ARE YOU WAKING UP WITH HEADACHES? CLUSTER HEADACHE COULD BE ONE POSSIBILITY WHY.
There are many types of headache disorders that can cause wake up headache. Cluster headache is one common cause of this pattern. It is a very distinct form of headache that is easy to pick out with its characteristics. Cluster headache is classified as a trigeminal autonomic cephalalgia (TAC). There are 4 types of TACs, and cluster headache is the most common of them. The other 3 TACs are hemicrania continua, paroxysmal hemicrania, and SUNCT/SUNA. There are some overlapping characteristics between all 4 of these TAC headache types, but cluster headache is the only one that often wakes the patient from sleep.
WHAT ARE THE SYMPTOMS OF CLUSTER HEADACHE?
Cluster headache is characterized by attacks of severe unilateral (one-sided) orbital (around the eye), supraorbital (above the eye), and/or temporal pain lasting 15 to 180 minutes if untreated. There is either agitation/restlessness with the headache attack and/or at least 1 autonomic sign or symptom on the side of the headache [lacrimation (runniness/tearing of the eye), conjunctival injection (redness of the eye), facial sweating or flushing (skin turning blushed), nasal congestion, rhinorrhea (runniness of nose), sense of ear fullness, eyelid edema (swelling), or partial Horner’s syndrome (miosis (pupil becomes small)) and/or ptosis (droopiness of the eye)]. Headache attacks typically occur from 1 every other day to 8 per day for more than half the time during a cluster cycle. Chronic cluster headache is defined by attacks that occur for more than 1 year without remission, or with remission periods lasting less than 1 month.
Cluster headache attacks occur in “clusters”, or cycles, of frequent headache attacks. These cycles of cluster attacks may last for weeks or months before they go away completely. Remission periods can last months to years. Cluster cycles often occur at a predictable time of year, such as season changes (Fall and Spring are most common). At the onset of a cluster cycle, a course of high dosed Prednisone is often started over 1-2 weeks to try to break up or shorten the cycle. Cluster headaches can occur anytime during the day, but classically occur at the same time every night, often waking the patient up from sleep. Men tend to be affected 3 times more than women, but it is seen in both men and women. It is a severely painful headache, and has been termed “suicide headache” at times because of the pain severity.
OTHER REASONS WHY YOU MAY WAKE UP WITH HEADACHE.
Another interesting but uncommon type of headache that wakes the patient up overnight is called hypnic headache. This headache has also been called “alarm clock” headache because it often wakes the person up at almost the same time every night. These recurrent attacks occur only during sleep, causing wakening. They typically occur on 10 or more days per month for more than 3 months. The headache lasts 15 minutes and up to 4 hours after waking. This headache usually begins after age 50, but can occur in younger ages too. The pain is typically mild to moderate, but can be severe occasionally. The pain usually occurs on both sides of the head. There is no restlessness during the headache. Hypnic headache is not associated with autonomic symptoms [lacrimation (runniness/tearing of the eye), conjunctival injection (redness of the eye), facial sweating or flushing (skin turning blushed), nasal congestion, rhinorrhea (runniness of nose), sense of ear fullness, eyelid edema (swelling), or partial Horner’s syndrome (miosis (pupil becomes small)) and/or ptosis (droopiness of the eye)]. All of these characteristics help to differentiate it from cluster headache.
Migraine commonly causes waking up with headaches for many patients as well. Other causes of wakeup headache can include rebound headache (medication overuse headache) from excess pain medications, including over the counter pain meds. This occurs because as the patient is sleeping, the overused medication is being eliminated from the body and the headache (typically migraine) is triggered. Caffeine withdrawal headache can sometimes be a cause of waking headache as well, for the same reasons as rebound headache.
Regardless of the possibilities above, any headache, including waking headaches, need to be discussed and evaluated by your doctor. Neuroimaging preferably with a brain MRI is recommended for waking headaches to exclude other causes such as brain tumor, etc., even if the risk is low.
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