When it comes to headaches, the difference between one rare type of head pain and more common conditions is a matter of night and day.
Imagine going to bed after an otherwise normal day, eager for a restful night of sleep, only to be suddenly awakened by a headache. You might feel the pain on just one side of your head or all around, and it might last anywhere from 15 minutes to 4 hours.
If this sounds familiar, you may have hypnic headache syndrome, a disorder that happens only while you’re asleep and mostly affects women over 50. People who get these types of headaches typically have more than 10 of them in a month.
Symptoms
Hypnic headaches are also called “alarm clock headaches,” because they usually happen at the same time of night, most often between 1 and 3 a.m. These headaches rarely occur during daytime naps.
The pain they cause can range from mild to severe. More severe pain is often described as throbbing. You also might have:
- Sensitivity to light or sound
- Nausea
Cause
Doctors aren’t sure what leads to hypnic headaches. Research suggests there may be a connection between them and certain stages of sleep, but more studies are needed to figure out what brings them on and how they might be prevented.
Diagnosis
Your doctor will start by asking about your sleep patterns and habits, like if you snore or are restless during the night. Then they’ll try to rule out other possible causes, including:
- Another primary headache disorder, like cluster headaches or migraine
- Sleep apnea
- Nighttime high blood pressure or low blood sugar
- Nighttime seizures
- Overuse of certain medicines
- Inflammation in an artery in your head
- Head injury or bleeding in your brain
- Brain tumor
To do this, your doctor may suggest one or more of these common tests:
- Blood tests
- Sleep studies
- Computed tomography (CT) scan -- a series of X-rays taken from different angles that are put together to show a more complete picture of your brain
- Magnetic resonance imaging (MRI) scan -- powerful magnets and radio waves are used to make detailed images of your brain
Treatment
If your symptoms match all those linked to hypnic headache and your doctor can’t find any other reason for them, the first thing they’ll probably recommend is some caffeine before bed. You might take it in a pill or simply have a cup of coffee before hitting the sack.
Your doctor also might suggest indomethacin, a non-steroidal anti-inflammatory drug (NSAID), to help with the pain.
If those don’t work well enough, another option might be lithium carbonate, a mood-stabilizing drug often used to treat bipolar disorder and cluster headaches. But you shouldn’t take it if you have heart disease or a problem with your kidneys.
Other medications used to treat hypnic headaches include:
- Aspirin
- Migraine medications like frovatriptan and sumatriptan
- Atenolol (a beta blocker)
- Belladonna, phenobarbital (a barbiturate), and ergotamine (a migraine medication)
- Flunarizine (a calcium channel blocker)
- Lamotrigine (a seizure medication)
- Melatonin
- Prednisone (a steroid)
For many people, these headaches go away with treatment, but more research is needed to find medications that work for everyone.