Evening Headaches: Causes and When to Seek Help

Normal during the day, headache at night?

Hello Doctor, I apologize for bothering you.
Currently, I work in the morning and attend classes in the evening, with my sleep schedule being approximately from 12:00 AM to 6:50 AM.
I have experienced similar situations before, but they did not last this long.
During the day, I feel normal, but around my off-work time (5:30 PM) or in the evening before bed, I feel like my body temperature is elevated.
However, my temperature readings remain between 36.4°C and 36.8°C (in the morning, it's between 35.7°C and 36.2°C).
Additionally, I have started experiencing headaches that feel like a tight band around my head, with a pressure sensation.
I also feel light sensitivity and dizziness, but there is no nausea.
Sometimes, I suddenly feel a brief sensation of swaying, similar to an earthquake.
Pressing firmly on my temples alleviates the pain, but it continues once I release the pressure.
Occasionally, I also experience a rapid heartbeat.
After the headache starts, lying down with my eyes closed helps alleviate the pain, and after sleeping, I wake up feeling normal with no issues.
This situation has persisted for two consecutive weeks; previously, I had similar episodes, but only two or three times within a month.
This is the first time it has lasted this long.
I would like to ask if this situation requires a visit to the hospital for examination or if it could be a symptom of migraines.
Thank you, Doctor, for taking the time to respond.
I appreciate your help.

Miss Lin, 20~29 year old female. Ask Date: 2022/11/20

Dr. Peng Shiwei reply Neurology

Based on your condition, it is recommended that you visit a neurology outpatient clinic for further evaluation, as additional tests may be necessary.

Reply Date: 2022/11/20

More Info

Evening headaches can be a perplexing issue, especially when they occur consistently after a long day of work or study. Based on your description, it seems that you experience a tight, throbbing sensation in your head, accompanied by light sensitivity, dizziness, and sometimes an increased heart rate. These symptoms can be indicative of several underlying conditions, and understanding the potential causes is crucial for effective management.

Potential Causes of Evening Headaches
1. Tension-Type Headaches: Given your long hours of work and study, tension-type headaches are a common culprit. These headaches often result from muscle tension in the neck and scalp, which can be exacerbated by poor posture, stress, and prolonged screen time. The sensation of your head feeling "tight" aligns with this type of headache.

2. Migraine: Your symptoms, particularly the sensitivity to light and the throbbing pain, could suggest a migraine. Migraines can be triggered by various factors, including stress, lack of sleep, and dietary choices. The fact that your headaches improve with rest and worsen with activity is also characteristic of migraines.

3. Cervicogenic Headaches: These headaches originate from issues in the cervical spine (neck). If you spend long hours in front of a computer, it can lead to neck strain, which may contribute to headaches that worsen in the evening.

4. Sleep Deprivation: Your sleep schedule, which allows for only about 6-7 hours of sleep, may not be sufficient for optimal recovery, especially if you are under stress. Sleep deprivation can lead to increased headache frequency and intensity.

5. Dehydration or Hunger: Sometimes, headaches can be triggered by dehydration or not eating regularly. Ensure you are drinking enough water throughout the day and eating balanced meals.

6. Stress and Anxiety: Given your busy schedule, stress and anxiety can play a significant role in the development of headaches. The body’s response to stress can lead to muscle tension and headaches.

When to Seek Medical Attention
While occasional headaches are common and often manageable with over-the-counter medications, there are specific circumstances under which you should seek medical attention:
- Persistent Symptoms: If your headaches persist for more than a few weeks, as you mentioned, it is advisable to consult a healthcare professional. Continuous headaches can indicate an underlying condition that requires evaluation.

- Severity and Frequency: If the intensity of your headaches increases or if you experience them more frequently, this warrants further investigation.

- Accompanying Symptoms: If you experience additional symptoms such as vision changes, severe nausea, confusion, or neurological deficits (like weakness or numbness), seek immediate medical attention.

- Impact on Daily Life: If your headaches interfere with your ability to work, study, or engage in daily activities, it’s essential to consult a healthcare provider.

Recommendations for Management
1. Maintain a Regular Sleep Schedule: Aim for 7-9 hours of quality sleep each night. Establish a calming bedtime routine to improve sleep quality.

2. Stay Hydrated: Drink plenty of water throughout the day to prevent dehydration-related headaches.

3. Manage Stress: Incorporate stress-reducing techniques such as mindfulness, meditation, or yoga into your daily routine.

4. Posture and Ergonomics: Ensure your workspace is ergonomically designed to reduce neck and back strain. Take regular breaks to stretch and move around.

5. Consult a Specialist: If your headaches persist, consider seeing a neurologist or headache specialist for a thorough evaluation. They may recommend imaging studies or other diagnostic tests to rule out serious conditions.

In conclusion, while your symptoms may suggest tension-type headaches or migraines, it is essential to monitor their frequency and severity. Implementing lifestyle changes and seeking professional advice when necessary can help manage and alleviate your headaches effectively.

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