Polysomnography in Hypnic Headache Syndrome

Abstract

Hypnic headache syndrome is an unusual chronic headache that usually begins after age 60 years and occurs exclusively during sleep. Despite the relationship between the headache and sleep, no formal sleep evaluation with overnight polysomnography has been reported for this syndrome. Three patients with long-standing hypnic headache underwent overnight polysomnography. The results were quite variable, ranging from normal to marked sleep insufficiency. A hypnic headache was captured in one patient arising out of rapid eye movement sleep at a time of severe oxygen desaturation. Formal sleep evaluation should be considered in patients with hypnic headache because there may be pathophysiologic and therapeutic implications.

Secondary “hypnic headache-

“…The other cases of symptomatic hypnic headache relate to OSAS [14], a posterior fossa meningioma [32] and a pontine stroke [27]. All other published cases were considered idiopathic or primary, although several patients presented with conditions that cause nocturnal or early morning headaches, such as arterial hypertension, obstructive sleep apnoea or depression [12-15, 17, 18, 24-26, 31, 39, 40].…”

“…The mechanism by which nocturnal hypertensive peaks can cause headache is not clear. Interestingly, only nine of the cases published included 24 h blood pressure monitoring [14,15,18,25,35,39] despite the fact that 17 patients had previous history of arterial hypertension [12,13,17,18,24,25,31,39,40]. It should be noted that four patients attained headache relief with monotherapy with antihypertensives, such as atenolol and verapamil.…”

“…All but one of these tests were considered normal or with changes unrelated to the headache [10, 12, 14, 15, 17-20, 23-26, 28, 31, 35, 37, 39, 40]. In one patient, severe obstructive sleep apnoea was diagnosed after polysomnography and the headache syndrome resolved with CPAP [14].…”

“…Interestingly, although 15 patients did not benefit from anti-hypertensive agents, such as propranolol/atenolol (14), verapamil (2) or clonidine (1) [10,14,15,18,29,30,35,37,38,44], two patients attained benefit from atenolol and two from verapamil, given as prophylactic monotherapy [13,17,36].…”

The Role of Melatonin in the Treatment of Chronic Headache

“…Синтез и секреция мелатонина уменьшаются с возрастом [37]. Имеются отдельные сообщения о том, что мелатонин может быть эффективен в терапии гипнической головной боли как в качестве терапии, так и в комплексном лечении [38,39]. В одном из исследований приняли участие 12 пациентов с гипнической головной болью, 3 пациента, при-нимающих мелатонин в дозе 3-5 мг, отметили уменьшение частоты и интенсивности головной боли наполовину [40].…”