6. Jaw Clenching or Grinding

Grinding or clenching teeth can occur without the individual even realizing it. You may have a morning migraine or headache but not notice symptoms from the jaw.

Clenching throughout the night can lead to fatigue and exhaustion of jaw muscles.

Individuals may notice a stiff jaw, aches in the temples and even damaged teeth. Extreme forces can occur in individuals who grind or clench during sleep. This is often several times more forceful than teeth clenching whilst awake during the day.

See 17 treatments for clenching or grinding-related headache.

7. Diet

Let’s be honest with ourselves. Many of us could be eating better. As a broad population, we generally do not eat as much healthy fresh food as we should.

Personally, I don’t think perfection is realistic, but making progress and rewarding ourselves with modest indulgences is a realistic balance.

We need to consider that food is information. Not merely fuel. It can be our poison or our medicine.

For migraine or chronic headache patients this can be particularly challenging when otherwise ‘healthy food’ can trigger attacks. See the best diet for migraine.

Certain foods may be triggering attacks without you being aware. Some people with migraine may not respond well to gluten, dairy or soy amongst other things.

Again, this is highly individual. The only way to really find out is through an elimination diet and a diary. Click here for a list of potential problematic foods or ingredients >>

8. Low blood sugar

Blood sugar concentration refers to the amount of glucose (sugar) in our bloodstream. The body tightly regulates blood sugar levels to keep our metabolism in balance.

Levels often rise after meals for an hour or two and then drop. After dinner, our blood sugar levels drop and continue to fall throughout the night.

Hypoglycemia refers to a condition where the blood sugar levels drop too low. Symptoms include lethargy, impaired mental function, irritability, shaking, twitching, weakness, pale complexion and sweating.

In severe cases, seizures and loss of consciousness may also occur. In the most severe cases, hypoglycemia can be fatal.

9. Dehydration

Dehydration is not likely to surprise many as a migraine trigger but many people don’t appreciate how easy it is to become dehydrated due to sometimes mild or subtle symptoms.

Dehydration can occur throughout the night which can trigger migraine attacks or headaches.

10. Alcohol

Alcohol is a depressant which may help initiate sleep, but it can also prevent deeper sleep states required for restorative rest.

In addition to sleep quality, alcohol can also shorten sleep duration. [vii] These factors combined may account for why so many people experience a migraine in the hours or days following alcohol consumption.

It is possible that the compromised sleep following alcohol may be a greater trigger than the actual alcohol itself.

Intoxication has become so common that we might easily forget that alcohol is a toxin and should be avoided in any significant quantity for those with chronic migraine or headache disorders.

11. Hormones

Dr Anne MacGregor reveals “More than 50 percent of women who suffer from migraines are more prone to them around the time of their menstrual period.”

This is due to changes in the levels of female sex hormones. Men do not experience the same fluctuations. This difference may help explain why females are three times more likely to experience migraine than men.

To read further about menstrual migraine, treatments and prevention click here >>

Another hormone that could be playing a role is melatonin. Melatonin production decreases with age. [viii] Melatonin has been shown to potentially help with migraine prevention although further high-quality studies are required.[ix]

12. Cluster Headache

Cluster headache is considered to be one of the most painful headaches. They are often referred to as “suicide headaches” due to the severe pain.

Some people may awake at night due to cluster headache.

Typical symptoms include pain that centers around the eye and/or in the front part of the head. It is not typically throbbing pain like migraine but rather a stabbing pain or hot poker in the eye. What characterizes cluster headache so distinctly is the restless agitation which makes it very difficult to lie still.

According to Dr Deborah Friedman at the 2016 Migraine World Summit, “80% of cluster patients have what we call episodic cluster headache, they’ll get these bouts that lasts for weeks and months, and then they’ll go for periods of months, or sometimes years without having cluster headaches.”

13. Hypnic Headache

Hypnic headache syndrome is a rare headache disorder that occurs exclusively at night. The cause is still unknown. Hypnic headache:

Rare

Begins from 40 – 50 years old

Occurs often between 1 am – 3 am

Typically lasts 30-60 minutes but can last up to 6 hours.

In some cases can also occur when napping during the day.

This type of headache is often called the “alarm clock headache” as it occurs at the same time. In a small study of 19 patients 68% experienced this headache more than 4 nights per week. [x]

It is not considered to be a migraine although it can share similar features such as unilateral pain (one side of the head), throbbing and in rarer instances sensitivity to light and sound.

14. Allergens & Chemicals

The living and breathing environment of our home can play more of a role than most people might think.

Allergens such as dust mites living in bed sheets and mattresses can cause sinus congestion and consequent headache or even migraine attacks.

Mold in the bedroom from the roof, floor or other damp areas could also lead to a range of symptoms including headaches although there is a lack of scientific evidence supporting this theory.[xi]

Chemical exposure or scents from certain products such as air fresheners, cleaners, deodorants and perfumes may also be playing a role in headaches.

If you think sinus may be playing a role use this symptom checker for sinus vs migraine.

15. Intracranial hypotension

Intracranial hypotension is often referred to as a ‘positional headache’ where sitting upright in the morning triggers head pain. In normal conditions the brain is supported by the cerebral spinal fluid. The cerebral spinal fluid in effect carries the bulk of the weight of our brain. The remaining weight is held by pain-sensitive structures. When the volume of cerebral spinal fluid is below it’s normal levels it is thought that the brain places pressure on these pain-sensitive structures which lead to pain. There is also some evidence that vasodilation may play a role. [xiv]

The nature and location of the headache can vary widely but it is often made worse from laughing or coughing and does not respond to typical painkillers. Patients may also experience nausea, vomiting, anorexia, neck pain, dizziness, changes in hearing, light sensitivity, difficulty concentrating, facial numbness or weakness and other symptoms. [xiv] Many of these symptoms overlap with migraine so the helpful distinguishing feature is that relief is experienced by simply lying down in a supine position.

