Early Morning Headaches

[MPetrey]

I am a 59 year old male who has suffered for as long as I can remember from early morning headaches that have gotten worse with age.  I go to bed typically at 10:00pm and then frequently I will wake up about 3:00-4:00am feeling pain behind one or both eyes.  What is strange, other than the frequency of the headaches is that at times, if I get up immediately and sit in a chair and not lay down again, the discomfort dulls to a level that I have learned to cope with throughout the day.  If I stay in bed, it worsens over time, starting in my forehead (normally my right side) then the pain increases to include my temples and progresses to the back of my head.  When this happens the pain will stay with me for the rest of the day, making it very difficult to concentrate on anything.  In addition, I do not know if it has any bearing, but I have also observed that if I choose to stay in bed, if I lay on my side (normally my right side), the headache seems to intensify quicker.  Also, when I get up with this type of headache, I have not found any over the counter medicine, such as Tylenol or Aleve, that will relieve it.  I have also tried prescription medicines Maxalt, Medrin for control and Propranolol (for prevention) and they have provided no change in the headache severity.  

Also, when I wake up, my sinuses will be partially plugged up.  Thinking that the sinuses may be the reason for these headaches and also due to an issue I have also noted regarded restricted breathing, I had a Frontal Sinusotomy performed in 2002.  The doctor who performed this out-patient surgery said that he was not able to access my upper sinus cavities in my forehead because they were deformed from birth.  I do not know if this was the reason for the headaches; however, having this Frontal Sinusotomy performed did not provide any headache or restricted breathing relief.  In addition, although it does not have much impact on my headaches, as a prevention measure to safe guard against sinus infections, normally about 2 times a week, when I wake up I use a water-pix to clean out my sinuses.  When I use the Water-Pick, I either use distilled water or a Sinus Wash Saline Packet added to the water.  

Other medications I take routinely for my sinus issues as a preventive measure are Nasonex Nasal Spray and Zyrtex-D in the morning.  Other than that, I also take Zegerid caps for Reflux control and am on 20mg of Prozac and show no signs of depression that would be abnormal to me or my family.  Also, I have been tested twice for allergies, and came out clean.  In addition, my blood pressure is normal.  

At this point, I do not know where to turn next.  My only thought is to try a gluten free diet and see if that has any impact.  I have spoken to many doctors about this and they have not had any luck pinning down the cause or solution.  Does anyone have a similar morning headache problem?  Any suggestionss are appreciated.  Michael

[dame_wilbur]

I'm guessing you're a mouth breather?
Have you thought about seeing a sleep specialist? It sounds to me like maybe if you have deformed sinuses, you might have a type of sleep apnea and the reason you're waking up with a headache is that your brain is being deprived of oxygen while you sleep. When you get up, your brain would be able to start getting more oxygen again.
just a thought,

~dame

[Ticker53]

I am a 56 year old female & for the last 3 years I have had headaches that start around 5 am, they are severe & on the top of my head, like you if I sit up they ease but return as soon as I nod off. They eventually settle to one side, behind my eye & around my ear, spreading to the back of my head. Usually by the end of the day my head is clear.

I do have an undiagnosed neurological condition, I see a neuro, once a year & this year he prescribed Amitripyline 10 mg, it worked at first but now even on 20 mg I am getting headaches.

I am now being referred to an Headache centre. The reply re. Sleep Apnea  is interesting; I am definitely a mouth breather.

[MPetrey]

Thank you for yor response.  I saw my Neurologist yesterday about these headaches and he is sending me to have several Blood tests done, to include tests for Gluten Intolerance and Celiac.  In addition, he is sending me to have an MRI done to see if he can get to the bottom of this problem.  I will let you know if any of these tests identify anything new.
I read the response from dame_wilbur about my possibly being a "mouth breather" with a sleep apnea issue.  Although I have heard the term "mouth breather" I never equatted it to me, so this has definately given me something else to think about.  I have started the blood tests and MRIs requested from my neurologist, dependin what they find (if anything), I will then try a sleep specialists.   I will also call him and see if I can get a sample of Amitripyline 10 mg to try.  I will let you know how it works.

[Ticker53]

Yes, please lets keep in touch. I see a Doctor at the Headache Clinic on the 5th Dec, so will update again after that.

M

[marileew]

Hi Michael,

One other possibility is cluster headaches. They are rare but since you mention that these are early morning headaches I thought I might suggest it as a possibility. Also since you mention you get them around the SAME TIME every morning, that is something that is usually unique to cluster headaches. Although, the fact that they go away on their own if you get up makes me think it is less of a possibility. Also, cluster headaches are unique in their level of pain severity too, they are one of the most painful headaches in existence... on average they are usually much more severe than migraine in terms of pain (on average). So, the fact you didn't mention pain severity also makes it less likely that they are cluster headaches. Still, the fact you get them around the same time every morning makes me think you should at least inquire with your doctor the possibility of cluster headaches.

You are male though so you fit the demographic (women can get cluster headaches too and lots of women do, it is just that men are much more likely to get them).

The medications you have tried in the past would not work on cluster headaches. Like with severe migraines, over-the-counter medications do absolutely nothing to touch the pain of a cluster headache. Maxalt is not a triptan that works on cluster headaches. The only two triptans that work on cluster headaches are Zomig Nasal Spray and Imitrex Injection. I would suggest asking your doctor for prescriptions for these triptans in order to try, starting with the Zomig Nasal Spray as no one likes to give themselves injections... so, leave the Imitrex Injection for last.

Lidocaine nasal spray is also another acute treatment for cluster headaches. It works quite well at aborting the headaches. It is a numbing spray that is sprayed into the nose.

The best acute treatment for cluster headaches is medical oxygen, although you need a prescription for this and depending on where you live prescriptions for oxygen can be difficult to get. A 100% absolute sure diagnosis of cluster headaches would probably have to be made before oxygen was ever prescribed. Although, you could get oxygen administered in a hospital setting if you ever had an emergency headache (a very severe headache).

Antidepressants such as Amitriptyline are not the first line of preventative treatment in cluster headaches, although they are one of the first line of preventative treatment in the case of migraine headache and daily chronic headache. If it did turn out to be a cluster headache, then the first line of preventative treatment would be a calcium channel blocker, probably Verapamil. Although, if it was something more like a migraine headache or a chronic daily headache, then your options for daily preventative therapy would include: Antidepressants (in the tricyclic category only, such as Amitriptyline); Anticonvulsants (such as Topamax); and Beta Blockers.

Hope you find some answers! Good luck! :)