In the past three years, I’ve solved a lot of health riddles. I’ve gotten leaner, cured my rosacea, discovered the root causes of my back pain and I almost never get colds anymore. However, one huge mystery remains and it has me stumped. For over 15 years, I will often wake up around 3 AM with a sinus headache. Not every day, but in patterns.
Because the patterns seemed to be erratic, it has been impossible for me to tell if a change that I initiate helps, doesn’t help, or partially helps. About 100 days ago, I started a headache journal. I was hoping that this exercise would shine a light on the guilty party to my headaches, but it has left me more confused.
I do not see a correlation between weather, pressure, pollen, coffee intake, chocolate, Neti pot use, or even the use of a few supplements. Note that this is not a Seattle thing. I had these headaches when I lived in San Diego, Northern Virginia, and Tampa Bay. My sister has them in Columbus. I’ve tried different pillows and different beds. I’ve eliminated wheat, alcohol, and most sugar. The headaches persist.
Photo by URBAN ARTefakte
My headaches wake me up at night. I have pressure around my eyes and nose. Whenever I lift my head off the pillow, the pressure decreases and my headache intensity declines. Caffeine helps. As a result, there have been many mornings in the past decade where I am sitting up drinking coffee or tea at 4 AM. It kills the headache, but then I’m unable to return to sleep.
Coffee and tea work so does patience and just having my head upright. Over-the-counter medication is pretty much worthless. I’ve had minor success with Mucinex-D, but then only for a limited amount of time and I can’t say for certain if it was the reason or something else.
Note that these feel nothing like the pain I feel when I cut way back on caffeine. These are completely different. A headache from caffeine withdrawal feels the same whether I am lying down or standing up. The headaches I am trying to prevent are far more intense when lying down.
I was positive my headache was sinus in nature until last week. Then I read about a study that said most people who believe they have sinus headaches don’t. From “Sinus Headache” May Be Migraine (2023: article offline):
A startling 97% of the participants, self-described sinus headache sufferers, actually had symptoms consistent with Migraine attacks as defined by the criteria of the International Headache Society.
My sinus headaches never lead to any mucus drainage or sickness. This may mean that I’m not suffering from sinus headaches. They may be migraines.
I’ve always discounted the idea that I suffer from migraines. Going through the Bellaire Neurology site, I made a list of the common elements for migraine headaches. They include:
- Lasting 4-72 hours.
- Throbbing pain often one-sided.
- Made worse by physical activity.
- Nausea or vomiting or photophobia (light sensitive) or phonophobia (sound sensitive).
- Speech difficulty.
- Runny nose or sinus stuffiness.
The only symptom that I have on that list is sinus stuffiness. None of the others apply. Not even close. This makes me think it may not be a migraine.
Cluster headaches are supposedly the most painful headaches and can even drive people to suicide. I do not believe I have cluster headaches, but I’m putting it on the list because I do have two of the symptoms.
- Often occur at night and they wake the sufferer.
- The headache is short in duration.
However, other symptoms do not match at all. It is said the pain feels like an ice pick pounding into your eye. Since I can’t measure the pain I’m feeling with someone else, I don’t know how severe my headaches are. They do vary in intensity and the majority are not the most severe. So I don’t think this is it, but it does share some similarities.
Then I read about hypnic headaches. From Hypnic Headaches – The Basics (2023: article offline):
Hypnic headache (HH) is a rare primary headache disorder (primary headache disorders are those that cannot be attributed to another condition.) It’s most identifying feature is that it only develops during sleep and wakes the sufferer.
It goes on to say that the pain lasts from 15 to 180 minutes and that caffeine helps. This type of headache, unlike migraines, has no nausea, photophobia, or phonophobia symptoms. So far it sounds like I found the answer. Then I got to this part of the diagnosis chart:
At least two of the following characteristics:
- occurs 15 or more times per month
- lasts 15 or more minutes after waking
- first occurs after age of 50 years
From my headache journal, you can see that these waking headaches occurred 40 times in 100 days. That is less than the threshold defined above. Also, if you just count those headaches where I define the intensity as a 3 or greater (out of 5), that number falls to just 21 times. Symptom #2 is mostly accurate, although I’ve had less severe headaches that went away minutes after sitting up. Symptom #3 is false, as these headaches started in my 20s.
I have no clue what type of headache I have. For all I know, there may be another type of headache that fits my condition. My current health insurance only protects me for catastrophic events, so seeking specialists is not an option. My headaches aren’t any worse today than they were 5 years ago. I am motivated by my success in solving other health riddles so that maybe I can figure out the root cause and solution for these headaches.
