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  • Updated 08.22.2020
  • Released 06.16.1999
  • Expires For CME 08.22.2023

Hypnic headache

Introduction

Overview

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 (56). Evers and Goadsby’s review, which was published in 2003, reported 71 cases in the literature (19). There are more than 350 cases reported (63), and therapeutic options have expanded (22; 36; 50; 11; 34; 46; 30; 51).

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