Intracranial hypotension can be caused by:

A cerebrospinal fluid leak: This can occur following a spinal tap (lumbar puncture) A defect in the spinal tube covering (the dura). This can be spontaneous or occur due to injury, congenital weakness or from surgery.

Following a shunt procedure.

Intracranial hypotension usually resolves with conservative management and bed rest. Lying down flat (supine) is believed to reduce cerebral spinal fluid pressure at the site of leakage and facilitate healing. For ongoing cases, if the site of the leak can be found then procedures to repair the leak are usually very effective. [xiv]

16. Rare Serious Conditions

There are rare serious conditions for which you should immediately see a doctor. Two of them are brain tumors and giant cell arteritis.

Brain tumors can cause patients to wake during the night. Increased pressure from within the skull is a common first symptom. Often the headache becomes more frequent until it is constant. Learn more about the similarities of brain tumors and migraine here >>

Giant cell arteritis is an inflammation in the lining of your head arteries. It’s also known as temporal arteritis for this reason. It can occur elsewhere in the body. The most common symptoms are severe head pain and tenderness as well as fever, fatigue, jaw pain, vision loss and double vision.

How to prevent migraine or headache attacks that wake you

Develop good sleep habits

Restful sleep delivers a refreshed feeling in the morning, improved mood, cognitive function, physical energy and perhaps most importantly for chronic migraine patients – an increased threshold for pain. [i]

To improve your sleep hygiene consider some or all of the following to start experiencing the benefits:

Setup a sleep routine: have consistent bed and wake times.

Avoid stimuli before bed: this includes LED lights which contain stimulating light and can negatively affect melatonin production. The TV, phone and computer all emit this light.

Temperature control: Keep the bedroom cool. The body falls asleep easier when the body temperature cools.

Eat a few hours before bed: give your body time to empty your stomach. Avoid eating sweets or sugary foods before bed that cause large spikes in your blood sugar levels.

Exercise during the day.

Keep your room dark and quiet.

Insomnia

According to Dr Jeannetta Rains, Clinical Director of the Center for Sleep Evaluation – “The treatment of choice for insomnia is behavioral sleep therapy.” Dr Rains also suggests speaking to your health care professional about “pharmaceutical grade L-tryptophan, 5-HTP or melatonin”.

Other options from sleep specialists or psychologists include:

Cognitive therapy

Relaxation training

Sleep behavior modification

Low blood sugar

A light balanced snack before bedtime can help to keep blood sugar levels more stable whilst you sleep and prevent night time hypoglycemia. Look for low GI foods or combinations and avoid sugary sweets which can spike blood sugar levels.

Dehydration

Drinking a large glass of water right before bed is only likely to wake you during the night and disrupt your sleep.

Instead maintain good hydration levels throughout the day to help prevent dehydration whilst you sleep.

Stress

There are many ways to better manage stress:

Exercise is a great way to relieve stress and improve your stress threshold.

Practice relaxation training such as mindfulness meditation.

Avoiding unnecessary stress.

Adapt. When you cannot change the stressor, perhaps you can change how you react to it. Manage your expectations and put it in perspective. Will this really matter 10 years from now?

Accept the things you can’t change.

Jaw Clenching

Clenching or grinding is typically diagnosed by a dentist. The dentist can provide an occlusal splint, a small mouth guard to prevent teeth damage and disable the jaw from fully contracting. This dramatically reduces muscle strain and tension resulting from clenching or grinding.

Breaking the habit itself of clenching can be challenging. Stress management techniques may also be helpful. See 17 treatments for clenching and grinding-related headaches.

Cluster Headache

There are several types of treatment strategies for one of the most painful types of headache. Treatments can be directed at treating the headache itself, trying to shorten the cluster period and for long-term prevention.

In treating the attack, high-flow oxygen at 10-15 litres a minute in a non rebreather mask is effective in around 80% of patients according to Dr Deborah Friedman.

Hypnic headache

Interestingly, caffeine is the recommended initial treatment for hypnic headache. A recommended treatment, for example, is having caffeinated tea or coffee around bedtime. This goes against some of the healthy sleep habits outlined above, but studies have shown this can be helpful and straightforward to self-administer for this particular type of headache. [xiii]

The other most helpful medicinal treatments are lithium, indomethacin, and flunarizine according to a systematic review of the research literature published in Neurology. [xiii] These treatments are taken preventatively [lookup in glossary] at bedtime.

Some of these treatments have common side effects which are not suitable for certain patients. Your doctor will be able to advise you whether they are appropriate or not.

Allergens & Chemicals

Minimise dust mites in your bed by using allergy-proof pillowcases, mattress covers, and duvets designed to minimize exposure to mites.

Wash your sheets more often and consult an allergist about your potential exposure to chemicals or irritating scents which may be affecting your home environment.

Use this symptom checker to find out if you may have sinusitis or migraine.

Conclusion

Waking with migraine or headache is a common and challenging problem. There may be multiple factors involved and it can be challenging to uncover which triggers are at work and address each of them.

Poor sleep, diet, and stress levels have become so commonplace today that they are often ignored, but this may be where we can find our most sustainable results.

Let me know in the comments what factors could be waking you up with an attack?