Hypnic headache

Lawrence C Newman MD (Dr. Newman, Director of The Headache Institute at Roosevelt Hospital Center in New York received honorariums from Allergan, Nautalis, and Zogenix as a consultant and speaker and from Labrys and NuPathe as a consultant.)
Stephen D Silberstein MD, editor. (Dr. Silberstein, Director of the Jefferson Headache Center at Thomas Jefferson University, receives honorariums from Allergan, Avanir Pharmaceuticals, Curelator, Depomed, Dr. Reddy's Laboratories, eNeura,  INSYS Therapeutics, Lilly USA, Supernus Pharmacerticals,  Thernica and Trigemina for consulting. He is also the  principal investigator for a clinical trials conducted by Alder Biopharmaceuticals, Amgen, electroCore Medical, Lily USA and Teva.)
Originally released June 16, 1999; last updated September 20, 2014; expires September 20, 2017

This article includes discussion of hypnic headache, alarm-clock-headache syndrome, and clockwise headache. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Hypnic headache is an uncommon primary headache disorder characterized by relatively short-lived attacks of headache that occur only during sleep. This disorder must be distinguished from other primary sleep-induced headaches, such as cluster headache and migraine, as well as other secondary mimics. Once considered strictly a disorder of the elderly, hypnic headaches have been reported to begin much earlier in life. Prompt recognition and treatment will prevent unnecessary suffering.

Key points

 

• Hypnic headache is a primary headache characterized by short-lived headaches that occur exclusively during sleep.

 

• Originally believed to be a disorder of the elderly, subsequent reports suggest that the disorder may begin earlier, but many patients suffer for decades before the diagnosis is made.

 

• As with all primary headache disorders, the diagnosis is predicated on exclusion of secondary mimics (posterior fossa and pituitary lesions, nocturnal hypertension).

 

• Evidence suggests that there may be a decrease in gray matter volume in the posterior hypothalamus.

 

• First-line therapy is bedtime doses of caffeine; second-line agents include indomethacin or lithium.

Historical note and terminology

Hypnic headache syndrome is a recurrent, benign headache disorder that occurs exclusively during sleep and usually begins after the age of 50 years. This rare syndrome was first characterized by Raskin in 1988, when he described 6 patients who were awakened regularly from nocturnal sleep by a short-lasting headache (Raskin 1988). In Evers and Goadsby's review published in 2003, the authors reported that 71 cases were identified in the literature (Evers and Goadsby 2003). There are now more than 170 cases reported, and therapeutic options have expanded (Gil-Gouveia and Goadsby 2007; Lanteri-Minet and Donnet 2010; Obermann and Holle 2010; Diener et al 2012; Jimenez-Caballero et al 2012; Mulero et al 2012; Holle et al 2013; Patel 2013).

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