Hypnic Headache – “Alarm Clock Headache”

Hypnic headache (HH) is a rare primary headache disorder (primary headache disorders are those that cannot be attributed to another condition.) The most recognizable feature of hypnic headache is that it only develops during sleep and wakes the sufferer.

Characteristics of HH:

  • The headache occurs at a consistent time each night, usually between 1 and 3 a.m.
  • The pain is usually mild to moderate, but can be severe.
  • The first occurrence of HH is typically after the age of 50, although more data shows the age of onset to usually be between the ages of 40 and 82.
  • The pain of HH is bilateral in approximately 66% of cases.
  • HH develops during sleep and awakens the sufferer.
  • The duration of HH is usually 15 to 180 minutes.
  • The symptoms of include only ONE of the following:

Diagnosing HH:

Before arriving at a diagnosis of hypnic headache, imaging studies should be performed to rule out any organic issues.

Treating HH:

  • Lithium carbonate, 300 mg at bedtime, is frequently used to treat HH, but it must be used with caution especially in the presence of renal disease, dehydration, or use of diuretics.
  • Doses of caffeine, flunarizine (a calcium channel blocker), and indomethacin at bedtime have been shown effective in some cases.
  • There have been some case studies of HH that have shown daily preventive use of topiramate (Topamax) to be effective in some cases.

IHS Classification:

The International Headache Society’s International Classification of Headache Disorders, 2nd Edition (ICHD-II), is the “gold standard” for diagnosing and classifying headache disorders. Here are the description, diagnostic criteria, and symptoms of HH as set forth in the ICHD-II:

4.5 Hypnic headache

Previously used terms: Hypnic headache syndrome, ‘alarm clock’ headache

Description: Attacks of dull headache that always awaken the patient from asleep.

Diagnostic criteria:

  1. Dull headache fulfilling criteria B–D
  2. Develops only during sleep, and awakens patient
  3. At least two of the following characteristics:
    1. occurs 15 or more times per month
    2. lasts 15 or more minutes after waking
    3. first occurs after age of 50 years
  4. No autonomic symptoms and no more than one of nausea, photophobia or phonophobia

E. Not attributed to another disorder1

Note:
1 Intracranial disorders must be excluded. Distinction from one of the trigeminal autonomic cephalalgias is necessary for effective management.

Comments:
The pain of hypnic headache is usually mild to moderate, but severe pain is reported by approximately 20% of patients. Pain is bilateral in about two-thirds of cases. The attack usually lasts from 15 to 180 minutes, but longer durations have been described. Caffeine and lithium have been effective treatments in several reported cases.

Wrapping it up:

Hypnic headache is rare, and it should be diagnosed only after any organic, physical causes have been ruled out with imaging studies. HH always begins during sleep and wakes the suffer. HH usually lasts from 15 to 180 minutes. Lithium carbonate, caffeine, flunarizine,  indomethacin, and Topamax have been successful in treating HH in some cases.

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
View References
1. The International Headache Society. "International Classification of Headache Disorders, 2nd Edition." Cephalalgia, Volume 24 Issue s1. May, 2004. doi:10.1111/j.1468-2982.2003.00823.x    2.     Silberstein, Stephen D.; Lipton, Richard B.; "Goadsby, Peter J. Headache in Clinical Practice, Second Edition." Martin Dunitz, Ltd. 2002.

Comments

View Comments (12)
  • mary06
    5 years ago

    My HH started when I was about 45. I have them about 75% of nights. Wake up about 3:00 am. They don’t go away without an intervention- medication or coffee. I finally discovered that drinking a cup of coffee sometime after dinner just about completely stopped them. What a life change.

  • veldon
    6 years ago

    Thanks Terri: I wake up at the same time almost every night with a headache, I thought it was a Migraine, since I have Migraines almost all the time. I wondered why am I getting these headaches at the same time each night, around 3 am. This is good to know I will talk to my Dr. Donna

  • Teri-Robert author
    6 years ago

    Donna,
    You’re very welcome. Certainly, it can’t hurt to talk with your doctor. It’s entirely possible to have both Migraine and another headache disorder. Please let me know how it goes?

    Teri

  • Janet
    6 years ago

    I forgot…I concur with Teri…topamax does help with HH and also several other kinds of migraines. However after years of use the side effects to topamax outweighed the benefit..so as of now I have no preventative meds due to other health issues and side effects. Trying to find a new doctor with a new solution here in the Atlanta area. If you know of a doctor here Teri please forward . Thanks.

    Blessings
    Janet

  • Janet
    6 years ago

    How can doses of caffeine help before bed?? Caffeine is often a trigger for
    me..and keeps me awake. A rip that has helped me…when I try caffeinated coffee that backfires..black tea ..it either works great or not at all…it’s 50/50 for me..but it has to be plain black tea…not orange pekoe or any other flavors…black tea. Drink slow…and sometimes it kicks that HH..my migraine sack has several different ones…and after having inpatient DHE if drip last year I now have a new migraine that I never had before..migraine with aura when my eyes are closed. It’s AWFUL!!! You can’t get away from it…eyes open..eyes closed ..it’s still there and frightening.
    Blessings,
    Janet

  • Cindi
    6 years ago

    OMG! This is me. Do you know if you can have more than one type of migraine? This is how mine start 95% of the time. The other 5% comes during the day for reasons I know not. Thanks Teri!

  • Teri-Robert author
    6 years ago

    Cindi,

    Yes, you can have more than one type of Migraine. Keep in mind though that this is not a form of Migraine.

    If you wake with Migraines, it could be helpful to talk with your doctor about your sleep patterns. Sleep issues are a very common Migraine trigger, especially if you wake with them.

    Hypnic headaches are very different from Migraine, and instead of waking at your “normal” time with these, they tend to wake you up like clockwork.

  • caradrouin
    6 years ago

    Very interesting, thank you for presenting this. This is not what I have, though it would explain why doctors have dismissed my headaches in the past. Mine usually start between 1am and 5am. All similarities end there.

  • Teri-Robert author
    6 years ago

    You’re very welcome!

  • Ricki
    6 years ago

    I get headaches during sleep, though usually between 4-5 AM. I don’t know if they would fall into this diagnosis, however, for anyone reading this that may be seeking a solution, I have found that taking melatonin at bedtime has reduced the frequency of these headaches from every night to maybe 50% of the time.

  • astrosdiva
    6 years ago

    I also am awakened with Migraine in the wee hours of the morning. The pain is so severe, it wakes me up about 5 hours after I have gone to bed. Topomax never helped me. I am taking magnesium and feverfew and seem to be a bit better.

  • Teri-Robert author
    6 years ago

    Ricki,

    Hypnic headaches are quite different from Migraines. If you think this is a possibility, talking with your doctor would be a good idea, if for no other reason than ruling them out.

    Melatonin can help with several different headache disorders, but as with any treatment, “natural” or not, I highly suggest checking in with our doctors before we try them.

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