scholarly journals Hypnic headache: a rare type of primary headache disorder

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S120-S120
Author(s):  
Muhammad Sayed Inam ◽  
Saifun Nahar ◽  
Mohammad Zubayer Miah
Keyword(s):  
Treatment Options ◽  
Primary Headache ◽  
Headache Disorder ◽  
Lithium Carbonate ◽  
Hypnic Headache ◽  
Rare Type ◽  
Falling Asleep ◽  
History Of ◽  
Waking Up ◽  
Secondary Causes

ObjectiveHypnic Headache are is a very rare primary headaches that affect the elderly, with an average age of 60 years. Research in the areas of neurophysiology and treatment options for Hypnic Headache are necessary in order to better understand, and improve outcomes for this rare headache disorder.Case reportMr. X is a 70-year-old patient, has been presenting with the complaints of headache during sleep at night for the last 1 year. The Headache started after 3 to 4 hours after falling asleep. Due to headache, he wakes up from sleep around 03:00 to 04:00 am almost every night and his headache persist for 30 to 40 minutes. After waking up from sleep he keeps himself busy with religious activity and the headache gradually resolves. He then goes back to bed again.Mr. X also informed that, the headache is dull in nature and located in left temporo occipital region. It is not associated with photophobia, phonophobia, nausea, vomiting, tearing or discomfort in the leg. He gives no history of early morning headache or day time headache, sleep disorder, snoring or sleep apnea. He has no past history of trauma to the head, fainting attack, unconsciousness, weakness or paralysis of limbs, seizures or non-epileptic seizures. He is an non-smoker, non-alcoholic, non-hypertensive & non-diabetic person.On general examination, his heart rate is 70 beats/min, blood pressure 138/68 mm of Hg. There are no anemia, jaundice or oedema present in him. His both lung fields are clear. On neurological examinations there are nothing abnormality detected. His Serological investigations, CBC (Complete Blood Count) FBS (Fasting Blood Glucose), lipid profile are within normal limit. CT scan of the brain is normal. There are no cerebral atrophy or volume loss compatible with age.Mr. X was treated by several general practitioners with paracetamol, diclofenac sodium, mefenamic acid, tramadol hydrochloride. He used these drugs either singly or in combinations. But with this treatment there were no significant improvement occurs. Mr. X is scared and depressed for his sleep time headache.DiscussionHypnic headache is a very rare headache disorder. It occurs in age groups over 60 years. It is occur at night during in sleep and waking the patient up, hence the name of it “alarm clock headache”. It is commonly unilateral and lasts for 15 minutes to 4 hours. Hypnic headache commonly dull or throbbing in character and does not make the patient restless, unlike in Cluster Headache. After waking up from sleep, most patients engage in some activity. Hypnic headache is not associated with rhinorrhea, tearing and ptosis. Diagnosis is mainly clinical. Secondary causes headache must be excluded. International Classification of Headache Disorders 3rd Edition (ICHD-3)-beta provides diagnostic criteria for hypnic headache. Pathophysiology of hypnic headache is not clearly identified. Usual treatment options of Hypnic headache includes bed time coffee, lithium carbonate, indomethacin. Our patient fulfil all the criteria of Hypnic headache and he fells improvement with Indomethacin 50 mg in devided doses.ConclusionHypnic Headache is a very rare type of primary headache. It should be diagnosed only after other secondary causes of headache have been excluded. Caffeine, lithium carbonate, flunarizine, indomethacin, used to treat the patient of Hypnic Headache. Lack of study and awareness about these disorders can lead to delays in diagnosis and treatment. Clinical trials are needed to find out proper treatment, but it will be difficult to perform because of the rareness of this disorder.

Hypnic headache

2020 ◽  
pp. 230-236
Author(s):  
Dagny Holle ◽  
David W. Dodick
Keyword(s):  
Primary Headache ◽  
Headache Disorder ◽  
Lithium Carbonate ◽  
Grey Matter Volume ◽  
Hypnic Headache ◽  
Diagnostic Uncertainty ◽  
Primary Headache Disorder ◽  
Cranial Autonomic Symptoms ◽  
Headache Onset ◽  
Motor Restlessness

Hypnic headache (HH) is a rare primary headache disorder. Its main clinical features are strict sleep-related headache attacks that awaken patients from sleep. As headache attacks often occur at the same time at night, HH has also been referred to as ‘alarm clock headache’. Currently, 225 cases have been reported in the literature. Patients are generally older than 50 years of age at headache onset, but occurrence in younger patients and even children has been described. More women than man are affected. The headache may be bilateral or unilateral. Some migrainous features, such as nausea or photophobia, or mild cranial autonomic symptoms, such as lacrimation, may accompany HH and create diagnostic uncertainty. While most patients display some motor activity during the headache attacks, the agitation and motor restlessness that is characteristic of cluster headache does not appear. The pathophysiology of HH is still enigmatic. Hypothalamic involvement has been considered on the basis of the circadian rhythmicity, relationship with sleep, and imaging evidence of a decrease in grey matter volume within the posterior hypothalamus. Caffeine, lithium carbonate, and indomethacin may be effective for the prevention of attacks, but randomized, placebo-controlled trials are not yet available.

