The incidence of narcolepsy increased in Finland, Sweden, Norway, Ireland, UK and France after the H1N1 influenza vaccination (Pandemrix) campaign in 2009–2010. The increase has been noted especially in people aged <20 years and in lesser degree in adults. The phenotype and disease severity are various. Cataplexy (CPL) is associated with low CSF-hypocretin-1 (hcrt) but few studies have investigated the relation of hcrt with other symptoms of narcolepsy. Our aim is to compare symptoms and findings of narcolepsy related to Pandemrix- and hcrt status. In all 89 [45 post- (19 men, 26 women) and 44 pre-Pandemrix (19 men, 25 women)] patients with diagnosed narcolepsy (ICSD-2 criteria) were clinically examined. A modified Basic Nordic Sleep Questionnaire was used. PSG, MSLT and/or hcrt measurements were done. All subjects with Pandemrix-association (post-PDRX) and 95% without association (pre-PDRX) were HLA-DQB1∗06:02 positive. Median ages at diagnosis were 16.4 and 26.5 years, respectively. 34 (77%) and 25 (68%), respectively, had onset at age <20. Age at onset was <10 years in 6 (14%) vs 5 (14%) subjects. One patient in post-PDRX and 2 in pre-PDRX had onset after 40 years. The median age of onset (15.2 years) in the post-PDRX did not differ significantly from the pre-PDRX (16.8 years). Patients <20 years had more SOREMPs (median 4 vs. 2, P = 0.001). Hcrt levels were similar, mean 44.7 pg/ml vs 48.3 pg/ml and median 3 pg/ml (0–264) vs 27 pg/ml (0–313). SL in MSLT was shorter in post-PDRX (median 2.4 min vs 3.6 min, P = 0.028). There were no significant differences in occurrence of CPL (88% vs 86%), hypnagogic hallucinations (58% vs 71%) or sleep paralysis (42% vs 39%) at diagnosis. There were no differences in ESS, Ullanlinna Narcolepsy Scale (UNS), Skogby Excessive Daytime Sleepiness Scale (SEDS), Rimon’s Brief Depression Scale (LKDA) or WHO Well-Being Scale (WHO5). Hcrt correlated with shorter SL in MSLT (r = 0.362, P = 0.012, Pearson correlation), diagnostic delay (r = 0.299, P = 0.032) and REM-latency in PSG (r = 0.564, P = 0.010) but not with sleep efficiency, ESS, UNS, WHO5, LKDA or number of CPL per week. CPL at time of diagnosis was present in 41/47 (87%) of subjects with hcrt <110 pg/ml and in 4/8 (50%) with hcrt⩾110 pg/ml (P = 0.012). Pre- and post-Pandemrix narcolepsies do not differ significantly. Hypocretin-1 levels correlated poorly with most symptoms. In sum our results implicate that also non-hypocretin-related mechanisms play an important role in narcolepsy. This study has been funded by the Academy of Finland grant 260603.