Rare Primary Headaches
Rare Primary Headaches
Hypnic headache is characterized by strict sleep related headache attacks. According to its low prevalence, the diagnostic criteria are still disputed based on the growing amount of small case studies and case reports. The new diagnostic criteria of hypnic headache try to reflect these new data. The diagnosis of hypnic headache can now be made in patients suffering from exclusively sleep-related headache attacks occurring on at least 10 days per month for more than 3 months lasting at least 15 min and for up to 4 h. The headache should be not accompanied by cranial autonomic symptoms or restlessness. The age of the affected patients is not included in the diagnostic criteria any more. However, the majority of patients are older than 50 years when the headache begins. The headache frequency was reduced from 15 to at least 10 days a month. Importantly, according to the new classification, hypnic headache attacks are now allowed to be accompanied by migrainous features such as nausea, photophobia and phonophobia. A review of all hypnic headache cases reported in the literature until now showed that there may be still some clinical features that are not met by the new criteria. Some patients report much longer headache attacks up to 10 h. Almost all patients show some kind of motor activity during the headache attacks. The suggested diagnostic workup of hypnic headache includes cerebral MRI and 24-h blood pressure monitoring to rule out symptomatic hypnic headache. Caffeine seems to be the best acute and prophylactic treatment option regarding side-effects and efficacy.
Hypnic Headache
Hypnic headache is characterized by strict sleep related headache attacks. According to its low prevalence, the diagnostic criteria are still disputed based on the growing amount of small case studies and case reports. The new diagnostic criteria of hypnic headache try to reflect these new data. The diagnosis of hypnic headache can now be made in patients suffering from exclusively sleep-related headache attacks occurring on at least 10 days per month for more than 3 months lasting at least 15 min and for up to 4 h. The headache should be not accompanied by cranial autonomic symptoms or restlessness. The age of the affected patients is not included in the diagnostic criteria any more. However, the majority of patients are older than 50 years when the headache begins. The headache frequency was reduced from 15 to at least 10 days a month. Importantly, according to the new classification, hypnic headache attacks are now allowed to be accompanied by migrainous features such as nausea, photophobia and phonophobia. A review of all hypnic headache cases reported in the literature until now showed that there may be still some clinical features that are not met by the new criteria. Some patients report much longer headache attacks up to 10 h. Almost all patients show some kind of motor activity during the headache attacks. The suggested diagnostic workup of hypnic headache includes cerebral MRI and 24-h blood pressure monitoring to rule out symptomatic hypnic headache. Caffeine seems to be the best acute and prophylactic treatment option regarding side-effects and efficacy.