Case series of sixteen patients with nummular headache

Cephalalgia ◽  
2010 ◽  
Vol 30 (12) ◽  
pp. 1527-1530 ◽  
Author(s):  
Justin Moon ◽  
Kamran Ahmed ◽  
Ivan Garza
Keyword(s):  
Medication Overuse ◽  
Age Of Onset ◽  
Medication Overuse Headache ◽  
Case Series ◽  
Primary Headache ◽  
Headache Disorder ◽  
Therapeutic Interventions ◽  
Nummular Headache ◽  
Primary Headache Disorder ◽  
History Of

Introduction: Nummular headache is a rare primary headache disorder described by a focal circumscribed area of pain (2–6 cm in diameter). Literature on this disorder is sparse. Patients and methods: Here, we describe a case series of 16 patients (6 men, 10 women) seen at the Mayo Clinic. Results: Mean age of onset was 50 years (range, 19–79 years) and mean duration of headache was 7.9 years (range, 0.33–40 years). Location of headache varied and was found to be an average of 3.9 cm in diameter (range, 2–10 cm). Headache was episodic (<15 days/month) in four patients and chronic (>15 days/month) in 12 patients. Attention was paid to therapeutic interventions. Resolution was seen in 38% of patients. Migraine was present in the history of 56% of patients and medication overuse headache was found in 25%. Conclusions: Our series results support previous findings. In our population, no specific therapy was identified to be effective in more than one patient.

Hypnic headache

Cephalalgia ◽  
2013 ◽  
Vol 33 (16) ◽  
pp. 1349-1357 ◽  
Author(s):  
Dagny Holle ◽  
Steffen Naegel ◽  
Mark Obermann
Keyword(s):  
Current Knowledge ◽  
Blood Pressure Monitoring ◽  
Case Reports ◽  
Case Series ◽  
Primary Headache ◽  
Headache Disorder ◽  
Hypnic Headache ◽  
Primary Headache Disorder ◽  
Primary Headache Disorders ◽  
Cerebral Mri

Background Hypnic headache (HH) is a rare primary headache disorder that is characterised by strictly sleep-related headache attacks. Purpose Because of the low prevalence of this headache disorder, disease information is mainly based on case reports and small case series. This review summarises current knowledge on HH in regard to clinical presentation, pathophysiology, symptomatic causes and therapeutic options. Method We review all reported HH cases since its first description in 1988 by Raskin. Broadened diagnostic criteria were applied for patient selection that slightly deviate from the current ICHD-II criteria. Patients were allowed to describe the headache character to be other than dull. Additionally, accompanying mild trigemino-autonomic symptoms were permitted. Conclusions Mainly elderly patients are affected, but younger patients and even children might also suffer from HH. Headache attacks usually last between 15 and 180 minutes, but some patients report headache attacks up to 10 hours. Almost all patients report motor activity during headache attacks. Cerebral MRI and 24-hour blood pressure monitoring should be performed in the diagnostic work-up of HH. Other primary headache disorders such as migraine and cluster headache may also present with sleep-related headache attacks and should be considered first. Caffeine taken as a cup of strong coffee seems to be the best acute and prophylactic treatment option.

scholarly journals Migraine patients in Germany - Need for Medical Recognition and New Preventive Treatments: Results from the PANORAMA Survey

2020 ◽  
Author(s):  
Mirja Koch ◽  
Zsazsa Katsarava ◽  
Caroline Baufeld ◽  
Katrin Schuh ◽  
Astrid Gendolla ◽  
...  
Keyword(s):  
Prophylactic Treatment ◽  
Treatment Options ◽  
Primary Headache ◽  
Headache Disorder ◽  
Comprehensive Overview ◽  
Treatment Algorithms ◽  
Primary Headache Disorder ◽  
Professional Perspective ◽  
Few Data ◽  
Healthcare Situation

