Medically reviewed guide · Last updated: 1 September 2026 · Reading time: approx. 10 min

Morning Headaches: Sleep Apnoea, Teeth Grinding or Painkiller Overuse?

The most common causes compared

The causes in detail

What is special about morning headaches is that they are already there when you wake up, or they wake you in the early hours. The causes therefore almost always lie in the night. How migraine, tension-type headache and other forms of headache work in principle is explained in the article on headaches; dull pressure with no fixed link to the time of day is covered in the article on head pressure. This article is only about what happens between falling asleep and waking up.

Sleep apnoea and breathing disorders at night

In obstructive sleep apnoea, the muscles in the throat relax during sleep and the airway collapses again and again. This leads to pauses in breathing: oxygen falls, carbon dioxide rises, the blood vessels in the brain widen, and sleep is fragmented by many brief arousals. The international headache classification describes a headache of its own for this: on waking, usually on both sides and pressing, without nausea or sensitivity to light, and gone again within four hours. With effective treatment, it usually improves.

Other clues are loud, irregular snoring with pauses and gasping for air, a dry mouth in the morning, needing to pass urine at night, daytime sleepiness, problems concentrating and high blood pressure that is difficult to control. Being overweight, older age, being male, alcohol in the evening and sedating medicines increase the risk. Morning headaches can also be a sign that, with severe lung disease or severe obesity, too much carbon dioxide remains in the blood at night — a case for a lung specialist. Everything about diagnosis and treatment is in the article on sleep apnoea.

Teeth grinding and jaw clenching

In sleep bruxism, the chewing muscles work rhythmically against each other at night — with grinding noises or clenching silently. Most people do not notice it themselves, only in the morning: the chewing muscles and temples hurt, the jaw is tired, sometimes the jaw joint clicks, and the teeth are sensitive or show signs of wear. Often a bed partner hears the noises. Stress, anxiety, alcohol, caffeine, smoking and certain medicines encourage grinding; it not infrequently occurs together with sleep apnoea.

The first port of call is the dental practice. A bite splint reliably protects the teeth. Whether it also relieves the headache is less well established — stress reduction, relaxation exercises for the jaw and, if needed, physiotherapy also help.

Medication overuse: the tablet as the trigger

If you take painkillers or migraine medicines very often for migraine or tension-type headache, you can develop medication-overuse headache. It is typically already there when you wake up, dull and pressing, often daily. That tempts you to take another tablet first thing in the morning — a cycle that keeps itself going. The details are in the medication section further down.

Caffeine, alcohol and the weekend headache

Caffeine levels fall overnight. If you regularly consume a lot of coffee, tea, energy drinks or cola, you can get a withdrawal headache in the morning — especially at the weekend, when the first coffee comes later. It typically improves quickly after the first cup. At weekends, a changed sleep rhythm, sleeping longer and the easing of stress add further triggers. Alcohol causes a delayed headache the next morning, disturbs deep sleep and makes snoring, sleep apnoea and grinding worse.

Too little, too much or restless sleep

Both too little sleep and unusually long sleep can trigger headaches in the morning, as can shift work and frequent waking at night. Morning headaches are common with sleep disorders and with depression involving early waking. Conversely, headaches disturb sleep — often the only thing that helps is to tackle both together.

Migraine and special forms at night

Migraine attacks often begin in the early hours of the morning, so many people with migraine already wake up with an attack — throbbing, usually on one side, with nausea and sensitivity to light; more on this in the article on migraine. Cluster headache tends to wake people during the night, often one to two hours after falling asleep: strictly on one side around the eye, extremely severe, with a watering eye, a runny nose and restlessness. A rare form in people over 50 is hypnic headache, which regularly wakes people from sleep at the same time of night. Both belong in the hands of a neurologist.

Low blood sugar at night and blood pressure

With insulin or sulfonylureas, blood sugar can fall too low at night without you noticing. Clues are headaches in the morning, restless sleep, bad dreams and night sweats. As for blood pressure: only very high, usually untreated readings cause headaches, and then typically in the morning at the back of the head. In the second half of pregnancy, a new headache with vision problems, upper abdominal pain and swelling can point to pre-eclampsia.

Sleeping environment: carbon monoxide, air and pillows

Carbon monoxide is produced by incomplete combustion — from faulty gas boilers, gas water heaters, wood-burning stoves, charcoal grills or gas heaters used indoors. It is invisible and odourless and causes headaches, dizziness, nausea and lightheadedness. Typically, several people or pets are affected, and things get better outdoors. More harmless causes are stuffy, dry bedroom air, a nose that is blocked at night, and an awkward head position with a pillow that is too high or too flat, which makes the neck tense.

Rare: raised intracranial pressure

When you lie down, the pressure inside the skull rises slightly. That is why headaches caused by raised intracranial pressure — for example with tumours or idiopathic intracranial hypertension — are often at their worst in the morning. What matters are the accompanying signs: an increase over weeks, vomiting in the morning, worsening when coughing or straining, vision problems, new neurological deficits or a change in personality. This is rare, but it should be assessed promptly.

Self-tests: first clues at home

These observations do not replace a diagnosis, but they provide exactly the information your practice will ask about.

