The Clinical Syndrome
Also known as alarm clock headache , hypnic headache is a term used to describe an uncommon headache syndrome characterized by its propensity to wake the person at the same time each night. Always occurring during sleep, hypnic headache is of short duration and rarely lasts more than 15 minutes after the patient is awakened by the pain ( Fig. 10.1 ). Research suggests that hypnic headache occurs most commonly during rapid eye movement (REM) sleep and it has been suggested that hypothalamic dysregulation may be the pathologic mechanism that triggers this rare headache syndrome ( Fig. 10.2 ). Hypnic headache occurs frequently, with a mean incidence of at least 15 attacks per month. The location of the headache pain varies, and the intensity of pain described as moderate with an aching character. Unlike cluster headache, which also occurs after sleep, patients with hypnic headache exhibit no autonomic signs or symptoms. Hypnic headache is a disease of the late fifth and sixth decades, with a mean age of onset of 63 years, although cases in the pediatric and adolescent population have been reported. It occurs more commonly in females.
The Clinical Syndrome
Also known as alarm clock headache , hypnic headache is a term used to describe an uncommon headache syndrome characterized by its propensity to wake the person at the same time each night. Always occurring during sleep, hypnic headache is of short duration and rarely lasts more than 15 minutes after the patient is awakened by the pain ( Fig. 10.1 ). Research suggests that hypnic headache occurs most commonly during rapid eye movement (REM) sleep and it has been suggested that hypothalamic dysregulation may be the pathologic mechanism that triggers this rare headache syndrome ( Fig. 10.2 ). Hypnic headache occurs frequently, with a mean incidence of at least 15 attacks per month. The location of the headache pain varies, and the intensity of pain described as moderate with an aching character. Unlike cluster headache, which also occurs after sleep, patients with hypnic headache exhibit no autonomic signs or symptoms. Hypnic headache is a disease of the late fifth and sixth decades, with a mean age of onset of 63 years, although cases in the pediatric and adolescent population have been reported. It occurs more commonly in females.
Signs and Symptoms
Hypnic headache is associated with no obvious neurological or musculoskeletal disease. Specifically, there are no autonomic signs or symptoms as are often seen with cluster headache. Furthermore, no accompanying focal neurological signs or systemic symptoms occur as with cluster headache and migraine headache, although rarely nausea can occur. The age of onset of benign hypnic headache is generally in the late fifth or sixth decade of life. Although no specific location is seen in hypnic headache, they are bilateral in 66% of patients. When the headaches are unilateral, they tend to occur on the same side night after night. What is fascinating to the treating physician and frustrating to the patient is the fact that hypnic headache wakes the patient from a sound sleep at almost the same time each night. Because the onset of hypnic headache occurs later in life, it must be considered a diagnosis of exclusion as with the other uncommon primary headache syndromes, for example, cough headache and thunderclap headache. The clinician must assiduously search for other explanations for the patient’s headache symptomatology, including intracranial pathological conditions and systemic disease.
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