Abstract Background: Migraine is a primary headache disorder characterized by recurrent attacks that may have a significant impact on patients’ daily life. Treatment options must often be re-evaluated in light of efficacy, tolerability and compliance issues. Few data on commonly applied treatment algorithms and treatment failures have existed in Germany in 2017/2018. The PANORAMA survey was designed to explore and characterize the migraine healthcare landscape and to demonstrate the medical treatment need at that time in Germany.Methods: Three different questionnaires were used to assess the profile of the 119 participating centers, characterize migraine patients at centers and evaluate qualitative aspects of the current migraine healthcare situation from a physician´s professional perspective. Data were analyzed as observed and summarized by descriptive statistics.Results: The results demonstrate that once referred to a migraine specialist, the majority of patients continue to be treated at a specialist. At specialized centers, 41.6% of migraine patients receive prophylactic treatment. 45.4% of prophylactic treatments are initiated with a beta-blocker and 28.1% with an anti-epileptic. Pivotal factors to initiate prophylactic treatment are migraine attack frequency and intensity (58.0%). Treatment decisions are largely based on prior / concomitant diseases and physical constitution of the patient (52.1%). Following an inadequate treatment, most patients either switch substance class or discontinue prophylactic treatment. Conclusions: PANORAMA gives a comprehensive overview of the migraine healthcare landscape in Germany in 2017/2018, elucidates a lack of common treatment algorithms and reveals a high demand for defined therapy strategies and new prophylactic treatment going forwards.

Complete alleviation of treatment refractory primary SUNCT syndrome with clomiphene citrate (a medicinal deep brain hypothalamic modulator)

Cephalalgia ◽  
2014 ◽  
Vol 34 (12) ◽  
pp. 1021-1024 ◽  
Author(s):  
Todd D Rozen
Keyword(s):  
Clomiphene Citrate ◽  
Treatment Options ◽  
Primary Headache ◽  
Headache Disorder ◽  
Decompression Surgery ◽  
Sunct Syndrome ◽  
Primary Headache Disorder ◽  
Treatment Refractory ◽  
Putative Mechanism ◽  
Deep Brain

Objective To report the first ever case of primary short-lasting unilateral neuralgiform headache attacks (SUNCT) syndrome completely responsive to clomiphene citrate. Methods Case report. Results SUNCT is a primary headache disorder marked by frequent attacks of one-sided headache with cranial autonomic associated symptoms. When SUNCT is deemed medicinally treatment refractory, it can cause tremendous patient-related disability. Surgical treatment options are available including hypothalamic deep brain stimulation, occipital nerve stimulator placement or arterial decompression surgery, but these procedures carry significant morbidity. A patient presented with a 10 month complaint of multiple, daily short-lasting, right-sided headaches each lasting from 60 to 120 seconds in duration and occurring from 100 to 200 times per day. The head pain was associated with ipsilateral eyelid ptosis and conjunctival injection. The patient was diagnosed with SUNCT but was unresponsive to multiple recognized medicinal treatments. He had complete alleviation of his attacks with clomiphene citrate, a synthetic, non-steroidal, ovulatory stimulant that directly binds to hypothalamic estrogen receptors. The clomiphene was tolerated without any adverse events. A putative mechanism of action for clomiphene in the prevention of SUNCT will be presented. Conclusion Clomiphene citrate is a unique treatment for SUNCT and appears to be very safe and effective.

Headache associated with head trauma

2020 ◽  
pp. 314-321
Author(s):  
Sylvia Lucas
Keyword(s):  
Primary Headache ◽  
Headache Disorder ◽  
Standard Of Care ◽  
Temporal Association ◽  
Prior History ◽  
Secondary Headache ◽  
Primary Headache Disorder ◽  
Global Health Issue ◽  
History Of ◽  
Probable Migraine

Traumatic brain injury (TBI) is an extremely important, common global health issue with approximately 2.5 million TBIs occurring yearly in the civilian population alone. The symptom manifestations of TBI are called ‘concussion’ symptoms and headache is the most common. Post-traumatic headache (PTH) is a secondary headache occurring in temporal association with the TBI and thought to be caused by the injury. Many studies have found PTH to be frequent and persistent, with a higher prevalence of PTH after mild than moderate to severe TBI. In both severity injuries, the most frequent phenotype of PTH is migraine or probable migraine. PTH risk factor after injury is a prior history of primary headache disorder. The relationship between TBI and PTH is unknown and currently the subject of intense research. As yet, treatment of PTH is empiric with standard of care to ‘phenotype’ the headache according to primary headache clinical characteristics and use the type as a guideline for management.

