Hypnic headache: Headache at night (Cause and treatment)

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Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine

If you've ever been woken up by a headache in the middle of the night, you may have experienced what is called a hypnic headache. It usually appears in patients over the age of 50. Only 174 cases have been reported in the literature so far. Due to its low prevalence, the clinical features and treatment options, as well as the underlying pathophysiological mechanisms, are largely unknown or controversially discussed.

However, in this article we will endeavor to provide information that you will need for a good understanding of this pathology. This will be to define the hypnic headache, to give its symptoms, its probable causes as well as the means of diagnosis. We will also discuss the means of treatment.

Definition

La hypnic headache is a rare primary headache that is characterized by headache attacks exclusively related to sleep. The hypnic headache occurs during sleep and awakens the patient. The pain can prevent sleep for at least 15 minutes or even longer. People with hypnic headaches usually suffer from it several times a week.

In what the hypnic headaches different from other types of headaches? Hypnic headaches only occur during sleep. This timing distinguishes them from other types of headaches, such as migraines which can disrupt sleep but can occur at any time of the day.

Note: Consult our articles on the retinal migraine and catamenial migraine to learn more about this type of migraine.

Symptoms of the disease

The main symptom of a hypnic headache is a throbbing, dull, or throbbing pain in the head that occurs during sleep, several times a month, usually around the same time of the night. Typically, the pain is in the forehead and temple.

Some people experience additional symptoms during a hypnic headache such as nausea or sensitivity to light (photophobia) or sounds (phonophobia). Some rare patients with hypnic headaches also show signs of nasal congestion (stuffy nose) or watery eyes.

Hypnic headaches can be unilateral or bilateral, meaning they can affect one or both sides of your head. However, it is more common that a hypnic headache affects both sides.

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Hypnic headaches can be more or less severe, but they are painful enough to pull you out of sleep. The majority of people describe the pain as moderate to severe.

Another hallmark of hypnic headaches is when they occur. The hypnic headaches usually occur in the middle of the night, about two to three hours after falling asleep, or between 1 a.m. and 3 a.m. They often occur at the same time and may even occur several times a night. The hypnic headaches can last from 15 minutes to three hours, with an average of 90 minutes.

Even though hypnic headaches Although rare, they are common in people who suffer from them. They occur at least 10 times a month. Some people suffer from it at least every other day.

Causes

The hypnic headaches are considered a primary headache disorder, meaning they are not caused by a known underlying condition. Also, researchers aren't sure what causes hypnic headaches.

Hypnic headaches often occur during REM sleep, so it's possible that an area of ​​the brain involved in pain processing is activated, resulting in a hypnic headache.

Hypnic headaches may also be related to the production of melatonin. Melatonin is a hormone that makes you feel sleepy, and its level of production goes up and down throughout the day depending on the sleep-wake cycle. Because hypnic headaches occur at the same time every night, some researchers believe that the underlying rhythms that regulate the production of melatonin can be disrupted, leading to lower melatonin levels and, as a result, hypnic headaches.

Some of the evidence supporting this theory comes from the effectiveness of lithium in the treatment of hypnic headaches, since lithium is effective in the treatment of other chronobiological disorders and helps to increase melatonin levels.

Diagnostic

For diagnose hypnic headaches, your doctor will inquire about your symptoms and when they occur. This will help him determine if your symptoms are due to hypnic headaches or another disorder with similar symptoms. Depending on your symptoms and medical history, your doctor may perform a number of tests, such as:

  • Blood tests : They will check for signs of infection, electrolyte imbalances, clotting problems or high (hyperglycaemia) or low (hypoglycaemia) blood sugar levels.
  • blood pressure measurement : This will rule out the possibility of a hypertension blood which is a common cause of headaches, especially in the elderly.
  • Un head scan or Magnetic Resonance Imaging (IRM): Both of these exams give your doctor a better view of the bones, blood vessels, and brain. They will make it possible to rule out a stroke (stroke), a brain tumor, an inflammation of an artery in the head, a head injury or a subdural hematoma (HSD).
  • A nocturnal polysomnography : This is a sleep test performed in a hospital or sleep laboratory. Your doctor will use equipment to monitor your breathing, blood oxygen levels, movements, and brain activity while you sleep.
  • Personalized home sleep tests. This is a simpler sleep test that can help detect symptoms ofSleep Apnea, another potential cause of nighttime headaches that wake you up.
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At the end of his examination, the doctor may also be able to rule out headaches from other pathologies such as migraine, a crisis ofepilepsy nocturnal, the trough, etc.

Treatment

There is no treatment specifically designed to treat hypnic headaches, but you can try some remedies for relief.

Your doctor will probably recommend that you start by taking a dose of caffeine before going to bed. Although it's contrary to common sense, most people with hypnic headaches have no problem sleeping after taking a caffeine supplement. Caffeine also has a lower risk of side effects compared to other treatment options.

To use caffeine to manage your hypnic headaches you can either drink a cup of strong coffee or take a caffeine pill. Caffeine is the recommended treatment both to prevent hypnic headaches and to relieve them once they have started. You can also try taking an over-the-counter migraine medication that contains an analgesic (pain reliever) and caffeine. However, taking these medications long term can cause chronic headaches.

Other people get relief from taking lithium, a drug used to treat bipolar disorder and other mental health conditions. the Topiramate, an anticonvulsant, also helps some people prevent hypnic headaches. Both of these drugs can cause bothersome side effects, including fatigue and slowed reactions.

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Other medications that have worked for some people include melatonin, flunarizine,indomethacin. The treatment prevents hypnic headaches in the majority of people. More than 40% of them never feel them again, even after stopping treatment.

In addition, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids and acetaminophen are not effective in relieving hypnic headaches.

Conclusion

La hypnic headache is a primary headache characterized by its onset during sleep, always at the same time and waking the patient. It is typically bilateral, almost daily and much more frequent in subjects over 50 years old.

Occurring during the paradoxical sleep phase, the hypothesis of an activation of a part of the brain has been evoked as well as the disturbance of the regulation cycle of the melatonin.

The diagnosis of hypnic headache goes through a good examination of the doctor. He may, however, have additional assessments carried out in order to look for other underlying pathologies or to have other causes of nocturnal headaches eliminated. L'high blood pressure, the syndromeSleep Apnea,cerebrovascular accident, migraine and trough are some differential diagnoses of hypnic headache.

Taking caffeine before the period of falling asleep is the first solution to relieve and prevent attacks of hypnic headaches. As other therapeutic alternatives, lithium,indomethacin and melatonin can also be used.

References

  1. https://www.sleepfoundation.org/physical-health/hypnic-headaches
  2. https://www.healthline.com/health/hypnic-headache#treatment
  3. https://www.webmd.com/migraines-headaches/hypnic-headaches
  4. https://www.concilio.com/neurologie-cephalee-hypnique/
  5. https://lacliniquedelatete.ca/corpus/7-5-4-liens-entre-sommeil-et-cephalees/

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