• The partner question: ask whether you snore loudly, stop breathing, gasp for air or grind your teeth. If you sleep alone, an overnight audio recording can give first clues — but it is not a diagnosis.
• The STOP-Bang questionnaire: eight questions on snoring, tiredness, observed pauses in breathing, high blood pressure, a body mass index over 35, age over 50, neck circumference over 40 cm and male sex. From three "yes" answers the likelihood of sleep apnoea rises, and from five it rises markedly.
• The Epworth Sleepiness Scale: how likely are you to doze off in eight everyday situations, such as while reading or as a passenger in a car? More than ten out of 24 points suggests excessive daytime sleepiness.
• The jaw check: are your chewing muscles and temples tender in the morning, your jaw tired and your teeth worn down, and does the edge of your tongue show tooth marks? That points to clenching or grinding at night.
• The painkiller count: for a month, mark every day on which you take a painkiller or migraine medicine. From ten days a month, medication-overuse headache is possible.
• The caffeine and location test: does the headache come mainly when your coffee comes later, and does it disappear afterwards? Then caffeine withdrawal is likely. If, on the other hand, it gets better away from home and others are affected too, think of carbon monoxide.
• The four-week diary: bedtime, waking time, alcohol, evening medicines, headache on waking, its intensity and duration. The guide Keeping a pain diary explains how.

Warning signs: when not to wait

• Several people or pets in the household have headaches, dizziness or nausea at the same time
• Morning headaches that increase over weeks, with vomiting or worsening when coughing and straining
• New paralysis, difficulty speaking or seeing, a seizure, confusion or a change in personality
• A sudden, extremely severe headache, or headache with fever and a stiff neck
• In the second half of pregnancy: headache with vision problems, upper abdominal pain or rapidly increasing swelling
• Morning headaches appearing for the first time from the age of 50 or after a head injury
• Pauses in breathing with daytime sleepiness so severe that you nod off at the wheel or at work

The treatment pathway: step by step

1. Observe for two to four weeks. Keep a diary, cut out alcohol in the evening, keep regular sleeping times at weekends too, keep your caffeine intake steady and count your painkiller days.
2. Assessment at the GP practice. A conversation about sleep, snoring, the jaw and medicines, blood pressure measurement, a physical and neurological examination and, if needed, blood tests.
3. If sleep apnoea is suspected. An outpatient sleep study at home (polygraphy) and, if needed, a night in a sleep laboratory. Treatment is usually with positive airway pressure through a mask at night (CPAP), and for milder forms also with a mandibular advancement splint, positional therapy and weight loss.
4. For grinding. Dental practice, bite splint, stress management and jaw exercises.
5. For overuse. A medically supervised break from the medication, often at a neurology practice or a headache centre, plus prevention of the underlying headache disorder.
6. For warning signs or an unusual pattern. A neurological assessment and, if necessary, an MRI scan. Which treatment is suitable is decided by the practice treating you, together with you.

The medication angle: what works overnight — and what lingers

Painkillers and migraine medicines

Overuse means taking simple painkillers such as ibuprofen, acetylsalicylic acid or paracetamol on 15 or more days a month, or triptans such as sumatriptan, combination products or opioids on ten or more days, in each case for more than three months. According to the guideline, what helps is education, a medically supervised break and preventive treatment of the underlying headache disorder; opioids are only reduced gradually. In the first few days the headache can get worse; after that, it improves markedly for many people. The German Migraine and Headache Society (DMKG) recommends the 10-20 rule: painkillers on no more than ten days a month, and none on at least 20 days. Without medical advice, the package leaflet usually says not to take over-the-counter painkillers for longer than three to four days in a row. The painkiller comparison gives an overview.

Sleeping pills, sedatives, opioids

Benzodiazepines, Z-drugs and sedating antihistamines can leave a hangover effect in the morning with headache and lightheadedness. More importantly, they relax the throat muscles and dampen the arousal response — existing sleep apnoea can get worse as a result. Opioids can also make breathing disorders at night worse. If you snore and take sleeping pills, raise this at your practice.

Antidepressants and stimulants

SSRIs and SNRIs such as sertraline or venlafaxine, as well as stimulants such as methylphenidate, can trigger or worsen teeth grinding at night. If morning headaches with a tired jaw start shortly after beginning treatment or increasing the dose, it is worth asking your practice.

Evening vasodilators, diabetes medicines, hormones

Nitrates, erectile dysfunction medicines and calcium channel blockers can cause headaches — if they are taken in the evening, this often shows in the morning. Insulin and sulfonylureas can cause low blood sugar at night; the practice can adjust the dose or timing or recommend a night-time measurement. Products containing oestrogen can trigger a withdrawal headache during the pill-free interval, and melatonin also lists headache as a possible side effect.

How to prevent morning headaches

• Little alcohol in the evening — and sleeping pills only after talking to your practice, especially if you snore.
• A regular sleep rhythm — similar bedtimes and getting-up times at weekends too.
• Steady caffeine — or cut down gradually rather than stopping abruptly.
• Count painkiller days — the 10-20 rule protects against medication-overuse headache.
• CO alarm and maintenance — a carbon monoxide alarm in rooms with a gas boiler or stove, and regular inspection of heating appliances and chimneys.

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