Hypnic headache

Hans-Christoph Diener MD (

Dr. Diener of the University of Duisburg-Essen received honorariums from Abbott, Allergan, Amgen, Lilly, MSD, Novartis, and Pfizer for service as an advisor or speaker and financial support from Allergan, Electrocore, Novartis, and Pfizer for research projects.

Stephen D Silberstein MD, editor. (

Dr. Silberstein, Director of the Jefferson Headache Center at Thomas Jefferson University, received honorariums from Abbie, Curelator, Ipsen Therapeutics, Lundbeck Biopharmaceuticals, Supernus Pharmaceuticals,  and Theranica for consulting. He is also the  principal investigator for clinical trials conducted by Amgen, ElectroCore Medical, and Teva.

Originally released June 16, 1999; last updated August 22, 2020; expires August 22, 2023


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. Hypnic headache is more prevalent in the elderly but has been reported to begin much earlier in life. As many patients derive significant benefit from preventative treatment, prompt recognition and management are 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.


• 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). Evers and Goadsby's review, which was published in 2003, reported 71 cases in the literature (Evers and Goadsby 2003). There are more than 350 cases reported (Silva-Neto et al 2019), 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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