Can you wake up with a headache during sleep?

This is the 4625th article of Da Yi Xiao Hu

Headaches are very common in life, but have you ever heard of a disease where a headache wakes you up during sleep? Today we are going to talk about a rare type of headache in clinical practice - sleep headache.

1. What is hypnic headache?

Hypnic headache, as the name implies, is a type of headache that wakes you up during sleep at night because of short headache attacks on both sides, usually accompanied by nausea, but without other autonomic nervous system symptoms such as sweating, increased heart rate, and increased blood pressure. It is more common in the elderly, and headache attacks occur at basically the same time every night, sometimes in dreams, with more than one headache occurring every night. Because the time of headache attacks is relatively fixed, hypnic headaches have also been called "timed headaches" and "chronological headaches", just like we set an alarm every day, and we start to have a headache at a certain time. It is also like a timed fountain in the square, which starts spraying at the top of the hour.

2. Characteristics of hypnic headache

Hypnic headaches usually occur during sleep at night or after waking up. Some patients may also experience headaches during daytime sleep, but headaches generally do not occur at other times. Hypnic headaches are closely related to sleep, and are mostly experienced during rapid eye movement sleep, which is what we usually call deep sleep. The headache site is mostly the entire head, bilateral head, or one side of the head. The degree of headache is moderate or severe, and the frequency of attacks ranges from once a week to 6 times a night. 60% of patients have a fixed time of headache every night, mostly about 3 hours after falling asleep, that is, 1 to 3 am. The cause of hypnic headaches is currently unknown, and the occurrence of fixed times every night suggests that it may be related to biological clock disorders. There are also reports that it is related to increased intracranial pressure, and may be related to hypertension and sleep apnea.

How to diagnose

Hypnic headaches are generally diagnosed based on clinical symptoms. A detailed medical history should be taken and other secondary causes should be excluded. The diagnostic criteria for hypnic headaches established in the trial version of the International Classification of Headache Disorders, 3rd Edition (ICHD-3) can be referred to:

A. Recurrent headaches that meet criteria for BE;

B. occurs only during sleep and causes awakening;

C. Attacks occur ≥10 days per month and last for more than 3 months;

D. Lasts for 15min-4h after awakening;

E. No autonomic symptoms or restlessness;

F. Not better explained by another ICHD-3 headache disorder diagnosis.

Treatment of hypnic headaches

It is divided into two types of treatment: drug treatment and non-drug treatment.

Drug treatment generally includes lithium salts, flunarizine, melatonin, and indomethacin. When using lithium, pay attention to the side effects of the drug. Other drugs such as amitriptyline, beta-blockers, and hormones may also be effective. Non-drug treatment generally includes cognitive behavioral therapy, drinking a small amount of coffee, and other measures. If sleep apnea syndrome exists, a ventilator can be worn to keep the airway open and alleviate symptoms.

Generally speaking, hypnic headaches are still very rare in life, but because they occur at fixed points, they bring a lot of trouble to sleep. After learning about the relevant knowledge today, you will no longer feel unfamiliar with it, and you will also know how to treat it. I hope you will never encounter it in the future and have a good night's sleep!

Author: Jilin University Second Hospital

Department of NeurologyMan YuhongChief Physician