Clinical characteristics and therapeutic options in hypnic headache.
BACKGROUND
Hypnic headache (HH) is a rare primary headache disorder that is characterized by exclusively sleep-related headache attacks. Because of its low prevalence, clinical features and therapeutic options are widely unknown or under discussion.


METHODS
Twenty patients with HH were examined and interviewed using a standardized questionnaire in regard to their clinical characteristics and effective treatment regimens. Data were evaluated according to current International Headache Society (IHS) diagnostic criteria. Individual treatment history and effective treatment options were compared with expected efficacy based on current literature.


RESULTS
In conflict to current IHS criteria, 15% of patients reported trigemino-autonomic symptoms. All patients showed distinct motor behavior during their headache attacks. In acute pain attacks caffeine was most effective. Lithium, topiramate, melatonin, amitriptyline and indomethacin were sometimes useful prophylactic treatment options but were often associated with side effects.


CONCLUSIONS
Our results underline the need for modification of the IHS diagnostic criteria of HH to better reflect the actual clinical characteristics of this headache. Caffeine should be considered as first-line acute therapy. Prophylactic medical treatment should be carefully evaluated in regard to side effects in this aged patient population, as this seems to be a major concern of patients apart from pure pain reduction.
University of Duisburg-Essen, Germany. agny.holle@uk-essen.de
Dagny
D
Holle
Steffen
S
Naegel
Sarah
S
Krebs
Zaza
Z
Katsarava
Hans-Christoph
HC
Diener
Charly
C
Gaul
Mark
M
Obermann
D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D002110:Caffeine / Q000627:therapeutic use*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D005260:Female; D051270:Headache Disorders, Primary / Q000188:drug therapy* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires
D000700:Analgesics; D000697:Central Nervous System Stimulants; D002110:Caffeine