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Reader's Mail: Nighttime Headache Requires Proper Diagnosis for Treatment

Q. Is it normal to get the majority of my headaches during sleep? I can go to bed feeling fine and will wake to a horrible pounding headache within 3 to 4 hours of falling asleep.  I’m not sure what to do about this.

A. Nighttime headaches are often the same ones that you experience during the day. Of the daytime headaches, cluster headaches are the more frequent cause of nighttime headaches. Cluster headaches are usually brief, between 30 minutes and 2 hours. These headaches are very painful and are often accompanied by red, tearing eyes and a runny nose on the same side of the head as the pain. Migraines can occur at night and awaken you from sleep, but usually last longer with additional symptoms, such as nausea and sensitivity to light and sound.

A third very uncommon type of nighttime headache is a hypnic headache. These headaches only occur during sleep, typically last 30 to 60 minutes, and are not as severe as migraine or cluster headaches. Hypnic headaches, called the “alarm clock” headache, tend to return at the same time each night.

Treatment varies depending on the type of headache you are experiencing.  If you have nighttime headaches or headaches that awaken you from sleep, see your doctor for an accurate diagnosis and the appropriate treatment.  Low-dose melatonin may actually help any of these three headache types.

David S. Larsen, M.D.
Center for Headache Medicine
Chicago, IL

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