Hypnic Headache: Causes, Symptoms, Diagnosis & Treatment

November 2, 2022

ypnic headaches are rare headaches which occur during sleep and usually wake the person up. Head pain may last anywhere from 15 minutes to 3 hours. While the causes are unknown, the main at-home treatment is caffeine, such as from a cup of coffee or caffeine pill.

Less than 1% of people are affected by hypnic headaches. But for those who do experience these annoying “alarm clock headaches,” be encouraged. According to the Sleep Foundation, more than 40% of people who treat their hypnic headaches one time never experience them again.

If hypnic headaches are disrupting your sleep cycle and circadian rhythm, schedule an appointment with Denver Upper Cervical Chiropractic to see if upper cervical chiropractic care is the solution for you. Call us at 303-955-8270 for more information.

Keep reading to learn more about hypnic headaches, whether you have them, and how to treat them.

What is a hypnic headache?

A hypnic headache is head pain which occurs while you’re asleep, usually waking you up and disrupting your sleep schedule. This primary headache disorder more commonly affects older individuals — one study found the average age of onset was 62.

The head pain is usually dull, but it may present as pulsating or throbbing. Some people with hypnic headaches report mild head pain, but most report the pain is moderate to severe.

Typically, these rare headaches are easy to treat and will not impact your health long term.

Hypnic headaches may also be called alarm clock headaches or nocturnal headaches.

What is the average duration of a hypnic headache? The average duration of a hypnic headache is 15-60 minutes. In extremely rare cases, headaches might last over 3 hours.

Symptoms

What are the symptoms of a hypnic headache? The common symptoms of hypnic headaches include:

Head pain that begins during REM sleep (REM = rapid eye movement)
Pain that wakes you up and persists once awake
Pain that lasts 30-60 minutes, though it is occasionally shorter or longer
Pain on one or both sides of the head
Pain which is spread out, not concentrated

According to the International Headache Society’s ICHD-3 (International Classification of Headache Disorders 3rd Edition), a diagnosis of hypnic headache would require at least 10 nights of head pain during sleep per month for 3 months. The IHS’s diagnostic criteria are widely used.

Causes & Risk Factors

Experts do not know what causes hypnic headaches, but there are a few possible root causes that raise your risk of hypnic headaches:

Age (over 50 years old)
History of other headache disorders
Pain management dysfunction
Melatonin production problems
Sleep disorders, such as sleep apnea
Hypertension (high blood pressure)
Migraine
Extreme thirst
Frequent urination

This headache condition seems to impact both genders equally.

What is the most likely cause of a hypnic headache? The most likely cause of a hypnic headache is an imbalance in brain chemistry.

Diagnosis

In order to diagnose a patient for hypnic headaches, a healthcare provider would likely rule out a tumor with an MRI and rule out sleep apnea with a sleep study (polysomnography).

Then a diagnosis of hypnic headaches would have to meet these clinical features :

Head pain occurs during sleep.
It wakes you up.
It lasts for 15 minutes up to 4 hours.
It occurs at least 10 nights a month, lasting for at least 3 months (AKA episodic).
It is typically spread out on both sides of the head , not concentrated in one area.
It is characterized by moderate to severe intensity, rather than minor pain.
It is characterized by dull aching , sometimes a throbbing or pulsating sensation.
It cannot be better accounted for by some other diagnosis.

Your doctor will try to rule out other root causes of your head pain. Common conditions that might better explain your symptoms include:

Obstructive sleep apnea
Brain tumor
Artery inflammation in the head
Migraine
Cervicogenic headache
Cluster headaches
Trigeminal neuralgia
Paroxysmal hemicrania
Medication overuse headache
SUNCT ( S hort-lasting, U nilateral, N euralgiform headache attacks with C onjunctival injection and T earing)

Treatments

There are a few potential treatments for hypnic headaches with scientific research to back them up, including caffeine, lithium , and indomethacin.

Less consistent treatment options that may be effective include melatonin, beta-blockers, flunarizine, acetazolamide, verapamil, and topiramate.

The Sleep Foundation cites research that 40% of individuals who treat their hypnic headaches never deal with them again. However, other research reports fewer than 20% of individuals who seek treatment actually achieve remission.

1. Caffeine

40-60 milligrams of caffeine is an effective treatment for hypnic headache that is well tolerated in most patients. Caffeine may even be preventative against hypnic headaches, not just treatment. Surprisingly, caffeine does not typically interfere with a patient’s sleep.

Caffeine is usually the first treatment for hypnic headache — partly because it works so often, partly because it’s so readily available. You can consume caffeine from a cup of coffee, a caffeine pill, or even a strong cup of hot tea.

2. Lithium

Lithium carbonate has been reported as an effective treatment for hypnic headaches since the 80s. The best dosage of lithium for this type of headache seems to be 150-600 milligrams per day in single or divided doses, to a serum level of 0.5-1.0 mmol/L.

Raskin published the first research touting lithium’s efficacy in treating hypnic headache, and several studies have since been published which corroborate these findings.

You need a prescription for lithium carbonate, which is usually used to treat bipolar disorder.

3. Indomethacin

Indomethacin (Tivorbex) is an NSAID (non-steroidal anti-inflammatory drug) which has shown effective in treating hypnic headaches. The best dosage is 25-150 milligrams of indomethacin at bedtime.

This NSAID is especially helpful for individuals with hemicranial hypnic headaches or with accompanying autonomic symptoms. (Autonomic features include drooping eyes, uncontrollable crying, runny nose, facial swelling, etc.)

Indomethacin is only available by prescription. Healthcare professionals need to be wary of the side effects when prescribing this medicine to older patients.

4. Botox

Case reports have suggested a form of Botox as a potential treatment for hypnic headaches. Botulinum toxin type A injection has shown promise as a hypnic headache solution.

Invasive treatments like this should be considered with caution since they can more easily result in complications compared to non-invasive treatments like caffeine.

When To See a Doctor

If you’re experiencing headaches in the middle of the night twice a week or more, you should see a doctor about diagnosis and treatment.

If you’re worried about your symptoms resulting from a brain tumor, seek a diagnosis right away.

Treat the root cause of your headache.

A lot of conventional doctors may prescribe painkillers to mask your symptoms, but it’s definitely best to treat the root cause of your headache instead.

Like migraines , the cause of hypnic headaches is not well understood. However, a lot of headache disorders can be treated with upper cervical chiropractic care. Schedule an appointment today to see if Denver Upper Cervical can help you with your unique situation.

Sources

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Tariq, N., Estemalik, E., Vij, B., Kriegler, J. S., Tepper, S. J., & Stillman, M. J. (2016). Long‐term outcomes and clinical characteristics of hypnic headache syndrome: 40 patients series from a tertiary referral center. Headache: The Journal of Head and Face Pain , 56 (4), 717-724. Abstract: https://pubmed.ncbi.nlm.nih.gov/27015738/
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Lipton, R. B., Diener, H. C., Robbins, M. S., Garas, S. Y., & Patel, K. (2017). Caffeine in the management of patients with headache. The journal of headache and pain , 18 (1), 1-11. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5655397/
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