Symptoms, causes, treatment, and more

A hypnical headache is a type of headache that occurs only during sleep, usually at a constant time. People may also refer to hypnical headaches as alarm clock headaches as they often cause people to wake up.

Research has shown that hypnotic headaches are rare – approximately 0.07% of people who see a doctor about headaches have hypnian headaches. However, they can be common in those who experience them, with an average occurrence of 10 times per month. They usually start after the age of 50, but they can also affect younger people.

Read on to explore the symptoms, causes, and diagnosis of hypnotic headaches. We are also investigating treatments and the outlook for this symptom.

According to a research article published in 2021, most people who report hypnical headaches describe them as dull, but the pain can also be pulsating or throbbing. While the pain is generally moderate to severe, some people experience mild discomfort. The headache may persist for 15 minutes to 4 hours after you wake up.

According to the article, Hypnical Headache:

  • affect adults of all genders equally
  • usually affects both sides of the head
  • Cause pain that typically lasts 30-60 minutes after waking up

People can also have more than one hypnical headache per night.

In rare cases, hypnotic headaches may also have the following symptoms:

  • Nausea
  • Vomit
  • extreme sensitivity to light
  • an uncharacteristic fear of noises

Experts don’t know exactly what causes hypnotic headaches, but it may be related to the following:

  • Pain Therapy: Different parts of the brain play a role in managing pain, so a problem with one of them can affect the perception of pain.
  • Melatonin production: The brain produces this hormone at night to induce sleep. Melatonin production decreases with age.
  • Rapid Eye Movement (REM) sleep: This is a phase of sleep where the eyes move quickly in different directions, while intense dreams can occur. The onset of hypnotic headaches is linked to REM sleep, which means that there may be a link between the headache and the physiological effects that can occur during this phase of sleep.

According to one source, hypnotic headaches mainly affect postmenopausal women. However, researchers have yet to specifically investigate the link between menopause and hypnotic headaches.

A 2018 article suggests that hormonal changes during menopause could be linked to some types of headache. Treatments such as hormone replacement therapy can make migraine headaches worse. Some people may also notice improvement or no change in headache symptoms during menopause.

However, not all migraine headaches are alike. Therefore, the results of the study may not necessarily apply to hypnical headaches.

Doctors usually base a hypnotic headache diagnosis on a person’s headache pattern. This is made up of the following factors:

  • if the headache occurs only at night
  • Duration of the headache
  • Frequency of headache

To diagnose a hypnical headache, health professionals may need to rule out other causes of nighttime headaches based on the symptoms associated with it. These include conditions such as:

  • Brain tumors, characteristic growth of cells in the brain
  • a brain aneurysm or other blood vessel abnormality in the brain
  • Side effects of medication
  • obstructive sleep apnea, a condition in which breathing stops temporarily while you sleep
  • Giant cell arteritis, which is the inflammation of the lining of the arteries that can occur in the temples

An MRI can rule out structural abnormalities such as brain tumors. In addition, an overnight study monitoring body processes during sleep may rule out sleep apnea.

An MRI of the brain can also show a decrease in the volume of gray matter in a part of the brain called the hypothalamus, which is responsible for keeping the body in a balanced, stable state. It also regulates the circadian rhythm, including the release of melatonin at night.

The most common treatment for hypnical headaches is caffeine in the form of coffee before bed. For most people who suffer from these headaches, it does not interfere with sleep.

The following drugs can be effective in some cases:

  • Melatonin
  • Indomethacin (Indocin), a nonsteroidal anti-inflammatory drug
  • Flunarizine (Abifluz), a calcium channel blocker that doctors can use to treat migraines

In addition, doctors can sometimes prescribe lithium carbonate (Lithobid), a drug for bipolar disorder. Because of the side effects, patients should use lithium carbonate with caution, especially if they are taking diuretics or have any of the following:

  • Kidney disease
  • Thyroid disease
  • Dehydration

Research suggests that around 17% of people with hypnical headaches go into remission over time, but most experience the condition long-term. Treatment for hypnotic headaches is effective in 40% of people.

A 2016 study also reports that treatment can make a difference. Researchers examined the medical records of 40 people who had hypnical headaches between 2008 and 2014. They found lithium was the most effective treatment, followed by caffeine before bed.

Of those who took lithium, 70% had a complete response and 20% had a moderate response. Of those who took caffeine before bed, 28% had a complete response and 43% had a moderate response. Individuals also experienced benefits from taking caffeine after waking up with a headache.

A hypnical headache involves a dull ache on either side of the head that causes a person to wake up from sleep. It can last anywhere from 15 minutes to 4 hours and can be repeated at least 15 times per month.

To diagnose the condition, doctors first rule out other possible causes of the headache, such as obstructive sleep apnea. Health professionals can use tests to monitor sleep or do MRI scans of the brain. They will also examine symptom patterns to help make a diagnosis.

Treatment may include drinking coffee before bed, which may not adversely affect sleep for people with hypnical headaches.

If caffeine isn’t working, a doctor may prescribe medications such as lithium (Lithobid) or indomethacin (Indocin). However, both can cause side effects so individuals may want to discuss these with a doctor.

Treatments can be effective in treating hypnotic headaches. Some people may go into complete remission, while others may need long-term treatment for the condition.