. This treatment is only recommended as a short-term solution.
• Other means: Resting quietly in a dark, calm space can help, as can icing, placing a cool cloth over your head, or even heating the affected areas. Further, drinking water or having a caffeinated beverage (if you’re a coffee drinker) can help. 

Preventive Medications and Treatments

Especially for tough-to-manage, chronic migraine cases (characterized by 15 or more attacks a month), doctors may prescribe medications to prevent the onset of attacks. These abortive drugs include:

• Beta-blockers: Drugs of this class, like Tenormin (atenolol) and Inderal LA (propranolol), lower blood pressure and have been shown to help with migraines.
• Tricyclic antidepressants: Elavil (amitriptyline) and Pamelor (nortriptyline), among others, are a type of antidepressant that can also help with pain.   
• Antiepileptic drugs: Medications to prevent seizures, antiepileptic drugs, like Depakote (valproic acid) and Topamax (topiramate), are also prescribed for migraine.
• Calcium channel-blockers: Verapamil (sold as a generic or as Calan or Veralan) may be prescribed. This class of drugs is typically used for high blood pressure and other cardiac issues.
• Calcitonin gene-related peptides (CGRP): A newer class for migraine prevention, drugs of this type include Vyepti (eptinezumab) and Ajovy (fremanezumab).

Another option for difficult, chronic migraines are Botox injections. Using a toxin made by the botulinum bacteria to essentially numb pain messaging, shots are delivered to specific areas on your forehead, sides, back of the head, and/or neck. The effects, however, only last about three months, so multiple appointments are necessary.      

When migraines are known to be associated with the menstrual cycle, hormone therapy may be attempted.

Alternative Treatments

There’s evidence that the traditional Chinese medical approach of acupuncture—the use of needles to stimulate nerves—can reduce the frequency and severity of migraines. Furthermore, acupressure, which involves putting pressure on specific areas of the body, may also help.

On top of that, some doctors or practitioners may recommend some herbs and supplements, including:

• Riboflavin (vitamin B2)
• Magnesium
• Feverfew
• Butterbur
• Co-enzyme Q10 (CoQ10)

 Sleep Hygiene

Since sleep disruptions and disorders can have such a big impact on migraines, a key aspect of preventing attacks is to ensure good sleep hygiene. According to the National Institutes of Health (NIH), this means:

• Getting enough sleep (seven to eight hours a night for adults)
• Going to bed and waking at consistent times every day
• Making sure your bedroom is a quiet, restful place
• Avoiding working, using a screen, or watching TV in bed
• Avoiding alcohol or caffeine shortly before bed
• Getting regular exercise

 Other Lifestyle Changes

Along with ensuring good sleep, other lifestyle changes and management methods involve:

• Relaxation: Since stress and anxiety are associated with attacks, relaxation methods, such as yoga, meditation, or even taking a hot bath or short hike, help head off headache and other symptoms.
• Keeping a headache journal: Note how long your attacks are, as well as how common and intense they are. Keep a list of stimuli or foods that serve as triggers. The more you know about your own condition, the better you’ll be able to prevent migraines.
• Regular exercise: Regular exercise has many health benefits, including reducing stress and improving sleep quality. Since obesity can predispose you to migraine, exercising, changing diet, and other measures to lose weight can reduce the frequency of attacks.
• Biofeedback: A helpful means of learning about factors that lead to attacks, biofeedback is the use of devices to detect signs of stress and tension. This allows users to sense internal triggers for migraine.

When to Seek Professional Treatment

It’s important to be vigilant if you have migraines or other headache disorders. Keep track of how you’re feeling and know when it’s time to call 911.

In addition, the following cases may not constitute an emergency but warrant a call to the doctor:

• The general pattern of your headaches has changed.
• Treatments and/or medications are no longer effective.
• Your medications are causing side effects.
• You’ve started taking birth control.
• You need pain medications three or more days a week.
• Your head pain gets worse when you lie down.

A Word From Verywell

Throbbing pain and other symptoms aren’t the greatest way to start your day, but they’re all too often the way many people get up. However, there are many things you can do to treat the attacks and prevent them. If you’re struggling with headaches or other symptoms, be sure to talk to your doctor about your options.