A headache when lying down can result from various causes, including changes in cerebrospinal fluid pressure, nasal congestion, and brain tumors.

Identifying the underlying cause is important, as it can vary from positional changes to health conditions such as high blood pressure or nasal blockages.

Read on to learn more about the possible causes of headaches when lying down, treatment, and how to prevent them.

Several factors can cause a headache when lying down but not standing.

Elevated intracranial pressure headaches

High blood pressure headaches, or idiopathic intracranial hypertension (IIH), result from increased pressure within the skull due to excess CSF or the brain’s hypersensitivity to this pressure.

Risk factors and triggers

Possible risk factors of IIH include:

  • obesity
  • chronic hypertension
  • being female and of childbearing age

Preventing elevated intracranial pressure headaches

To prevent elevated intracranial pressure headaches, consider:

Hypnic headaches

Also called alarm clock headaches, these rare headaches typically start during sleep, often at the same time each night.

Risk factors and triggers

Although the specific triggers for headaches at night are not fully understood, adults over age 50 are more likely to experience hypnic headaches.

Preventing hypnic headaches

While there’s no definitive way to prevent hypnic headaches, preventive strategies may help suppress these headache episodes. These include:

  • incorporating a regular sleep schedule
  • drinking a cup of strong coffee before going to bed
  • taking prescribed medications like lithium carbonate

Brain tumor

A brain tumor is a cluster of atypical cells that grow in the brain and can be malignant (cancerous) or benign (noncancerous). These tumors can elevate intracranial pressure (ICP), a serious medical condition that can lead to various symptoms, including headaches while lying down.

Risk factors and triggers

Certain risk factors can increase the risk of developing brain tumors. These include:

  • having a weakened immune system
  • family history of brain tumors
  • exposure to radiation therapy

Preventing tumor

While preventing brain tumors may not be possible since the exact causes are not fully understood, you can take steps to prevent elevated ICP, such as wearing protective headgear during activities that may cause head injuries that lead to intracranial hemorrhage and getting regular medical checkups.

Cervicogenic headaches

Cervicogenic headaches cause pain that begins in the neck and radiates to the head. They’re often triggered by specific neck movements or positions, such as lying down.

Risk factors and triggers

The risk factors of cervicogenic headaches include:

  • being middle-aged
  • neck injuries or conditions like osteoarthritis in the neck
  • poor posture when sitting or standing

Preventing cervicogenic headaches

Prevention of cervicogenic headaches involves avoiding triggers, which may include:

  • maintaining proper posture
  • taking breaks during prolonged sitting or standing
  • seeking prompt medical treatment for any neck injuries

Nasal congestion

Nasal congestion occurs when the blood vessels in your sinuses become inflamed, causing your nose to feel blocked or stuffy.

Risk factors and triggers

Various factors may trigger or increase your risk of developing nasal congestion, including:

Preventing nasal congestion

You may prevent nasal congestion by:

  • limiting your exposure to allergens
  • staying hydrated
  • using a humidifier at home
  • treating any underlying structural anomalies (this can involve a surgical procedure)

If you experience worse headaches when lying down, it may be due to positional changes in intracranial pressure, which intensify pain in migraine episodes.

Lying flat can also lead to sinus pressure buildup and worsen frontal headaches. Stress and poor posture may strain neck muscles and trigger a tension headache when lying down.

These types of headaches vary in intensity or occurrence when you change your body position. However, they usually occur when moving from lying down to standing.

Risk factors and triggers

Risk factors for developing a positional headache include:

Preventing positional headaches

Preventing positional headaches may involve:

  • avoiding postures that trigger symptoms
  • managing CSF pressure
  • staying hydrated

Speak with a healthcare professional if:

  • you experience sudden, severe headaches
  • other symptoms like fever, stiff neck, confusion, and seizures accompany your headache
  • your headache occurs after a head injury

A healthcare professional will begin by taking a thorough medical history. They will then perform physical and neurological examinations to determine the type of headache and whether there are any neurological problems.

If they suspect an underlying condition, they may order imaging tests like MRI or CT scans to rule out other conditions.

Some home remedies and medical treatments can help relieve headaches and head pressure when lying down.

Home remedies may include:

  • adjusting your sleep position
  • staying hydrated
  • maintaining a regular sleep schedule
  • applying a cold or warm compress, depending on the type of headache
  • practicing relaxation techniques to manage stress-related headaches

Medical treatments include:

  • over-the-counter pain relievers like acetaminophen (Tylenol) or prescription medications for severe headaches
  • physical therapy for people with cervicogenic headaches
  • saline nasal spray used before bed to clear sinus passage, if a sinus infection contributes to your headaches

Here are some frequently asked questions about headaches when lying down.

What causes throbbing pressure in the head when lying down?

A sinus infection may cause throbbing pressure in the head when lying due to fluid accumulation in the sinuses, leading to increased pressure on certain parts of your head or face.

What can cause a frontal headache when lying down?

Frontal headaches when lying down can often result from sinus infections that worsen when you’re lying flat.

What is a positional headache red flag?

A positional headache red flag is a headache that worsens when you stand up and subsides when you lie down, or vice versa.

A headache that worsens when you stand up can indicate secondary conditions, such as intracranial hypotension.

A headache that worsens when you lie down can be a sign of increased ICP, such as from idiopathic intracranial hypertension (IIH) or a brain tumor.

Several things can cause headaches when lying down, including elevated ICP. However, if the pain is affecting your daily routine or is accompanied by symptoms such as confusion, seizures, or fevers, consider speaking with a healthcare professional for a thorough evaluation and appropriate management.