Case report of hypnic headache: a rare headache disorder with nocturnal symptoms

Abstract

Background: Headache is one of the commonest complaints reported to physicians worldwide. Yet, arriving at the proper diagnosis can be a challenge in many patients. Although most headaches belong to common categories of migraine and tension-type headache, which are diagnosed and managed relatively easily, several uncommon headache disorders can lead to delays in diagnosis. Certain medications are more efficacious than others in managing these headache disorders, hence establishing the correct diagnosis is of paramount importance.Case presentation: An 86-year-old female presented with chronic daily headache of 1 year duration. Her headaches were exclusively nocturnal and woke her up daily around midnight. Clinical examination was unremarkable. All basic investigations were normal. Subsequent gadolinium enhanced Magnetic Resonance Imaging (MRI) brain did not show any significant pathology. There was no satisfactory response to paracetamol, diclofenac sodium, mefenamic acid, tramadol, flunarizine and sodium valproate. Indomethacin was started with the provisional diagnosis of hypnic headache. There was absolute response by day 3 of indomethacin. She remains headache free on low dose indomethacin maintenance at 1 year after the diagnosis. Conclusion:Better understanding of uncommon headache syndromes can help in early diagnosis and appropriate treatment. Hypnic headache should be considered in the differential diagnosis of chronic daily headaches, especially when nocturnal and occurs during sleep.

Seltene primäre Kopfschmerzen

“…So kann in der Attacke eine Tasse starken Kaffees getrunken werden. Ebenfalls wirksam sind Indometacin [77] und in geringerem Maße andere NSAIDs. Koffein vor dem Zubettgehen kann auch prophylaktisch wirken [78,79].…”

Case report: Hypnic headache responds to agomelatine–a potential prophylactic treatment option

“…Brain MRI did not reveal any midline structural abnormalities associated with circadian rhythms (Figure 1). To explore the possible causes of secondary headaches, such as sleep apnea, nocturnal hypertension (22), and awakening from sleep, we performed polysomnography and ambulatory blood pressure monitoring (Figure 2). The patient was awakened by a headache at approximately 5:40 am after the last REM phase.…”

Indomethacin‐responsive headaches—A narrative review

“…185 Indomethacin has been proposed as the third-line prophylactic treatment after caffeine and lithium. 186 A number of case reports and case series have described partial to complete relief or prevention of attacks with the use of oral indomethacin, 187,[192][193][194][195][196][197][198] and doses between 25 and 150 mg orally before bed have been reported to be effective. In one case series, indomethacin has been proposed to be more efficacious in patients who only experience unilateral pain.…”