Hypnic Headache (Alarm Clock Headache)

What Are Hypnic Headaches?

Hypnic headaches are a rare type of headache that occurs during sleep and wakes the person up, which is why they’ve earned the nickname “alarm-clock headaches” Trusted Source Practical Neurology View Source . The pain can keep people up for at least 15 minutes, if not longer.

Hypnic headaches only occur while a person is sleeping Trusted Source Current Pain and Headache Reports View Source . This timing distinguishes them from other types of headaches, such as migraines or cluster headaches Trusted Source Cephalalgia View Source , which may cause difficulty falling asleep but can occur at any time of day.

People who experience hypnic headaches typically have them several times a week. The onset of hypnic headache typically occurs after age 50 years, though a few cases younger than age 40 years have been reported.

Hypnic Headache Symptoms

Hypnic headaches have a distinct symptom profile Trusted Source Neurologia View Source that sets them apart from other types of headaches. These include:

• Dull or throbbing pain affecting one or both sides of the head
• Waking up in the middle of the night due to headache, multiple times a month
• Nausea
• Sensitivity to light or sounds
• Runny eyes or nose

The primary symptom of a hypnic headache is dull or throbbing head pain that occurs during sleep, multiple times per month, usually around the same time of night. Hypnic headaches can be unilateral or bilateral, which means they can affect one or both sides Trusted Source Journal of the Neurological Sciences View Source of your head. However, it’s more common for a hypnic headache to affect both sides.

Another distinguishing feature of hypnic headaches is that they usually occur in the middle of the night, or around two to three hours after falling asleep. They often occur around the same time and may even happen multiple times per night Trusted Source American Academy of Sleep Medicine (AASM) AASM sets standards and promotes excellence in sleep medicine health care, education, and research. View Source , lasting for 15 minutes to four hours. Hypnic headaches can range in severity, but they’re painful enough to rouse you from sleep.

“Symptoms of a hypnic headache are common to many other types of headaches, including serious conditions. If someone has any symptoms, they need to speak with a medical professional immediately.”

Dustin Cotliar, MD, MPH

Physician

Hypnic Headache Causes

Hypnic headaches are considered a primary headache disorder, which means they’re not caused by a known underlying condition. Hypnic headaches often occur during rapid eye movement (REM) sleep, so it’s possible that an area of the brain involved with processing pain gets activated, leading to a hypnic headache. Beyond that, researchers don’t know for sure what causes hypnic headaches.

Hypnic headaches may also be linked to melatonin production. Melatonin is a hormone that makes you feel sleepy, and its production levels rise and fall throughout the day in line with your circadian rhythm (sleep-wake cycle) Trusted Source Journal of Neuroendocrinology View Source . Because hypnic headaches occur at the same time each night, some researchers believe there may be a disturbance to the underlying rhythms that regulate melatonin production, which causes lower melatonin levels and, subsequently, hypnic headaches.

Part of the evidence supporting this theory comes from the efficacy of lithium in treating hypnic headaches, since lithium is effective in treating other chronobiological disorders and helps increase melatonin levels.

Risk Factors

Older adults and women are more likely to get hypnic headaches. Over 90% of people experience their first hypnic headache after age 50 Trusted Source Cephalalgia View Source , with an average age of onset of 62 years old. Women are between 1.5 to two times more likely to have hypnic headaches than men.

It usually takes a long time from onset of headaches to a diagnosis of hypnic headaches, which may skew the ages of those who have them to be older. On average, people don’t receive a diagnosis until seven years after their first hypnic headache. This is because various other more common causes of headache need to be considered first.

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Diagnosing Hypnic Headaches

Diagnosing hypnic headaches can be challenging, as they’re rare and share symptoms with other types of headaches. There’s no single test that can confirm a hypnic headache, so diagnosis relies heavily on a detailed clinical evaluation and a process of exclusion.

A doctor will begin by reviewing the patient’s medical history and asking detailed questions about their headache patterns. Key characteristics that point to hypnic headaches include:

• Headaches that occur exclusively during sleep
• Headaches that wake the person up, typically at the same time each night
• Symptoms present in individuals over the age of 50
• Headaches that last between 15 minutes and 4 hours

It’s also important to assess for the absence of other neurological symptoms, like visual disturbances or muscle weakness, which might indicate a different condition. Since several other disorders can cause headaches while sleeping, doctors will often recommend tests to rule out secondary causes. These may include:

• MRI or CT scans to check for brain abnormalities, tumors, or lesions
• Polysomnography, or sleep study, to identify sleep-related issues like sleep apnea
• Blood tests to rule out infection, inflammation, or metabolic disorders

Treatment of Hypnic Headaches

Because hypnic headaches are relatively rare and typically occur in older adults, treatment focuses on both prevention and symptom relief. Unlike other headache disorders, hypnic headaches have a unique profile that often responds well to certain medications not commonly used for other headache types.

Caffeine Before Bed

Caffeine—in the form of a cup of coffee, caffeinated tea, or caffeine tablets (typically 40 to 60 mg)—is considered to be the most effective treatment for hypnic headaches. It sounds counterintuitive, but a caffeine pill can help people with hypnic headaches sleep reduce their symptoms. It also has relatively minimal side effects, especially when compared with other medications for hypnic headaches.

However, regular use of caffeine pills and pain relievers can lead to medication overuse headaches, a type of rebound headache caused by excessive use of medications. Always speak to your healthcare provider before taking new medications as they can recommend the right timing, dosage, and type of medication for your situation.

Medications

Several medications have been shown to be effective in preventing hypnic headaches:

• Lithium: Often used for bipolar disorder, lithium carbonate can reduce the frequency and severity of hypnic headaches. However, lithium requires careful monitoring due to potential side effects and drug interactions.
• Indomethacin: This nonsteroidal anti-inflammatory drug (NSAID) has been helpful for some patients. It works by reducing inflammation and relieving pain but can cause stomach irritation with long-term use.
• Melatonin: As a natural hormone that regulates sleep-wake cycles, melatonin may help some people with hypnic headaches, especially those with sleep disturbances.
• Topiramate or Verapamil: These medications, often used for migraine prevention, may be tried if other treatments fail.

When to Talk to Your Doctor

If you’re regularly waking up in the middle of the night with headaches, it’s important to speak with a healthcare professional—especially if the headaches are severe, disrupt your sleep, or follow a consistent pattern. While hypnic headaches are rare, they share symptoms with other potentially serious conditions such as sleep apnea, high blood pressure, or brain tumors, making a proper diagnosis essential.

You should contact your doctor if:

• You experience new or unusual headaches that wake you up from sleep.
• The headaches occur frequently or at the same time each night.
• You notice other neurological symptoms like confusion, vision changes, or weakness.
• Over-the-counter pain relievers are ineffective or required often.
• You have a personal or family history of migraines or other headache disorders.

Early evaluation and treatment can improve your quality of life and help rule out more serious health issues. A doctor may refer you to a neurologist or recommend a sleep study to better understand what’s causing your nighttime headaches.

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