I am hoping to discover a non-pharmaceutical solution. I prefer to work from the premise that I am not broken, but may need to tweak something in my diet or environment. I’m going to cut my caffeine intake by 50% for a month to see if it has any effect. If you have any insights or ideas, please leave them in the comments. Thanks.
Follow-up: Hunting Headaches Take 2
Jul 3, 2011 — 9:53 am
Sorry to hear about your struggles. It does sound baffling.
Have you experimented with aromatherapy (particularly lavender)?
A massage every 10-14 days always goes down well with me.
You could also try an aromtherapy room diffuser…
Jul 3, 2011 — 2:13 pm
@GWhitney – Interesting idea. I had never thought of aromatherapy. I’m going to give it a try. I love the smell of lavender.
Jul 3, 2011 — 2:53 pm
Sorry to hear about this. In my childhood I was prone to migraine headaches. My parents ultimately resorted to pharmaceuticals for me. Can’t even remember the medication now, but I do recall building a monster tolerance to it. At first a 1/2 tablet knocked me out for hours. After a while 2 didn’t even put me to sleep (and, no, I didn’t have a big growth spurt in the middle). The ultimate solution for me was identifying my triggers and then avoiding them. This was a long, painful process of self-experimentation that was also tremendously empowering. For the first time in my life I felt that I was in control of my headaches, instead of them controlling me. The last time I had a migraine was probably 4 years ago because I was under circumstances in which I couldn’t avoid simulateneous exposure to three of my primary stressors (lack of sleep, stress, and second-hand cigarette smoke). This shows to me that I didn’t “outgrow” my headaches – which is what people often think when they hear about my experience. I am still vulnerable, just more knowledgeable.
Enough about me – what to do about you? The baffling part of your experience to me is that they come on while you are asleep. So I’m inclined to rule out external triggers as the cause. If caffiene helps (it sometimes did with me when I was a kid, as did sugar), then perhaps it is due to its vasoconstricting effects. One cause of headaches is blood vessel dilation in the head. Caffiene may undo that dilation. But that’s just a possible mechanism.
Here’s the theory: You’ve adapted to a level of caffiene induced vasoconstriction over time with caffiene use (I note your caffiene coffee consumption has increased since March/April). The effect of the caffiene dose begins to wear off early in the AM. You are asleep and lying down, so vasodilation results in an increase of blood flow to the head. This results in a headache. Sitting up reduces some of the flow and eases the pain. Caffiene use constricts the blood vessels and the cycle begins again. If this is the theory then cutting caffiene may be really bad in the short term but essential for a long term solution.
I’m no specialist though, just a guy who learned how to deal with headaches “the hard way.” Hang in there and keep doing the analysis. You conqured back pain and will knock this one down too.
Jul 3, 2011 — 5:36 pm
@Geoff – Thanks for the feedback. Last summer I cut way back on caffeine and felt great. Unfortunately, I wasn’t tracking headaches then. I do think it is a good idea to take a break from caffeine. One thought is that with much lower levels of caffeine, my sleep will be deeper. If the sleep is deep enough, I might be able to sleep through headaches of lower intensity. I’d much rather deal with a headache after 8 hours of sleep than after 4 or 5.
Jul 3, 2011 — 7:00 pm
No expert opinion here but my handbook on Neuromuscular Therapy (massage) indicates many muscle and connective tissue trigger points around the Sternocleinomastoid and Cervical Spine that can refer pain to the sinus and other areas. I would hazard to point the finger at postural strain and the use of the head and neck in relation to your occupation.
“How many different complains turn up at the doctor’s office which may, in fact, have their origins in trigger points of the SCM? Headaches, neck aches, earaches, eye aches … sinus aches, sore throats and even involvement in TMJ dysfunctions. … Clients can be taught — and encouraged — to work on this muscle for themselves.”
NMT may be helpful.
Alexander Technique has been clinically demonstrated to improve posture, reduce pain (studies addressing common low back pain below) and ease movement of all sorts.
Specific Yoga exercises and a regular practice could be helpful. Note that not all yoga are the same or even beneficial and I wouldn’t recommend many popular versions of it to anyone. The practices promoted by TKV Desikachar would be a reasonable point of entry for therapeutic purposes. See also BKS Iyengar.
Final comment is that I’ve had some success with a very skilled acupuncturist for stubborn chronic pain and old injuries. Some studies have shown this work to be effective for specific ailments like insomnia, headache and chronic pain, but finding a skilled and knowledgeable practitioner in a culture of new age snake-oil profiteers (I’m in California) can be difficult. Try to get a reference from someone you trust and identify well with since the placebo effect, though it works, is well represented in these more subtle modalities.
Jul 3, 2011 — 7:36 pm
@Justin – You’ve given me something interesting to think about. Do I get more headaches after spending more time on the computer? I’m guessing that would most likely be the time that my neck posture could be the most compromised.
