Hypnic Headache Research Articles

Lithium-responsive headaches

Introduction: Lithium-responsive headaches are primary and they have beginning nocturnal or on awakening. They are classified in three groups: Nocturnal Migraine, Cluster Headache, and Hypnic Headache. All three types show a positive therapeutic response to lithium and the average dose is from 300 to 900 mg at bedtime. Objective: To review the headaches that have nocturnal or on awakening beginnings and those which demonstrate a therapeutic response to lithium. Method: We reviewed the literature on lithium and its historical and pharmacological aspects, and its use in the treatment of nocturnal headaches. Conclusion: Lithium isan efficient drug in the treatment of nocturnal headache and headache on awakening.

Hypnic headache secondary to haemangioblastoma of the cerebellum

We report a case of secondary hypnic headache in a patient with a haemangioblastoma of the cerebellum. The number of secondary cases is steadily increasing in the medical literature and magnetic resonance imaging of the brain should be considered mandatory after arriving at a presumptive diagnosis.

14th International Headache Congress: Basic Science Highlights

During the 14th International Headache Congress the results of several innovative studies that contribute to our understanding of headache pathophysiology and treatment were presented. Here we summarize work expected to contribute substantially to understanding headache mechanisms, while an accompanying manuscript summarizes presentations regarding the treatment of headache. This manuscript highlights research on mechanisms of photophobia and phonophobia, pharmacologic inhibition of cortical spreading depression, a proposed mechanism by which oxygen effectively treats cluster headache, identification of functional and structural aberrations in people with hypnic headache, and research on functional imaging markers of a migraine attack.

Sleep and Headache

Headache has been linked to a wide range of sleep disorders that may impact headache management. There are no evidence-based guidelines, but the authors believe that literature supports the following clinical recommendations: 1. Diagnose headache according to standardized criteria. Specific diagnoses are associated with increased risk for specific sleep and psychiatric disorders. 2. Collect sleep history in relation to headache patterns. Screening questionnaires and prediction equations are cost-effective. 3. Rule out sleep apnea headache in patients with awakening headache or higher-risk headache diagnoses (cluster, hypnic, chronic migraine, and chronic tension-type headache); patients with signs and symptoms of obstructive sleep apnea warrant polysomnography and treatment according to sleep medicine practice guidelines. There is no evidence for suspending conventional headache treatment in suspected or confirmed cases of sleep apnea. Treatment of sleep apnea with CPAP may improve or resolve headache in a subset of patients. The impact on sleep apnea headache of other treatments for sleep apnea (eg, oral appliances, surgery, weight loss) is largely untested. At a minimum, sedative-hypnotic drugs should be avoided in suspected apneics until the sleep apnea is treated. 4. Among patients with migraine and tension-type headache, insomnia is the most common sleep complaint, reported by one half to two thirds of clinic patients. Patients who suffer from chronic migraine or tension-type headache may benefit from behavioral sleep modification. Pharmacologic treatment may be considered on a case-by-case basis, with hypnotics, anxiolytics, or sedating antidepressants used to manage insomnia, tailoring treatment to the symptom pattern. 5. Individuals with chronic headache are at increased risk for psychiatric disorders. Assessment for depression and anxiety may be warranted when either insomnia or hypersomnia is present. Psychiatric symptoms affect the choice of sedating versus alerting versus neutral pharmacologic agents for headache. 6. All headache patients, particularly those with episodic migraine and tension-type headaches, may benefit from inclusion of sleep variables in trigger management.

A Consecutive Series of 22 Cases of Hypnic Headache in France

A series of 22 patients was consecutively diagnosed with hypnic headache (HH) from June 2007 to June 2008 in two headache specialty centres participating in the French Observatory of Migraine and Headaches. Patients and headache characteristics were compared with the 2004 International Classification of Headache Disorders, 2nd edn (ICHD-II) criteria for HH and published series of HH patients. One-third of HH patients reported migraine-like headaches (pulsating/unilateral/stabbing) and > 20% were aged < 50 years at symptom onset. Of note, HH patients displayed typical motor activities during the headache (getting up, eating/drinking especially a cup of coffee, reading/watching television) that differentiate HH from migraine and suggest relationships between HH and trigeminal autonomic cephalalgias. The functional and emotional impact of HH appears low and similar to that of migraine in patients consulting in primary care practice. Improvements in ICHD-II criteria are suggested, especially to introduce the typical motor behaviour acted out by HH patients.

