Headaches causing early morning waking, or headaches which are more prominent on waking, always raise the suspicion of raised intracranial pressure, and hence the need for prompt evaluation to exclude the diagnosis of a brain tumour (particularly if they are associated with vomiting and papilloedema). However, there are many other much more common causes of “morning headache”, both primary and secondary. As ever, history taking is key to the diagnosis. Attention to the possibility of analgesic medication overuse is particularly pertinent, but other treatable conditions such as depression and epilepsy must not be overlooked.
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