Hi

Thanks for asking.

Early morning headaches have a variety of causes, and needs to be investigated especially if it present for more than 2-3 years.

The most common types of headache are the "primary headache disorders", such as tension-type headache and migraine.
Do you have associated vomiting or nausea along with the pulsating headache, which is typical of migraine.
Tension headache presents with non-specific pain, along with band like sensation mainly on the back of the head.

Headaches may be caused by problems elsewhere in the head or neck. Some of these are not harmful, such as cervicogenic headache (pain arising from the neck muscles). Medication overuse headache may occur in those using excessive painkillers for headaches, paradoxically causing worsening headaches.

Headache that is worsened by straining or a change in position may be caused by increased pressure in the skull; this is often worse in the morning and associated with vomiting. Raised intracranial pressure may be due to brain tumors, idiopathic intracranial hypertension (IIH, more common in younger overweight women) and occasionally cerebral venous sinus thrombosis.

As your headache falls into the red flag sign (early morning) along with increased duration of 2-3 years, you need to get it checked, general physical examination along with imaging of the brain ( CT or MRI) is needed as soon as possible.

Thanks.

Please let me know if you have any other question.

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