Transient Hypnic Headache Syndrome in a Patient With Bipolar Disorder After the Withdrawal of Long-Term Lithium Treatment: A Case Report

Transient Hypnic Headache Syndrome in a Patient With Bipolar Disorder After the Withdrawal of Long-Term Lithium Treatment: A Case Report

Phenotype-Driven Preventive Strategies for Migraine and Other Headaches

Satisfactory prevention of migraine and other headaches is fraught with difficulties in the real world. Tolerability and safety issues are of concern just as is effectiveness or efficacy and all often seem to be patient-dependent. Maximizing migraine prevention and getting treatment right the first time ought to result in improved patient outcomes. Identifying headache phenotypes recognizes that clinical phenomenology may define or approximate genotypes that may predict specific preventive treatments. The concept of phenotype-driven headache and migraine prevention relies heavily on the indomethacin-responsive headache experience wherein specific treatment is dictated by headache phenotype. Herein are described several additional headache phenotypes: migraine with typical and atypical aura, dopaminergic migraine, new daily-persistent headache, migraine with cluster or sinus features, short-lasting unilateral neuralgiform headache with conjunctival injection and tearing, hypnic headache, thunderclap headache, and imploding headache. Phenotype-driven preventive strategies are described that may offer reasonable first treatment choices, appropriate second choices, or choices when other treatments have failed. These headache preventive recommendations are based on the best available evidence; however, all reports are observational. Perhaps some of these choices will be tested in prospective, randomized, blinded and controlled trials in the future, but historically clinical medicine has relied on clinical observations. The observations reported herein may help define specific, effective treatments for some patients or simply inspire further discussion and research about patient-specific preventive treatment regimens.

Symptomatic Hypnic Headache Secondary to a Nonfunctioning Pituitary Macroadenoma

We report the case of a woman whose hypnic headache syndrome ceased following pituitary tumor removal. Symptomatic hypnic headache cases are rare, but are starting to appear in the literature. Until more is known, brain neuroimaging, ideally with magnetic resonance imaging, should be considered when the initial diagnosis of hypnic headache is made.

Chronic Headache in the Elderly

This article covers some of the major headache types found in the geriatric population. Misperceptions regarding headache in the elderly will be addressed and updated with current perspectives from the literature. Both diagnostic and treatment updates are covered, with special emphasis on headaches unique to those over the age of 60 years: giant cell arteritis, hypnic headache, trigeminal neuralgia, paroxysmal hemicrania, cervicogenic headache, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing, and short-lasting unilateral neuralgiform headache attacks with cranial autonomic features. We will focus on both common and unique causes of headache in the elderly. While the medical literature on headache in older patients is rich with case reports, small case series and uncontrolled trials, we will emphasize the last 5 years of medical literature and systematic reviews where they exist.

Hypnic Headache Secondary to a Growth Hormone-Secreting Pituitary Tumour

Hypnic Headache Secondary to a Growth Hormone-Secreting Pituitary Tumour

First Austrian Case of Hypnic Headache: Serial Polysomnography and Blood Pressure Monitoring in Treatment With Indomethacin

Hypnic headache is a rare sleep-associated primaryheadache disorder. It was first described by Raskinin 1988 (1) and has been recognized as a primaryheadache disorder. In 2004, hypnic headache wasincluded in group 4 (other primary headaches) ofthe 2nd edition of the International Classification ofHeadache Disorders (ICHD-II) (2). According toICHD-II, subjects complaining of exclusively sleep-related dull headache can be diagnosed with hypnicheadache if at least two of the following arepresent: occurrence > 15 times per month; durationof pain for 15 min after waking; age at onset after50 years. In addition, absence of autonomic symp-toms, presence of not more than one of nausea,photophobia or phonophobia and exclusion ofanother disorder are required for diagnosing hypnicheadache.The pathogenesis of hypnic headache remainsunclear. Several possible mechanisms, includingdysfunction of brainstem neural networks, havebeen discussed (3).Polysomnographic studies have been performedin only 24 (22%) of the 109 reported cases of hypnicheadache, and 15 patients (14%) had an attackduring polysomnography (4). In 10 patients, theattacks showed a close temporal relation to rapideye movement (REM) sleep (5–10). In five patients,the attacks had an onset during non-REM sleep (9,11, 12). Although sleep-disordered breathing wasfound in seven of the 24 patients (29%) who under-went polysomnography, only one attack was defi-nitely time-related to severe hypoxia (5).Gil-Gouveia and Goadsby (13) have reviewed 101patients and found that arterial hypertension wasthe most prevalent co-morbidity (

