Nighttime Headaches: Causes and Solutions

Q: Nighttime Headaches: Causes and Solutions

Hello： The headache you mentioned may be related to issues with the cervical myofascia. <br>Many primary headaches do not show abnormalities on MRI, primarily caused by abnormal activation of the trigeminal nerve. <br>Brain imaging is performed to rule out structural problems suc

Waking up with a headache in the middle of the night versus waking up with a headache in the morning?

Hello, Dr.
Jiang! Regarding my headache issue, I have undergone an MRI, and the neurologist said there were no abnormalities.
However, I still wake up in pain during the night.
The pain is a tightening and soreness in the right temple and temporalis area, as well as the right crown of my head, accompanied by pain in the right side of my neck.
This discomfort persists until I get up in the morning.
It usually eases a bit after I get up and brush my teeth, but sometimes the discomfort lasts longer when my condition is worse.
Currently, I take half a tablet of Rivotril before bed and half a tablet of Doxepin during the day to help with sleep (both for naps and nighttime).
Even as I fall asleep, I still experience limb twitching and involuntary swallowing movements in my throat, although my throat is dry and I have no saliva.
I previously did not have any sleep disorders and did not feel earthquakes.
Many articles state that experiencing headaches during sleep is concerning, especially if it causes waking up in pain.
I would like to ask if the likelihood of an MRI misdiagnosis is high, and whether I should seek a second opinion from another doctor.
Additionally, can my MRI images be accessed at another hospital, or do I need to request a copy from the original hospital before seeking treatment elsewhere? Thank you!

Amy, 30~39 year old female. Ask Date: 2021/09/12

Dr. Jiang Junyi reply Neurology

Hello: The headache you mentioned may be related to issues with the cervical myofascia.
Many primary headaches do not show abnormalities on MRI, primarily caused by abnormal activation of the trigeminal nerve.
Brain imaging is performed to rule out structural problems such as tumors, etc.
Additionally, I would like to ask the doctor if my MRI images can be accessed at another hospital, or do I need to request a copy from the hospital and bring it to the other facility? A: It is advisable to obtain copies of the images and reports, as cloud-based image retrieval often experiences signal anomalies.
I recommend consulting with a neurologist specializing in headaches for discussion and examination.
Please ensure to practice self-protection, cleanliness, and disinfection before and after your medical visits, adhering to the new preventive measures.
Thank you for your inquiry, and feel free to discuss any related questions! Wishing you good health and peace.
Dr.
Jiang Junyi, Department of Neurology, Taoyuan Hospital, cares about you.

Reply Date: 2021/09/12

More Info

Nighttime headaches can be a perplexing and distressing issue, particularly when they disrupt sleep and lead to waking up in pain. Based on the information provided, it seems that you are experiencing a specific type of headache that is localized to the right side of your head, including the temple and the occipital region, accompanied by neck pain. This combination of symptoms can be indicative of several underlying causes, and understanding these can help in finding effective solutions.

Potential Causes of Nighttime Headaches
1. Tension-Type Headaches: These are the most common type of headaches and can be triggered by stress, poor posture, or muscle tension in the neck and shoulders. Given that you experience pain in the neck and head, this could be a contributing factor.

2. Migraine: Migraines can also occur at night and may be associated with specific triggers such as changes in sleep patterns, stress, or dietary factors. The unilateral nature of your headache (right side) aligns with typical migraine presentations.

3. Sleep Disorders: Conditions like sleep apnea can lead to fragmented sleep and headaches upon waking. The mention of leg movements and throat sensations could suggest a possible sleep disorder that might be contributing to your headaches.

4. Medication Side Effects: The medications you are taking, such as the antidepressant and sleep aid, can have side effects that include headaches. It’s important to discuss these with your prescribing physician to determine if they could be contributing to your nighttime discomfort.

5. Cervicogenic Headaches: These headaches originate from issues in the cervical spine or neck. If you have neck pain that accompanies your headaches, this could be a significant factor.

Diagnostic Considerations
You mentioned that you have undergone an MRI, which returned normal results. While MRI is a powerful tool for identifying structural issues in the brain, it is not infallible. The likelihood of a false negative is low, but it is not impossible, especially if the headache is due to functional or non-structural causes. If your symptoms persist or worsen, seeking a second opinion from another neurologist or headache specialist could provide additional insights.

Next Steps and Recommendations
1. Consult a Specialist: Given the complexity of your symptoms, it may be beneficial to consult a headache specialist or a neurologist who focuses on headache disorders. They can provide a comprehensive evaluation and possibly recommend further testing or treatment options.

2. Medication Review: Discuss your current medications with your healthcare provider. They may need to adjust your dosages or consider alternative treatments that do not contribute to headache symptoms.

3. Lifestyle Modifications: Implementing regular sleep hygiene practices can be beneficial. This includes maintaining a consistent sleep schedule, creating a restful sleep environment, and avoiding stimulants before bedtime.

4. Physical Therapy: If tension-type headaches or cervicogenic headaches are suspected, physical therapy focusing on neck and shoulder relaxation techniques may help alleviate symptoms.

5. Keep a Headache Diary: Documenting the frequency, duration, and intensity of your headaches, as well as any potential triggers, can help your healthcare provider identify patterns and tailor treatment accordingly.

Accessing MRI Results
Regarding your MRI results, they are typically stored in a digital format that can be accessed by other medical facilities. However, it is advisable to request a copy of your MRI images and reports from the original hospital. This ensures that the new physician has all the necessary information to provide an informed opinion.

In conclusion, nighttime headaches can stem from various causes, and a thorough evaluation is crucial for effective management. By addressing lifestyle factors, reviewing medications, and consulting with specialists, you can work towards alleviating your symptoms and improving your quality of life.

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