- F Michael Cutrer, MD
F Michael Cutrer, MD
- Associate Professor of Neurology
- Mayo Clinic College of Medicine
Hypnic headache is one of several relatively uncommon headache syndromes that may occur either as a primary headache or as a headache secondary to potentially malignant processes. Careful evaluation for underlying causes is important for these uncommon types of headache.
This topic will review hypnic headache. Other types of uncommon primary headache disorders are discussed separately. (See "Primary stabbing headache" and "Primary cough headache" and "Exertional headache" and "Primary headache associated with sexual activity" and "Thunderclap headache" and "Nummular headache".)
The cause of hypnic headache is not understood. The apparent cyclicity, the similar duration, and response to lithium suggest a pathophysiologic connection with cluster headache and hypothalamic dysfunction . (See "Pathophysiology of the trigeminal autonomic cephalalgias", section on 'Hypothalamic activation'.)
To test this hypothesis, a voxel based morphometric MRI study compared 14 patients with hypnic headache and 14 matched healthy controls . Subjects with hypnic headache had reduced gray matter volume in the posterior hypothalamus. Ironically, an earlier report using similar methods found increased gray matter volume in a similar location among patients with cluster headache . Nevertheless, both studies implicate the posterior hypothalamus in headache disorders with a tendency toward cyclical and nocturnal occurrence. Although early reports suggested that hypnic headache might be a rapid eye movement (REM) sleep disorder, later studies showed that the majority of hypnic headaches attacks arise from non-REM sleep stages, mainly sleep stage N2 [1,4].
The onset of hypnic headache typically occurs after age 50 years, though a few cases younger than age 40 years have been reported, including five pediatric cases ranging from 8 to 11 years in age [1,5,6]. While hypnic headache is rare, the actual incidence and prevalence are unknown. In data from tertiary headache centers and clinics, the overall proportion of patients with hypnic headache ranged from 0.07 to 0.35 percent, while the proportion among geriatric patients with headache ranged from 1.4 to 1.7 percent . There is a female predominance of approximately 2:1 [1,6].
- Holle D, Naegel S, Obermann M. Hypnic headache. Cephalalgia 2013; 33:1349.
- Holle D, Naegel S, Krebs S, et al. Hypothalamic gray matter volume loss in hypnic headache. Ann Neurol 2011; 69:533.
- May A, Ashburner J, Büchel C, et al. Correlation between structural and functional changes in brain in an idiopathic headache syndrome. Nat Med 1999; 5:836.
- Holle D, Naegel S, Obermann M. Pathophysiology of hypnic headache. Cephalalgia 2014; 34:806.
- Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013; 33:629.
- Liang JF, Wang SJ. Hypnic headache: a review of clinical features, therapeutic options and outcomes. Cephalalgia 2014; 34:795.
- Raskin NH. The hypnic headache syndrome. Headache 1988; 28:534.
- Rains JC, Poceta JS. Sleep-related headache syndromes. Semin Neurol 2005; 25:69.
- Caminero AB, Martín J, Sánchez del Río M. Secondary hypnic headache or symptomatic nocturnal hypertension? Two case reports. Cephalalgia 2010; 30:1137.
- Gil-Gouveia R, Goadsby PJ. Secondary "hypnic headache". J Neurol 2007; 254:646.
- Gould JD, Silberstein SD. Unilateral hypnic headache: a case study. Neurology 1997; 49:1749.
- Peatfield RC, Mendoza ND. Posterior fossa meningioma presenting as hypnic headache. Headache 2003; 43:1007.
- Mullally WJ, Hall KE. Hypnic headache secondary to haemangioblastoma of the cerebellum. Cephalalgia 2010; 30:887.
- Dodick DW, Mosek AC, Campbell JK. The hypnic ("alarm clock") headache syndrome. Cephalalgia 1998; 18:152.
- Buzzi MG, Cologno D, Formisano R, Caltagirone C. Hypnic headache responsive to indomethacin: second Italian case. Funct Neurol 2005; 20:85.
- Newman LC, Lipton RB, Solomon S. The hypnic headache syndrome: a benign headache disorder of the elderly. Neurology 1990; 40:1904.
- Morales-Asín F, Mauri JA, Iñiguez C, et al. The hypnic headache syndrome: report of three new cases. Cephalalgia 1998; 18:157.
- Schürks M, Kastrup O, Diener HC. Triptan responsive hypnic headache? Eur J Neurol 2006; 13:666.
- Ouahmane Y, Mounach J, Satte A, et al. Hypnic headache: response to lamotrigine in two cases. Cephalalgia 2012; 32:645.
- Dodick DW. Polysomnography in hypnic headache syndrome. Headache 2000; 40:748.
- Relja G, Zorzon M, Locatelli L, et al. Hypnic headache: rapid and long-lasting response to prednisone in two new cases. Cephalalgia 2002; 22:157.
- Guido M, Specchio LM. Successful treatment of hypnic headache with topiramate: a case report. Headache 2006; 46:1205.
- Autunno M, Messina C, Blandino A, Rodolico C. Hypnic headache responsive to low-dose topiramate: a case report. Headache 2008; 48:292.
- Peng H, Wang L, He B, et al. Hypnic headache responsive to sodium ferulate in 2 new cases. Clin J Pain 2013; 29:89.