Relapsing remitting hypnic headache responsive to indomethacin in an adolescent: a case report

Hypnic headache (HH) is a rare sleep-associated primary headache disorder that usually begins after the age of 60 years. Here we report a 19-year-old male with 4-year history of predominantly left sided HH. He is the youngest person reported who fulfills the IHS diagnostic criteria for HH. The patient had history of relapsing–remitting course. The headache occurred every night at a constant time in each relapse. It was non-throbbing, moderate to severe, for 30 min to 5 h, and usually after 3 h of sleep. The patient showed complete response to indomethacin (75 mg at bedtime). Frequent tapering of indomethacin was required to look for the remission phase.

Clinical Features, Polysomnography and Outcome in Patients with Hypnic Headache

Hypnic headache is rarely reported in Asians, and the proposed International Classification of Headache Disorders (ICHD)-2 criteria have never been field-tested. We studied 17 consecutive Taiwanese patients (M/F: 9/8, mean age at onset 69.6 years) with hypnic headache from a headache clinic. Fifteen patients (88%) reported >15 headache attack days per month. Polysomnography studies done on 11 patients recorded 12 attacks in seven patients: two during rapid eye movement (REM) sleep, three during non-REM sleep and two having both. Five of the seven patients reported their headache profile during polysomnography studies. The clinical course was mostly episodic without recurrence (n = 9, 53%), followed by relapsing/remitting (n = 5) and chronic (n = 3). The ICHD-2 criteria were not fulfilled in 35% (6/17) patients based on patient recall or 60% (3/5) patients based on direct questioning during polysomnography studies. The major reason was the presence of pulsatile rather than dull headache in our patients. Unlike previous studies, our study showed hypnic headache occurred equally in both REM and non-REM sleep, and most patients ran an episodic course.

Kopfschmerzen im Alter

Chronic headache is still a frequent problem in old age, affecting about 10% of all women and 5% of all men older than 70 years. The incidence of primary headache decreases with advancing age, while that of secondary headache increases. The clinical characteristics of migraine can also change with age; for example, vegetative symptoms are less prominent, and less intense migrainous pain localized predominantly in the neck is frequently reported. Migraine aura can also be experienced more frequently in isolation, without a headache. Hypnic headache is a rare primary headache syndrome that occurs almost exclusively in the elderly. Most of the secondary headache syndromes that occur more frequently in old age present clinically as tension-type headache. Examples of rather common reasons for secondary headache syndromes in the elderly are intracranial space-occupying lesions, ophthalmological problems and autoimmune diseases such as giant cell arteritis. Elderly patients are especially likely to have a number of illnesses at any one time for which they take various medications each day, so that headaches can also quite often be caused by their medication or by withdrawal of these. As a result of such multimorbidity the homeostasis is disturbed in such patients, leading to various conditions that can entail concomitant headaches (sleep apnoea syndrome, dialysis headache, headache attributed to arterial hypertension or hypothyroidism). Familiar facial neuralgias, such as trigeminal neuralgia or postherpetic neuralgia following manifest herpes zoster affecting the face, become markedly more frequent with age. In general, in the treatment of headaches in the elderly it is essential to pay careful attention to potential interactions with the multiple drugs needed because of other diseases; in addition, the comorbidities themselves have to be taken into account, especially depression, anxiety and cognitive impairment, necessitating multimodal, interdisciplinary therapy plans.

