“Alarm Clock” Headaches

Abstract

A 54-year-old Vietnamese male with a history of a subdural hematoma in 2004 with no neurological sequel and no other medical problems presented with complains of a new pattern of headache for the last 6 weeks. He mentions that the headaches wake him up around 01:00 to 01:30 persistently, as if woken by an “alarm clock.” The headaches last for 15 to 30 minutes and resolve on their own most of the time. The character of the headaches are mostly dull pressure-like or sometimes throbbing in nature, and these headaches are located mostly in the bilateral temporal region. There are no other associated features of photophobia, phonophobia, nausea, vomiting, unilateral tearing, or any nasal stuffiness with these headaches. He denies any headaches during the day. Once in the last 6 weeks he woke up for a second time with the same type of headache around 04:00. He denies any early morning headache or any exertion headache. The rest of his medical and psychiatric history is nonsignificant. He denies any other sleep related problems, including insomnia, snoring or any witnessed apneas, or any discomfort in the legs. His family history is negative for migraine headaches. He did not have any history of trauma prior to the onset of these headaches. On examination, his vital signs were within normal limits. His Mallampati score was 1, and his BMI was 25. He had a normal neurological and a general examination. Patient had good venous pulsation on funduscopic examination, and there were no pretectal or long tract signs noted. The patient was sent for a MRI scan of the brain, which was normal. QUESTION: What is the most likely cause of these headaches? Exploding head syndrome Migraines Cluster headaches Hypnic headaches Recurrent subdural hematoma ANSWER: d. Hypnic headaches