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 With
only 80 documented cases, hypnic headache (HH) is one of the rarest headache
disorders. HH is primary headache disorder, which means that it cannot be attributed to another condition.
The most
identifying feature of HH is that it develops only during sleep and wakes the
sufferer.
The International Headache Society's International Classification of Headache
Disorders, 2nd Edition (ICHD-II), is the "gold standard" for diagnosing and
classifying headache disorders. Here are the description, diagnostic criteria,
and symptoms of HH as set forth in the ICHD-II:
4.5 Hypnic headache
Previously used terms:
Hypnic headache syndrome, ‘alarm clock’ headache
Description:
Attacks of dull headache that always awaken the
patient from asleep.
Diagnostic criteria:
- Dull headache fulfilling criteria B–D
- Develops only during sleep, and awakens patient
- At least two of the following characteristics:
- occurs 15 or more times per month
- lasts 15 or more minutes after waking
- first occurs after age of 50 years
- No autonomic symptoms and no more than one of nausea, photophobia or
phonophobia
E. Not attributed to another disorder1
Note:
1 Intracranial disorders must be excluded. Distinction from one of the trigeminal autonomic cephalalgias
is necessary for effective management.
Comments:
The pain of hypnic headache is usually mild to moderate,
but severe pain is reported by approximately
20% of patients. Pain is bilateral in about two-thirds
of cases. The attack usually lasts from 15 to 180
minutes, but longer durations have been described.
Caffeine and lithium have been effective treatments
in several reported cases.
What does it all mean?
Characteristics of HH:
- Pain is usually mild to moderate, but
sometimes severe.
- Develops during sleep and awakens the
sufferer.
- Usually lasts 15 to 180 minutes.
- Symptoms include only ONE of nausea,
photophobia (sensitivity to light), and phonophobia (sensitivity to sound).
- Usually occurs first after the age of 50,
although more data shows the age of onset to usually be between the ages of
40 and 82.
- Headache occurs at a consistent time each
night, usually between 1 and 3 a.m.
Diagnosis of HH:
Before assigning a diagnosis of hypnic
headache, imaging studies should be performed to rule out any organic issues.
Treatment of HH:
Lithium carbonate, 300 mg at bedtime, is
frequently used to stop HH, but must be used with caution especially in the
presence of renal disease, dehydration, or use of diuretics.
Bedtime doses of caffeine, flunarizine (a
calcium channel blocker), and indomethacin have been shown effective in some
cases.
Some case studies have shown daily preventive
use of topiramate (Topamax) also to be effective in some cases.
Summary:
Hypnic headache is very rare, and should be
diagnosed only after any organic, physical causes have been ruled out. HH begins
during sleep and wakes the suffer, then generally lasts 15 to 180 minutes.
Lithium carbonate, caffeine, flunarizine, indomethacin, and Topamax have
been successful in treating HH.
____________
Resources:
The International Headache Society. "International Classification of Headache
Disorders, 2nd Edition." Cephalalgia, Volume 24 Issue s1. May, 2004.
doi:10.1111/j.1468-2982.2003.00823.x
Silberstein, Stephen D.; Lipton, Richard B.;
"Goadsby, Peter J. Headache in Clinical Practice, Second Edition." Martin Dunitz,
Ltd. 2002.
 © Teri Robert, 2009.
Last updated January 6, 2008.
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