When it comes to pain, such as back, shoulder and neck, I actually feel great right now. Better than I have in many years. I do a neck mobility exercise routine every 5th day that I think has really helped me.
Thanks for all the links.
Jul 4, 2011 — 4:21 am
I struggled for several years with severe headaches that woke me up during the night. I eventually figured out that they were tension headaches (referred pain from the neck and lower in the spine). Chiropractic has helped immensely, as well as learning some more effective neck mobility exercises (using a towel to create traction). I still wake up with headaches occasionally, but I have trained myself to go back to sleep and know that I can deal with it in the morning. Mine improve upon sitting up and having a cup of coffee as well.
Jul 4, 2011 — 8:27 am
@Lynn – Thanks for the ideas. I am going to start doing neck mobility work, including the towel exercise just before bed.
Jul 4, 2011 — 11:15 am
I still think you should take a look at dairy. Also, one thing you don’t seem to have followed up on (at least here) is the fact that your sister gets them too. I assume her lifestyle is pretty different from yours – eats SAD, not very active, probably not as much computer time. Have you compared notes with her? Do her headaches follow a pattern similar to yours? If so, maybe you both just picked the wrong parents 🙁
Jul 4, 2011 — 11:26 am
@Marian – Dairy is where I draw the line. Without dairy, I’m certain I’d lose muscle. Unacceptable alternative. I’d rather have headaches than atrophy. Plus, I consume dairy daily, yet the headaches of concerning intensity happen just 20% of the time.
However, I did read that aged cheese can be problematic for those with migraines (and I still am not sure if I in the migraine camp).
From What’s Triggering Your Migraine?:
So I can swap out cheddar cheese for cottage and cream cheese. I can certainly test that.
Jul 4, 2011 — 4:32 pm
Have you considered your salt intake? Fermented foods often contain a considerable amount. Also, fermented foods can trigger migraines.
Jul 5, 2011 — 8:21 am
@Rachel – I’ve only been doing the fermentation for less than 2 years, yet these headaches have gone on much longer. Also my ferments use very little salt (compared to other recipes). If the fermented foods are problematic then something else of equal magnitude was bothering me prior to my kimchi hobby. Probably not likely.
Jul 5, 2011 — 6:00 pm
I have used peppermint oil with some success in the past. I’ll put a dab under my nose. I also found this online:
Create your own healing peppermint massage oil which can be applied topically to help relieve a headache. Mix equal parts of peppermint essential oil and extra-virgin, cold pressed olive oil and gently massage into your temples, jaws and the back of your neck. Do not wipe off the oil when finished, rather allow it to absorb fully into your skin.
Use a peppermint steam treatment, particularly if your headache is caused by sinus pressure. Boil a small pot of water and remove from heat, adding 10 drops of peppermint essential oil. Drape your head with a towel and lean over the steaming water, inhaling deeply for 10 minutes.
Jul 5, 2011 — 6:43 pm
@Melissa – Cool. Thanks for the tip.
Jul 22, 2011 — 1:39 pm
Not sure if you’ve had any resolution on your headaches yet but I just wanted to offer my solution.
I thought I had sinus headaches for a number of years as well. I had an MRI of my neck years back and they said that although I had a bulging disk, a lot of people had that and it didn’t cause headaches. Well perhaps that’s true but how many of those people have swollen muscles in their neck as well.
I finally had a physical therapist tell me to clasp my hands behind my head and push my head up against my hands. If I experienced any relief at all, there was a good chance it was coming from my neck. I tried it and I did have some relief. It turns out my neck muscles would swell after a work out or any type of ordinary lifting at all. My headaches generally came on around 3 as well so sleep position may have been at play.
Regardless, I got some great excercises to use, plus I learned how to relax those muscles when I felt a headache coming on. I haven’t had a headache since (about 9 months now)
Hope this helps!
Jul 22, 2011 — 4:17 pm
@Dee – Interesting thought. I did have back X-Rays taken a few years ago and nothing was spotted. I’ll put it on the radar. My latest ideas seem to be failing.
May 3, 2012 — 8:40 am
Dee, I suffer from almost the exact same headaches as Michael for the last 6-7 yrs I am 43. I am very interested in knowing the exercises you have used. I am currently seeing a chiropractor once again because I am up every hour on the hour again at night, got some relief but not enough. He does seem to think they are neck related and possibly poor nutrition. Waiting for a total nutrient test to come back, Vitamin D level came backI’m at a level of 21 and started 8000units per day of Vitamin D 3 drops will recheck in 6 weeks. Thanks for any info.
Apr 16, 2014 — 12:00 pm
Closing comments on this post.