Q: I wake with a headache every morning and go to bed with a headache. When I wake in the morning I always seem to have congestion at the back of my nose. I’m being treated for sinus headache with decongestants and antihistamines but symptoms never go away. This has been going on for 3 years and I’m not sure what to do next.
A: Headaches that occur when you wake up in the morning could be caused by several things.
First, the nasal congestion you are experiencing could produce sleep apnea. If you cannot breathe through your nose at night then you are likely “mouth breathing” and snoring becomes more likely. Snoring is often associated with sleep apnea particularly if you are sleepy during the day. Your physician could order a sleep study to diagnose this if the above symptoms apply to you.
Second, you could be suffering from rhinitis, which could trigger headaches in some people. If your nose becomes engorged with blood upon lying down this could activate the trigeminal nerve in your nose and produce headache. This could be relieved by a variety of medications prescribed by your physicians.
Third, you could be experiencing hypnic headaches. These are headaches that wake people from sleep- usually in the middle of the night. These can be treated by a headache physician.
Fourth, migraine- particularly chronic migraine- can cause headaches upon wakening. These headaches could be diagnosed and treated by your primary care physician or a specialist in headache disorders.
Fifth, cluster headaches commonly occur at night and often awaken patients from sleep. These headaches always occur on the same side of the head, are severe and only last 30 minutes to 3 hours. They also commonly have tearing of the eye or running of the nose on the same side as the headache.
Sixth, headaches related to pseudotumor can occur at night and worsen with lying down. Pseudotumor headaches result from increases in the pressure of spinal fluid within the head. They can be suspected by your physician by noting swelling of the optic nerve upon examination and later confirmed by a spinal tap. These headaches also have specific treatments.
Therefore, your first step would be to obtain a diagnosis for your morning headaches. If you are having problems I would suggest that you consult a headache physician in your area.
Vincent Martin, MD
Headache and Facial Pain Program
University of Cincinnati Neuroscience Institute