There is either agitation/restlessness with the headache attack and/or at least 1 autonomic sign or symptom on the side of the headache. It is a severely painful headache, and has been termed “suicide headache” at times because of the pain severity.Ĭluster 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. Men tend to be affected 3 times more than women, but it is seen in both men and women. 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.Ĭluster headaches can occur anytime during the day, but classically occur at the same time every night, often waking the patient up from sleep, many times shortly after falling asleep within an hour or two. The other 3 TAC syndromes are hemicrania continua, paroxysmal hemicrania, and SUNCT/SUNA, none of which are waking headache types. There are 4 types of TAC syndromes, and cluster headache is the most common of them. Cluster headache is classified as a trigeminal autonomic cephalalgia (TAC). It is a very distinct form of headache that is easy to pick out with its characteristics. There are many options for this including a daily pill, natural supplements, a once monthly or quarterly CGRP monoclonal antibody (Aimovig, Ajovy, Emgality, Vyepti), Botox, or a neuromodulatory device.Ĭluster headache is another classic cause of wake up headaches. If you are averaging more than 4 migraines per month, a daily preventive treatmentis generally recommended. A neuromodulatory devicecould also be considered. Other options for waking migraines would be DHE (Migranal nasal spray or injection), or one of the new gepants (Nurtec ODT, Ubrelvy) since they can still be effective if taken up to 4 hours past the migraine onset, which is really great and expands the migraine onset treatment window. With that said, sometimes patients can get away with a fast-acting oral triptan such as Rizatriptan (Maxalt) as well. So for waking migraines, injectable Sumatriptan (Imitrex), nasal Zolmitriptan (Zomig) or Sumatriptan (Imitrex), are typically going to be the most effective triptans. The difficulty with waking migraines is that you are already “behind the ball” by the time you wake with the migraine because you’ve missed the early treatment window where most medications such as the triptanswould normally be most effective. The key for abortive (as-needed) migraine treatment for waking migraines is that is must be something fast acting to have a chance to catch the migraine. Treatments for migraine are discussed here. Caffeine withdrawal headache can also be a cause of wake up headaches, for similar reasons as described for rebound headache. This pattern is characteristic for rebound headache. It starts to worsen again as they are due for another dose and it is wearing off. Patients in this cycle will often notice that after they take their overused medication, the headache calms back down again. Rebound headache occurs because as the patient is sleeping, the overused medication is being metabolized and eliminated from the body and the headache (typically migraine) is triggered as a result of withdrawal from the medication and the need to take more. This occurs when a person with migraine is using triptans, OTCs (over-the-counter pain meds), or NSAIDs (non-steroidal anti-inflammatory drugs) more than 10 days per month, opiates or opioids more than 8 days per month, or butalbital medications such as fioricet or fiorinal more than 5 days per month, on average. Other causes of wakeup headache commonly occur in patients that are stuck in chronic migraine (15-30 days per month with at least 8 headache days with migraine features), particularly if they are in rebound headache (medication overuse headache) from excess pain or “as-needed” medications. Thus, trying to maintain a similar sleep schedule on the weekends and weekdays can help with this type of trigger. So for many, sleeping in (such as on the weekends or on vacation) can be a common (and cruel) migraine trigger leading to waking up with headaches. Migraine is also susceptible to changes in sleep patterns. Sleep stage transitions can be a trigger for migraine attacks in many patients. Migraine commonly causes wake up headaches for many patients, and is by far THE most common cause of wake up headaches.
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