Bases anatómicas y neuroquímicas que explican la frecuente asociación de las cefaleas con el sueño: el paradigma de la cefalea hípnica

The relationship between headache and sleep is complex and runs in two directions. Headache may be the consequence of a (primary or secondary) sleep disorder or its cause (in chronic tension-type headache and/or chronic migraine with or without painkiller abuse). It can also be related to sleep in an intrinsic way, as in the case of hypnic headache (which only appears during sleep) or other primary headaches, such as migraine and certain trigeminal-autonomic cephalgias (which can appear during the waking state or during sleep); this type of headache occurs mostly during REM sleep.The neural pathways that control sleep and pain are anatomically, physiologically and neurochemically cross-linked. These neural systems are located in the brain stem, the hypothalamus and the basal brain. Such cross-links are produced on two different levels. On the one hand, they occur in the serotoninergic nuclei of the brain stem, whose activity in physiologically diminished during REM sleep and which are involved in antinociceptive control. On the other hand, they are also to be found in the hypothalamus, where serotoninergic terminals have been detected in the suprachiasmatic nucleus (SCN). As cells in the SCN are lost with age, their circadian and homeostatic functioning fails, the activity of the hypothalamus-pineal axis is reduced and the endogenous melatonin rhythm is altered. This results in a disorder affecting the control of the sleep-waking cycle and antinociceptive control.Dysfunctions in these neuronal networks in the brain stem (especially in the serotoninergic nuclei) or the hypothalamus (SCN) can account for headaches that begin in the REM phase of sleep and affect biologically predisposed subjects.

Hypnic Headache Responsive to Low‐Dose Topiramate: A Case Report

This is a clinical report of a 63-year-old woman, with a 3-year history of severe episodes of hypnic headache responding to low-doses of topiramate (25 mg at bedtime). Topiramate has been used at the dosage of 100 mg/day for hypnic headache prevention in one recent case report with benefit. This report confirms the efficacy of topiramate in hypnic headache even using low-dose regimen therapy.

Refractory Chronic Headache Associated with Obstructive Sleep Apnoea Syndrome

The aim was to investigate the comorbidity of chronic refractory headache with obstructive sleep apnoea syndrome (OSAs). Seventy-two patients (51 women and 21 men) with chronic and refractory headaches, whose headache occurred during sleep or whose sleep was accompanied by snoring, were submitted to polysomnography. Patients diagnosed with OSAs (respiratory disturbance index > 10) began continuous positive airway pressure (C-PAP) treatment and were followed up for >or= 6 months. Twenty-one cases of OSAs were identified (29.2% of the total investigated, 13.7% of the women and 66.6% of the men). Headaches were classified into several headache disorders, medication overuse headache and cluster headache being the most prevalent (nine and six of the 21 cases, respectively). In one case (1.4% of the total sample, 4.7% of all the men), the criteria for hypnic headache were fulfilled. Multivariate regression analysis revealed that age, male gender and body mass index were associated with OSAs. C-PAP treatment improved both sleep apnoea and headache in only a third of the cases. Patients suffering from chronic refractory headache associated with sleep or snoring, in particular those who are also middle-aged, overweight men, should be considered for polysomnography. C-PAP treatment alone does not seem to improve headache, but further investigation is needed.

