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Q: When I wake up, I have a headache and can feel a pulse beating in my head. The headache is at the top of my head and moves toward the front. This is only when I first wake up and lasts about an hour. Should I be worried, or do anything about this?

— Tina, Georgia

A:  It is the lucky person who has never awakened with a headache! Having a headache is a universal experience and one of the most common reasons for visiting a physician.
There are many characteristics of headaches that help clinicians decide on the most likely explanation for the headache, and what, if any tests, are indicated. Questions that you may be asked include:

• Are the headaches new?
• Are they severe?
• Are they associated with other symptoms, such as weakness in a body part or altered sensation?
• What makes them better or worse?
• Where in the head do they start?
• Do they move to different places in your head?
• Do you have any problems with vision or balance?
• What time of day do they start?

Headaches that are prominent in the morning may be caused by sleep apnea, bruxism (grinding of the teeth), or depression. Interestingly, the early morning hours (between 4 and 8 a.m.) are when the body has its lowest levels of natural painkillers, so most headaches — including cluster headaches, migraines, and those caused by muscle tension — can be present and have their worst symptoms when you wake up. Only rarely is a morning headache the sign of a serious medical problem.
I strongly encourage patients to see a headache specialist whenever there is a change in the pattern of headache, such as when a person who has never suffered from headaches in the past starts having headaches, or when headaches become more frequent or change in character. A thorough evaluation will put your mind at rest and will develop an approach to combat your morning headaches.