Nocturnal headache is a rare form of headache in which a patient wakes up at every stage of sleep with a popping headache that can usually be felt on both sides of the head. Often middle-aged or elderly patients experience headache attacks. Treatment with caffeine or lithium is needed to stop the attacks so that the quality of life improves. Nocturnal headache was first described by physician Pearce in 1988.
Synonyms nocturnal headache
Nocturnal headache is also known as
the exploding main syndrome
alarm clock headache
Epidemiology night headache
Women are more often confronted with alarm clock headaches than men. Often the symptoms appear in middle-aged and elderly patients.
Causes alarm clock headache
The neurotransmitters (chemicals that transmit a stimulus from one nerve cell to another at the level of the synapse, the contact point in the connection between nerve cells) change during sleep. An underlying indication for hypnic headache is unknown. Most patients do have a history of other forms of headache before the diagnosis of hypnic headache was established.
Symptoms: Popping headache during sleep
Persistent and explosive pain in the head
The headache attacks vary in frequency as well as in duration. The headache attacks may occur during any sleep stage without the indication of an epileptic seizure or other underlying problem. The attacks most often occur between 1 and 5:30 a.m., usually (but not always) around the same time. The patient wakes up in the event of night pain, feeling that an enormous bang (explosion) is occurring in the head. This almost always persistent pain appears in a large proportion of patients on both sides of the head. The headache attack usually lasts 15 minutes on average, but in some cases it lasts up to eight hours.
In addition to the popping and / or throbbing headache, one in ten patients will have to deal with photophobia (light-shyness), photopsy (see flashes of light), watery eyes, a stuffy nose and phonophobia (a hypersensitivity to sound). Furthermore, one of the twenty patients reports that they get a strange feeling with the headache attack. This is because it seems as if breathing has stopped and they have to consciously breathe again.
Diagnosis and investigations
The patient must suffer from recurring headache that only occurs during sleep and that awakens the patient. In addition, the headache must occur for at least ten days a month and must have been present for at least three months. The headache lasts at least fifteen minutes to four hours after the patient has awakened. Furthermore, no other brain-related problems are present.
The doctor uses imaging and medical examinations to exclude secondary causes of night headache such as
cervicogenic headache (headache caused by a problem in the neck)
chronic Paroxysmal hemicrania: This type of headache appears during the day and at night, lasts less than half an hour and occurs ten to thirty times a day.
cluster headache: The autonomous symptoms of cluster headache appear during the day and during sleep. The pain is usually one-sided.
the abstinence from drugs
a brain tumor
the nocturnal hypertension headache syndrome
the excessive use of medicines
hypertension (increased blood pressure)
hypoglycaemia (a lowered blood sugar level)
intracranial disorders (problems in the brain)
Migraine: Migraine is characterized by attacks of an aura and / or unilateral headache, but usually other complaints are also present and this only occurs during sleep.
temporal arteritis (inflammation of the arteries during sleep)
Treatment via lithium or caffeine
Preventive treatment is essential to reduce the pain and suffering of nocturnal headache.
The doctor usually prescribes lithium for what the patient should take before sleeping time. Seven out of ten patients taking these preventive medicines experience a complete remission within two months. Two out of ten patients notice a significant decrease in the frequency and severity of the symptoms. Regular blood tests and an accurate follow-up by the doctor are necessary because this medicine may cause (serious) side effects.
In addition, patients are advised to drink a drink containing caffeine (such as coffee) prior to sleeping time in order to achieve better sleep quality. If an attack does occur, the patients immediately fall asleep again. Most patients drink a caffeinated drink, but caffeinated medication is also available. This medicine is known as 'Indomethacin'. However, indomethacin may cause side effects in patients with a history of stomach ulcers.
Other treatments are also effective for some patients such as botox injection, lamotrigine and hypnotics such as diphenhydramine.
Prognosis hypnic headache
The symptoms of hypnic headache usually disappear over time and when the patient is reassured that this type of headache is benign. However, night headache seriously affects the quality of life in a number of patients. Regular attacks occur. The frequency of the attacks is often reminiscent of that of migraine.
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