Precipitation of long duration hypnic headaches after ACE inhibitor withdrawal

Sirs: Hypnic headache is a rare headache disorder characterised by recurrent attacks of pain occurring during sleep. Headaches tend to occur in the middle or later stages of the night and patients are abruptly awakened from sleep. We present an unusual case of an 84-year-old female who developed hypnic headaches, although lasting longer than classically described, after stopping her angiotensin converting enzyme (ACE) inhibitor. These resolved completely when the ACE inhibitor was re-started. An 84-year-old female had her ACE inhibitor (enalapril, 5 mg) and a benzodiazepine (flurazepam) stopped abruptly. She immediately developed a distinctive pattern of headache, which would wake her from sleep at 3 a. m. each night. The pain was bi-temporal and it would last approximately 10 hours. Paracetamol and ibuprofen were not effective, and indomethacin was not tried. There were no other symptoms associated with the headache; in particular there were no autonomic features. Her consumption of tea and coffee had not changed, and she did not drink alcohol. There was no previous history of headache and the only significant past medical history was hypertension for which she had been taking enalapril for four years. She had also taken flurazepam and chlordiazepoxide. The enalapril had been stopped by her general practitioner as her blood pressure was considered acceptable at approximately 150/85. Her daytime blood pressure off the enalapril did rise to approximately 180/100. Although we think it unlikely that this rise is significant enough to cause the headache, this does remain a possibility. Neurological and general physical examination was otherwise normal. A biochemical profile, full blood count and computed tomography head scan were normal. Benzodiazepine re-prescription for 2 months did not alleviate the headache, therefore her enalapril was restarted. Her headache responded immediately and one week after recommencing enalapril, her headache had completely resolved. There is general agreement that the mechanisms that underlie sleep regulation and nociception are fundamentally linked although the specific nature and underlying neurochemical processes are poorly defined [4]. The pathogenesis of hypnic headache as a specific sleep related headache, however, remains speculative. There is evidence for a role for the renin-angiotensin system (RAS) in the aetiology of some headache types. The ACE inhibitor lisinopril has been shown to have a prophylactic effect in migraine [5] and migraineurs with a DD genotype have both a higher ACE activity and frequency of attacks than other migraineurs [3]. It has also been shown that dialysis headache, where the headache is not related to blood pressure changes or a ‘dysequilibrium syndrome’, can improve after treatment with ACE inhibitors [2]. We feel that our case report suggests that the RAS may be implicated in the aetiology of hypnic headache. It is not clear how ACE inhibitors mediate the beneficial effect in migraine. Angiotensin II is a neuropeptide produced within the central nervous system (CNS) and may function as a neurotransmitter, influencing neurotransmission and excitability of neurons via glutaminergic and GABAergic neurons [3]. As well as inhibiting the conversion of angiotensin I to angiotensin II, ACE inhibitors also increase prostacyclin synthesis and inhibit the breakdown of bradykinin, encephalin and substance P. Hypnic headache is considered by many to be a rapid-eye movement (REM) sleep-phase phenomenon. In a meta-analysis of 71 cases of hypnic headache, four had headache during polysomnography, three emerging from REM sleep and one from slow wave sleep. The reason for the association with REM sleep is unknown, but it has been suggested that certain areas of the brain of fundamental importance to antinociception, for example the locus coeruleus, an area which is normally inactive during REM sleep, might be impaired [1]. This may perhaps provide a link with the RAS as this is one area of the brain in particular which has been demonstrated to possess high numbers of angiotension receptors [3]. In conclusion, a potential association between hypnic headache and the RAS is suggested. The posLETTER TO THE EDITORS

Kopf- und Gesichtsschmerz im Alter

Whilst headache disorders belong to the most common health problems of the younger population, the occurrence diminishes with advancing age. However, in individual cases headaches may be especially severe in old age significantly reducing the quality of life. Typical causes of headache in the elderly are giant cell arteritis (arteritis temporalis), cranial neuralgia and hypnic headache. The incidence of intracranial mass lesions also increases with age. In addition to these secondary forms of headache, the typical primary headache disorders migraine, tension headache and cluster headache may also persist in the elderly. In drug treatment of headaches in the elderly, an impairment of renal and/or hepatic function has to be taken in account, as should be the potential multimorbidity of elderly patients.

The differential diagnosis of chronic daily headaches: an algorithm-based approach.

Chronic daily headaches (CDHs) refers to primary headaches that happen on at least 15 days per month, for 4 or more hours per day, for at least three consecutive months. The differential diagnosis of CDHs is challenging and should proceed in an orderly fashion. The approach begins with a search for “red flags” that suggest the possibility of a secondary headache. If secondary headaches that mimic CDHs are excluded, either on clinical grounds or through investigation, the next step is to classify the headaches based on the duration of attacks. If the attacks last less than 4 hours per day, a trigeminal autonomic cephalalgia (TAC) is likely. TACs include episodic and chronic cluster headache, episodic and chronic paroxysmal hemicrania, SUNCT, and hypnic headache. If the duration is ≥4 h, a CDH is likely and the differential diagnosis encompasses chronic migraine, chronic tension-type headache, new daily persistent headache and hemicrania continua. The clinical approach to diagnosing CDH is the scope of this review.