Primary stabbing headache

2020 ◽  
pp. 215-219
Author(s):  
Rashmi B. Halker ◽  
Esma Dilli ◽  
Amaal Starling
Keyword(s):  
Treatment Options ◽  
Headache Disorder ◽  
Primary Stabbing Headache ◽  
Drug Of Choice ◽  
Prophylactic Drug ◽  
Stabbing Headache ◽  
Idiopathic Stabbing Headache ◽  
The Brain ◽  
Cyclooxygenase 2 Inhibitors ◽  
Secondary Causes

Primary stabbing headache is a unique headache disorder, also known as idiopathic stabbing headache, ice pick headache, and jabs and jolts syndrome. The headache is described as a sharp, stabbing pain, lasting seconds to minutes, with no associated symptoms, including any autonomic features. It is more common in women by a 3:1 ratio and is comorbid with migraine, with some studies reporting that up to 40% of migraineurs also have primary stabbing headache. Performing magnetic resonance imaging of the brain is reasonable in patients who present with stabbing headache, as there are secondary causes. Meningiomas, hemorrhages, and giant cell arteritis have all been reported to present in this manner. As primary stabbing headache is a benign disorder, infrequent attacks do not require treatment and patients can be counselled accordingly. For more frequent attacks, indomethacin is the prophylactic drug of choice. Other treatment options include melatonin and cyclooxygenase-2 inhibitors.

scholarly journals Suspected Status Migrainosus During Flu Season

2020 ◽  
Author(s):  
Jacob Hascalovici
Keyword(s):  
Case Report ◽  
Treatment Options ◽  
Episodic Migraine ◽  
Secondary Headache ◽  
Acute Rhinosinusitis ◽  
History Of ◽  
Status Migrainosus ◽  
Multidisciplinary Pain Management ◽  
High Index Of Suspicion ◽  
Secondary Causes

Objective: The following case report is presented to highlight the importance of maintaining a high index of suspicion for secondary causes of headache, especially during influenza season. Case Report: A 61-year-old woman with a history of infrequent episodic migraine without aura presented to our multidisciplinary pain management center during the flu season with a 1-month history of persistent and continuous headache, suspicious for status migrainosus. Imaging of the brain was obtained to rule out secondary causes of headache and was notable for findings consistent with acute rhinosinusitis. Conclusion: We discuss a case of headache secondary to acute rhinosinusitis during the flu season presenting as suspected status migrainosus. Herein, we discuss the differential diagnosis of secondary headache of 1-month duration and present the treatment options for headache secondary to acute rhinosinusitis.

Acoustic neuroma presenting as a hypnic headache

2021 ◽  
Vol 14 (3) ◽  
pp. e235830
Author(s):  
Bryan Ceronie ◽  
Frederick Green ◽  
Oliver Charles Cockerell
Keyword(s):  
Acoustic Neuroma ◽  
Neurological Examination ◽  
Cerebellopontine Angle ◽  
Tumour Growth ◽  
Obstructive Hydrocephalus ◽  
Gamma Knife Radiosurgery ◽  
Primary Headache ◽  
Hypnic Headache ◽  
History Of ◽  
One Year

Hypnic headache (HH) is a rare, primary headache syndrome that invariably occurs during sleep and wakes the patient. Acoustic neuroma (AN) is a benign tumour that uncommonly presents with isolated headache. Here, we describe a patient with AN that presented with an HH-like syndrome. A 40-year-old woman presented with 4 months of generalised, throbbing, nocturnal headaches that woke her from sleep. Neurological examination was unremarkable. Retrospectively, she reported a 4-year history of mild, bilateral tinnitus. Neuroimaging demonstrated a large, left-sided AN in the cerebellopontine angle without obstructive hydrocephalus. Gamma knife radiosurgery controlled tumour growth. One year after radiosurgery, she became nocturnal headache-free. AN has not previously been described as presenting with an HH-like syndrome. There are four previous reports of an HH-like syndrome secondary to intracranial masses. In all cases, patients became headache-free following surgery. This advocates for neuroimaging to exclude structural causes.

Pathophysiology of hypnic headache

Cephalalgia ◽  
2014 ◽  
Vol 34 (10) ◽  
pp. 806-812 ◽  
Author(s):  
Dagny Holle ◽  
Steffen Naegel ◽  
Mark Obermann
Keyword(s):  
Electrophysiological Study ◽  
Primary Headache ◽  
Headache Disorder ◽  
Primary Headaches ◽  
Hypnic Headache ◽  
Primary Headache Disorder ◽  
Study Results ◽  
Symptomatic Headache ◽  
Underlying Mechanisms ◽  
Underlying Pathophysiology

Background Hypnic headache (HH) is a rare primary headache disorder that is characterized by strictly sleep related headache attacks. Purpose The underlying pathophysiology of HH is mainly enigmatic but some clinical characteristics such as circadian rhythmicity and caffeine responsiveness may point toward possible underlying mechanisms. Method Current studies that deal with the pathophysiology of HH are summarized. Data on cerebral imaging, sleep, electrophysiology studies, effectiveness of drugs, and symptomatic headache types are discussed to illuminate underlying pathophysiologic mechanisms. Conclusion HH can be clearly differentiated by its clinical presentation as well as imaging and electrophysiological study results from other primary headaches such as migraine or cluster headache. The underlying pathophysiology is still enigmatic but a hypothalamic involvement seems to be likely.

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