Hypnic Headache

Hypnic Headache (HH) is a rare primary headache disorder with an age of onset typically more than 50 years old. Women are affected more than men. They are strictly sleep related headache attacks. Because the headaches often occur at the same time at night, they have been called ‘alarm clock’ headaches.

The headaches have to occur at least 10 days of the month and last between 15min and 4 h after awakening the patient from sleep. They are moderate in intensity and may be on both sides, or one side of the head. There are no associated autonomic features (eyelid drooping, eye redness, tearing, nasal stuffiness). Patients may have nausea, light and noise sensitivity. Rising from bed appears to ease the pain.

Hypnic headache like presentation can at times be reported secondary to brain pathology, night time elevated blood pressure, certain blood pressure medications, and obstructive sleep apnea. An MRI of the head, an evaluation for night time elevated blood pressure, and a review of medications, should be considered as part of the evaluation for HH.

Treatment options include a cup of strong coffee at bedtime, lithium and indomethacin have also been described as being effective.

References:Indomethacin-Responsive Headaches. Current Neurol Neurosci Rep (2015), VanderPluym, 15:516

Headaches of the Elderly. Current Neurol Neurosci Rep (2015) Bravo, 15:30

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