Maybe they start after dinner, just as you're getting ready for bed. They may appear just before your head hits the pillow. They might even wake you up in the middle of the night. Regardless of their timing, headaches that occur at night are frustrating. When they interfere with sleep, nighttime headaches can lead to additional problems the next day, such as fatigue and irritability. In the rest of the text, learn about the possible causes of headaches that occur at night.
Tension headaches
Almost every person experiences a tension headache at some point in their life. The pain from this type of headache varies from mild to severe. Doctors are not sure of the exact cause of tension headaches, but they are often caused by stress, exhaustion and muscle tension. All of these can appear at the end of a long, hard day's work.
Additional signs of a tension headache include:
- dull or throbbing pain in the head
- pain on both sides of head or forehead
- tension in the neck, shoulders and head
- feeling of tightness or pressure around the head
- Cluster headache
Cluster headaches are an extremely painful type of headache that occurs in attacks. People describe the pain as extremely strong - as if a spike was stuck in their head. In many patients, cluster headaches often begin at night, usually a few hours before going to bed.
Other symptoms include:
- extremely severe pain in the head, usually in the area around one eye
- headaches that recur at the same time of day
- pain that starts on one side of the head but spreads
- redness, swelling, discharge or tearing in the affected eye
- stuffy or runny nose on one side
- pale skin or reddening of the skin
Migraine
Migraines cause severe attacks of pain in the head accompanied by other symptoms such as:
- nausea or vomiting
- a flash of light
- extreme sensitivity to noise and light
- blurred vision
- Migraines are often provoked by certain factors such as:
- hormonal changes during menstruation, pregnancy or menopause
- changes in weather conditions and pressure
- certain foods and food additives
- changes in sleep patterns
- stress
- sensory stimuli, such as smells, sounds or lights
Hypnic headache
Hypnic headache is the only type of headache that occurs exclusively at night. Hypnic headaches are rare and usually start after age 50. The pain can range from mild to severe and usually affects both sides of the head.
How do I know what type of headache I have?
While some headaches have unique characteristics that make them easy to diagnose, most headaches aren't that simple. If you regularly have headaches at night and aren't sure why they occur, it might be a good idea to make an appointment with your doctor.
To make a diagnosis, your doctor will likely ask you a series of questions about several things:
Severity of pain:
Do headaches keep you up at night? Does it keep you awake? How much sleep do you lose due to headaches? Is it the worst pain you've ever experienced?
The type of pain you feel:
Is the pain dull and aching? Is the puck sharp? Do you feel like your eye is throbbing?
Location of pain:
Does it affect one side of the head or both? Does it affect only the forehead or does it spread to the back? Does the pain radiate into the neck or shoulders? Is the pain focused in the area around one eye?
Some accompanying symptoms:
Are you feeling nauseous or vomiting? Do you feel dizzy or are you hypersensitive to light and sound?
Warning signs:
Do you have symptoms - such as visual disturbances or mood changes - before the headache occurs?
Possible triggers:
Have you noticed that you get headaches at night when you eat certain foods? Do they occur during weather changes? Do the symptoms match any patterns in the menstrual cycle?
Time of onset of headaches:
Do they only happen when you sleep? Do they happen at the same time every night?
Duration of symptoms:
How long do these headaches last? When was the first headache attack?
What works and what doesn't: Does something make the headache better or worse?
How are nocturnal headaches treated?
Paracetamol, ibuprofen or other non-steroidal anti-inflammatory drugs can help you treat headaches. Taking a melatonin supplement at night can also help with hypnic and cluster headaches. If you have tension headaches, try relaxation techniques before falling asleep. Even a brisk walk around the block can help relieve stress and muscle tension.
There are several classes of medications that your doctor may prescribe to treat headaches
Triptans
These are drugs that narrow blood vessels and block pain pathways and are used to treat migraines. They can also help with chronic tension headaches and cluster headaches.
Ergot preparations
They belong to an older class of drugs that can help with chronic migraines.
Beta-blockers and calcium channel blockers
These drugs are usually used to treat high blood pressure, but they can also help prevent migraines and cluster headaches.
Antidepressants
Although generally used for mental illness, antidepressants can also be effective in preventing migraines.
Antiepileptics
Some doctors recommend anti-epileptic drugs to prevent the development of chronic migraines, but they can cause many side effects.
Corticosteroids
They can provide short-term pain relief during an intense cluster headache period.
indomethacin
This medication is a nonsteroidal anti-inflammatory drug that can help prevent hypnic headaches.
When to seek immediate help?
Headaches at night are usually not a sign of anything serious. However, it is best to seek medical help immediately if the headache does not resemble the one you had before.
You should also seek emergency care if the headache is accompanied by:
- speech problems
- vision problems
- loss of balance
- confusion
- unconsciousness
- unusually stiff neck
- numbness or weakness on one side of the body.
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