Migraine episodes can strike at any time, including at night or while you’re sleeping.

Migraine is a neurological condition that can cause severe headaches and other symptoms like nausea or vomiting.

Roughly 17.6% of women and 5.7% of men have at least one migraine episode per year. It’s not a life threatening condition but can be very painful and disruptive to your life.

The underlying cause of migraine still isn’t well-understood, but poor sleep and disrupted circadian rhythms are potential triggers for some people. Some research has also connected migraine episodes to nightmares.

Keep reading to understand more about why you might develop migraine episodes at night and how they’re treated.

Researchers aren’t exactly sure why migraine episodes develop or why some people develop symptoms at certain times of the day. The following factors may contribute.

Poor sleep quality

Not getting enough sleep or not getting quality sleep can potentially trigger migraine symptoms. Poor sleep quality doesn’t necessarily make you more prone to developing migraine episodes at night, but it does seem to make you more prone to developing migraine episodes in general.

In a 2016 study from Taiwan, researchers found migraine episode frequency correlated with poor sleep quality for people with migraine with aura and without aura.

In a 2022 study, researchers found that the risk of migraine in people with poor sleep quality was about four times higher than in people with good sleep quality.

In a 2022 review, researchers found evidence that chronic migraine is associated with poor sleep quality and that poor sleep quality is linked to worse migraine headache pain.

Circadian rhythm factors

Your circadian rhythm is your body’s internal clock that regulates your sleep-wake activity in 24-hour cycles. Some research suggests that migraine episodes might be more common at certain times in your circadian cycle.

In a 2019 review of studies, researchers found that studies report migraine episodes most often in the early morning or late at night. However, there’s a significant amount of contradiction between studies.

Chronotypes

It’s been hypothesized that migraine episodes might also strike more often at certain times related to your individual circadian rhythm.

People are often classified into “chronotypes” based on their inclination to stay up late or go to bed early relative to the sun cycle.

In a 2017 study, researchers found evidence that people who experience migraine episodes are more likely to fit into one of these two chronotypes and less likely to follow a more typical sleep schedule.

The researchers also found night owls were slightly more likely to experience headaches between 6 p.m. to midnight and morning larks were more likely to have migraine episodes in the mornings.

Timing of medication

According to the American Migraine Foundation, people are particularly vulnerable to migraine episodes in the early morning because most pain medications wear off after 4 to 8 hours, especially if these medications are overused.

If you stay up very late or take your medication early in the day, it’s plausible that it could start to wear off before you go to bed and make you more prone to migraine episodes.

Nightmares

A small number of studies have found a link between nightmares and increased nighttime migraine episodes. More research is needed to understand the link.

It’s been hypothesized that strong negative emotions during nightmares may be a trigger for migraine episodes.

In an older study from 1984, researchers categorized 23 dreams that occurred with migraine episodes into 1 of 6 categories. They found that by far that the largest category of dreams was “dreams of terror.”

Migraine episode frequency tends to diminish during pregnancy. It’s been hypothesized that this is because of increased estrogen levels, but more research is needed to understand the connection.

Some people do experience worse or more frequent migraine episodes during pregnancy.

Migraine symptoms at night are similar to those during the day. They can include:

Sometimes an aura occurs before or during the headache. It can cause symptoms like:

Hypnic headaches occur exclusively during sleep. They most often affect people over 50 and are characterized by headaches more than 15 times per month.

Hypnic headaches can feel similar to migraine headaches, but they only occur at night. They’re also called “alarm clock headaches” because they often happen at the same time each night.

Migraine headaches often cause pain on one side of your head. Hypnic headaches usually cause pain that spreads across both sides of your head. A doctor can help you figure out if you’re experiencing hypnic headaches or migraine headaches based on your symptoms and when your headaches occur.

Migraine doesn’t have a cure, but treatment can help you manage your symptoms.

Home remedies and over-the-counter treatment

Many people find they can reduce the severity of their migraine headaches by:

Over-the-counter (OTC) medications that may ease your symptoms include:

Medical treatment

Medications for migraine pain include:

Medications that can help you prevent future migraine episodes include:

It’s important to get medical help you if have severe or frequent migraine symptoms that are disrupting your sleep. Any time a headache wakes you from sleep, it’s suggested you see a doctor for evaluation, as a headache can be a symptom of a more serious underlying cause.

It’s also important to get medical help if your symptoms worsen.

Medical emergency

Call emergency medical services or go to the nearest emergency room if you or somebody you’re with develops emergency symptoms, such as:

  • paralysis or weakness in one or both limbs
  • slurred or garbled speech
  • sudden headache causing worse pain than you’ve previously experienced
  • trouble speaking
  • confusion
  • a high fever

Focusing on getting high quality sleep and staying on a regular sleep schedule might help you prevent nighttime migraine episodes. You may be able to improve your sleep quality by:

  • going to bed only when you’re ready to sleep and avoiding using a screen in bed
  • trying to stick to the same sleep schedule every night
  • exercising regularly
  • making your bedroom as quiet as possible
  • avoiding drinking an excess amount of fluids before bed
  • avoiding alcohol before bedtime

Researchers aren’t exactly sure what causes migraine. Some people develop migraine episodes while they’re sleeping or at night. Factors like poor sleep and disrupted sleep cycles may potentially trigger migraine episodes. A few small studies have also linked nighttime migraine to nightmares.

Migraine headaches that occur at night can be confused with another headache disorder called hypnic headaches. A doctor can help you determine whether you’re experiencing migraine and how you can best manage your symptoms.