Hypnic headache

Daniel Ackerman MD (

Dr. Ackerman of Lewis Katz School of Medicine at Temple University and Director of Stroke and Vascular Neurology at St. Luke’s University Health Network received honorariums from Janssen.

Sameer Ali MD (

Dr. Ali of VA Connecticut Health Care System, Yale School of Medicine, and St. Luke's University Health Network has no relevant financial disclosures.

Ilya Bragin MD (

Dr. Bragin of St. Luke’s University Health Network has no relevant financial disclosures.

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 August 28, 2018; expires August 28, 2021

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.


Hypnic headache is an uncommon primary headache disorder characterized by relatively short-lived attacks of headache that occur only during sleep often with striking circadian rhythmicity. This disorder must be distinguished from other primary sleep-associated headaches, such as cluster headache and migraine, as well as secondary mimics. Once considered strictly a disorder of the elderly, hypnic headache has been reported to begin much earlier in life. As many patients derive significant benefit from preventative treatment, prompt recognition and management is crucial to prevent unnecessary suffering.

Key points


• Hypnic headache is a primary headache disorder 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 causes (posterior fossa and pituitary lesions, nocturnal hypertension) and other mimics.


• Evidence suggests that there may be an associated 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 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 250 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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