Hypnic Headache Responds to Topiramate: A Case Report and a Review of Mechanisms of Action of Therapeutic Agents

Abstract

Hypnic headaches are unique as they are exclusively nocturnal, occurring in rapid-eye movement (REM) and non-REM sleep. Their nocturnal nature suggests a role for cyclic mechanisms involving the hypothalamus despite conflicting imaging results for the role of the posterior hypothalamus. Nevertheless, pharmacological therapeutics acting as highly effective agents, such as caffeine and melatonin, can modulate the sleep-wake cycle. In addition, indole agents such as indomethacin that are anti-nociceptive and affect cerebral blood flow also prove to be efficacious. Gabanoids and topiramate also have reported efficacy. We report the case of a topiramate-responsive hypnic headache patient and outline in detail the potential mechanisms of topiramate and the other therapeutic agents and adumbrate on the neuronal networks of migraine, the trigeminal autonomic cephalgias and suggest a potential neural circuit for hypnic headaches.

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

“…Acute and prophylactic treatment of HH is based on only a few case reports. Caffeine, lithium, and indomethacin are the three most reported effective drugs for HH (8,10,11,23,24). A cup of strong coffee before bedtime appears to be a safe option for acute treatment.…”

“…HH is more frequent after the age of 50 years and is more common in women but may also occur in young adults and children (10). It usually occurs in the whole brain but may also occur bilaterally in the frontotemporal lobe and rarely in the occipital lobe as moderate to severe dull pain (11). However, epidemiological data regarding HH are limited.…”

“…However, subsequent reports have shown that many HHs occur during non-REM ( 14). The nocturnal nature of this activity suggests hypothalamic involvement (11,15). The hypothalamus is considered a major integration center that regulates the neurological and endocrine systems.…”

Seltene primäre Kopfschmerzen

“…Die wirksamen Dosen liegen zwischen 150 und 600 mg. Positive Therapieerfahrungen gibt es auch mit Topiramat [82] und Onabotulinumtoxin A. Unwirksam sind Sauerstoff, Paracetamol, Opioide, Verapamil, Melatonin und Kortikosteroide.…”

Hypnic Headache – What do we know in 2022?

“…For acute treatment ergotamine derivates, opiates, 100% oxygen inhalation, triptans, paracetamol and NSAIDs showed a response rate below 25% and are consequently not effective as HH treatment (3,9,49). For prophylactic treatment, topiramate and flunarizine had response rates of approximately 40% and may be effective (3,59,60). Lamotrigine was tried in very few cases, but with good response (61,62).…”