Head Pain When Lying Down: Neurological Symptoms

Experiencing a headache when lying down?

Since the day before yesterday, I've had a slight headache, but last night it suddenly became an explosive pain, the kind that makes my whole head hurt and prevents me from sleeping well.
However, sitting up provides some relief.
After sleeping for a long time, I felt better, but as soon as I lie down, the pain returns.
When I lie flat, the pain is concentrated at the back of my head near my neck.
When I lie on my side, the pain shifts to the top of my head and my temples.
When I sit up, I feel pain in the area at the back of my head that is indented, and my forehead also hurts, but it's not as severe as when I'm lying down.
The pain feels like pressure, tight and throbbing.
Recently, I've been experiencing insomnia and my sleep has been very fragmented.
I often lie in bed playing on my phone, and I'm not sure if that has anything to do with it.
Oh, and lately, when I'm about to fall asleep, I sometimes have a sudden jerk; I'm not sure if that's related, but I wanted to mention it! Thank you!

Xiao Fan, 10~19 year old female. Ask Date: 2021/06/06

Dr. Jiang Junyi reply Neurology

Dear Ms.
Hsiao,
The common cause of the neck compression and pain you are experiencing is likely cervical myofascial pain.
Prolonged periods of looking down can lead to overuse of the trapezius muscle in the back of the neck, resulting in neck and shoulder discomfort.
Initially, resting may alleviate the pain, but over time it can worsen and disrupt your daily activities.
Some patients report experiencing severe neck pain upon waking, characterized by stiffness, tightness, and intolerable pain.

I recommend the following strategies:
1.
Change Positions: Alter your posture every 15 minutes to allow the neck tissues to rest.
Maintaining any position (including a normal one) for an extended period can lead to tissue fatigue and inflammation, so moving around briefly can reduce the risk of muscle inflammation.
2.
Rest: Rest is essential for allowing the muscles to utilize their self-repair capabilities.
Avoid vigorous exercise during this time.
You mentioned poor sleep, which may also diminish your body's repair abilities.
3.
Neck Heat Therapy: Apply a warm compress for 15 to 20 minutes, ensuring the temperature is safe to prevent burns.
4.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): If you do not have a history of peptic ulcers, allergies to NSAIDs, or impaired kidney function, consider using NSAIDs to reduce inflammation and alleviate pain.
Muscle relaxants may also help with tightness.
5.
Neck Stretching Exercises: After the acute pain phase, develop a habit of performing gentle neck stretches every 15 to 20 minutes, moving slowly and within a comfortable range of motion in all directions (up, down, left, right).
Additionally, maintain adequate hydration and electrolyte balance.
Monitor your urine output for any decreases or changes in color.
Supplementing with vitamins and staying well-hydrated can enhance your body's natural healing abilities.
I suggest consulting with a neurologist or a rehabilitation specialist for further evaluation and treatment.
However, due to the current COVID-19 pandemic, it may be advisable to wait until the situation stabilizes before visiting a hospital for examination.
Please ensure to practice self-protection measures, including cleaning and disinfecting, and adhere to new health protocols.
Thank you for your inquiry.
If you have further questions, feel free to discuss them.
Wishing you good health and safety,
Dr.
Jiang Jun-Yi
Department of Internal Medicine, Taoyuan Hospital

Reply Date: 2021/06/06

More Info

Head pain, particularly when lying down, can be a complex issue that may involve various neurological and physiological factors. Based on your description, it seems that you are experiencing a range of symptoms that could be indicative of several underlying conditions. Let's break down your symptoms and explore potential causes and recommendations.

Symptoms Overview
1. Pain Location and Type: You mentioned that the pain is primarily located at the back of your head near the neck when lying flat, and it shifts to the top and temples when you lie on your side. The pain is described as a "pressure" or "tight" sensation, which can be indicative of tension-type headaches or cervicogenic headaches, where pain originates from the cervical spine.

2. Relief with Position Change: The fact that sitting up alleviates the pain suggests that your symptoms may be related to posture or muscle tension. Poor sleeping positions or prolonged periods of lying down, especially while using a phone, can lead to muscle strain and tension headaches.

3. Sleep Issues: You mentioned experiencing insomnia and fragmented sleep. Sleep disturbances can exacerbate headache disorders, as poor sleep quality is often linked to increased headache frequency and intensity.

4. Neurological Symptoms: The sensation of "jerking" or "twitching" as you are about to fall asleep could be related to hypnic jerks, which are benign muscle contractions that occur as one transitions into sleep. However, if these jerks are frequent or accompanied by other neurological symptoms, it may warrant further investigation.

Potential Causes
1. Tension-Type Headaches: These are the most common type of headaches and can be triggered by stress, poor posture, or muscle tension. They often present as a tight band-like sensation around the head and can be exacerbated by lack of sleep.

2. Cervicogenic Headaches: These headaches originate from issues in the cervical spine and can cause pain that radiates to the head. They are often associated with neck stiffness and may worsen with certain positions.

3. Migraine: Although you did not describe classic migraine symptoms (such as nausea or sensitivity to light), migraines can sometimes present with atypical symptoms. Migraines can also be triggered by sleep disturbances and stress.

4. Sleep Disorders: Conditions such as sleep apnea can lead to fragmented sleep and morning headaches. If you snore or experience pauses in breathing during sleep, this could be a contributing factor.

Recommendations
1. Posture and Ergonomics: Evaluate your sleeping position and ensure that your pillow supports your neck properly. Consider using a cervical pillow that maintains the natural curve of your neck.

2. Sleep Hygiene: Establish a regular sleep schedule, limit screen time before bed, and create a restful sleeping environment. Reducing blue light exposure from screens can help improve sleep quality.

3. Stress Management: Engage in relaxation techniques such as yoga, meditation, or deep-breathing exercises to help manage stress, which can contribute to tension headaches.

4. Hydration and Nutrition: Ensure you are well-hydrated and maintain a balanced diet, as dehydration and certain food triggers can exacerbate headache symptoms.

5. Consult a Specialist: If your symptoms persist or worsen, it would be prudent to consult a neurologist or headache specialist. They may recommend imaging studies, such as an MRI, to rule out any structural issues in the brain or cervical spine.

6. Physical Therapy: A physical therapist can help address any musculoskeletal issues contributing to your headaches through targeted exercises and manual therapy.

In conclusion, while your symptoms may be related to tension and sleep disturbances, it is essential to monitor them closely. If you experience any new or worsening symptoms, such as visual changes, severe nausea, or neurological deficits, seek medical attention promptly. Understanding the underlying causes of your headaches will be key to finding effective relief and improving your overall quality of life.

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