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Waking with Headaches "Every Day without Fail"

Q. For about six months I have been waking up with what are, for me, unusual headaches—at the front of my head above my eyes. They start in the very early morning between 1 am and 3 am and are still there when I wake up at 7 am. This happens every day without fail. The headaches disappear about an hour after waking. I also have lightheadedness and some blurred vision.

Two weeks ago my doctor diagnosed high blood pressure (220/114). He put me on amlodipine. My lightheadedness has nearly disappeared, but I still get the headaches even though my blood pressure is now down to 145/79. Do you think these headaches are still linked to hypertension or are they something more sinister?

A. The pattern of your “waking” headaches is typical of hypertensive headache. Usually the diastolic (lower) reading is over 120 in a true hypertensive headache. The fact that you not only had severe hypertension, but blurred vision, makes me think that your pressure may actually have been even higher at times.

Another cause of a waking headache that eases after being up and about is sleep apnea. This is thought to be caused by low blood oxygen and retention of carbon dioxide. Hypnic headache is another headache that comes on in the early morning hours and tends to last for two to three hours. Its cause is unknown and it generally remits after a while, but may require preventive medication. It is not caused by any underlying illness.

Certainly your blood pressure needs to be brought under control. If the headaches persist, then other possible causes should be investigated.

Robert Kunkel, M.D.
Consultant, Center for Headache and Pain Neurological Institute
Cleveland Clinic
Cleveland, OH

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