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Mark Obermann - One of the best experts on this subject based on the ideXlab platform.

  • Hypnic Headache.
    Expert review of neurotherapeutics, 2020
    Co-Authors: Mark Obermann, Dagny Holle
    Abstract:

    Hypnic Headache is a rare primary Headache disorder that is characterized by exclusively sleep-related Headache attacks in patients usually beyond 50 years of age. Only 174 cases have been reported in the literature so far. Owing to its low prevalence, clinical features and therapeutic options, as well as underlying pathophysiologic mechanisms, are widely unknown or being controversially discussed. The association of Hypnic Headache with rapid-eye movement sleep was strongly contradicted in recent articles, while an association with hypothalamic dysfunction is thought to be one important pathophysiological mechanism. Common acute, as well as prophylactic, treatment is caffeine intake, either in the form of a cup of coffee or a caffeine tablet. Lithium, indomethacin and melatonin were promoted as potent medical treatments, while almost every other drug commonly used to treat Headache or other pain syndromes was reported to be effective in single case reports on Hypnic Headache.

  • no pattern alteration in single nocturnal melatonin secretion in patients with Hypnic Headache a case control study
    Headache, 2017
    Co-Authors: Steffen Naegel, Mark Obermann, Hanschristoph Diener, Charly Gaul, Janaisabel Huhn, Dagny Holle
    Abstract:

    Objective To investigate Headache-related serum melatonin levels and melatonin excretion rhythmicity in patients with Hypnic Headache (HH). Background Strict sleep dependency of Headache attacks is a pathognomonic feature of HH. Changes in melatonin levels, a marker for circadian rhythm, are assumed to play a pivotal role in the pathophysiology of HH. Methods Serum melatonin levels were acquired in nine patients with HH and nine age- and gender-matched healthy controls over a 20-hour time period (12 pm, 4 pm, 7 pm, 10 pm, time of Headache, and 8 am). Results No significant changes of melatonin levels could be detected comparing HH patients and healthy controls. Melatonin excretion rhythmicity was not significantly altered in patients with HH (Mean melatonin level in ng/mL ± SD, patients vs controls at 12 pm: 21.5 ± 9.5 vs 13.6 ± 6.3 [P = .077], 4 pm: 18.4 ± 8.4 vs 14.0 ± 4.7 [P = .222], 7 pm: 19.4 ± 5.1 vs 15.1 ± 4.5 [P = .094], 10 pm: 59.5 ± 45.0 vs 29.4 ± 12.7 [P =.136], Headache time: 96.9 ± 68.3 vs 49.1 ± 22.8 [P = .94], and 8 am: 31.6 ± 18.3 vs 26.7 ± 15.6 [P = .489]). Conclusion This study is not able to confirm a significant role of melatonin concentration changes in the pathophysiology of HH and vetoes that melatonin deficiency plays a major role in the pathophysiology of the disorder.

  • pathophysiology of Hypnic Headache
    Cephalalgia, 2014
    Co-Authors: Dagny Holle, Steffen Naegel, Mark Obermann
    Abstract:

    BackgroundHypnic Headache (HH) is a rare primary Headache disorder that is characterized by strictly sleep related Headache attacks.PurposeThe underlying pathophysiology of HH is mainly enigmatic but some clinical characteristics such as circadian rhythmicity and caffeine responsiveness may point toward possible underlying mechanisms.MethodCurrent studies that deal with the pathophysiology of HH are summarized. Data on cerebral imaging, sleep, electrophysiology studies, effectiveness of drugs, and symptomatic Headache types are discussed to illuminate underlying pathophysiologic mechanisms.ConclusionHH can be clearly differentiated by its clinical presentation as well as imaging and electrophysiological study results from other primary Headaches such as migraine or cluster Headache. The underlying pathophysiology is still enigmatic but a hypothalamic involvement seems to be likely.

  • Hypnic Headache.
    Cephalalgia : an international journal of headache, 2013
    Co-Authors: Dagny Holle, Steffen Naegel, Mark Obermann
    Abstract:

    Hypnic Headache (HH) is a rare primary Headache disorder that is characterised by strictly sleep-related Headache attacks. Because of the low prevalence of this Headache disorder, disease information is mainly based on case reports and small case series. This review summarises current knowledge on HH in regard to clinical presentation, pathophysiology, symptomatic causes and therapeutic options. We review all reported HH cases since its first description in 1988 by Raskin. Broadened diagnostic criteria were applied for patient selection that slightly deviate from the current ICHD-II criteria. Patients were allowed to describe the Headache character to be other than dull. Additionally, accompanying mild trigemino-autonomic symptoms were permitted. Mainly elderly patients are affected, but younger patients and even children might also suffer from HH. Headache attacks usually last between 15 and 180 minutes, but some patients report Headache attacks up to 10 hours. Almost all patients report motor activity during Headache attacks. Cerebral MRI and 24-hour blood pressure monitoring should be performed in the diagnostic work-up of HH. Other primary Headache disorders such as migraine and cluster Headache may also present with sleep-related Headache attacks and should be considered first. Caffeine taken as a cup of strong coffee seems to be the best acute and prophylactic treatment option.

  • Hypnic Headache and caffeine
    Expert Review of Neurotherapeutics, 2012
    Co-Authors: Dagny Holle, Mark Obermann
    Abstract:

    Hypnic Headache (HH) is a rare primary Headache disorder primarily affecting patients over the age of 50 years. This Headache entity occurs exclusively at night almost always at the same time. Imaging data as well as the strict circadian rhythm of Headache attacks suggest a hypothalamic involvement in the underlying pathophysiology of this Headache disorder. One interesting clinical feature about HH is its therapeutic response to caffeine as an acute as well as prophylactic agent. This review addresses the efficacy of caffeine in HH as well as in other Headache disorders, and attempts to give insight into the analgesic properties of this substance. In addition, it depicts possible problems of caffeine consumption with regard to Headache.

Dagny Holle - One of the best experts on this subject based on the ideXlab platform.

  • Hypnic Headache.
    Expert review of neurotherapeutics, 2020
    Co-Authors: Mark Obermann, Dagny Holle
    Abstract:

    Hypnic Headache is a rare primary Headache disorder that is characterized by exclusively sleep-related Headache attacks in patients usually beyond 50 years of age. Only 174 cases have been reported in the literature so far. Owing to its low prevalence, clinical features and therapeutic options, as well as underlying pathophysiologic mechanisms, are widely unknown or being controversially discussed. The association of Hypnic Headache with rapid-eye movement sleep was strongly contradicted in recent articles, while an association with hypothalamic dysfunction is thought to be one important pathophysiological mechanism. Common acute, as well as prophylactic, treatment is caffeine intake, either in the form of a cup of coffee or a caffeine tablet. Lithium, indomethacin and melatonin were promoted as potent medical treatments, while almost every other drug commonly used to treat Headache or other pain syndromes was reported to be effective in single case reports on Hypnic Headache.

  • Hypnic Headache
    Oxford Textbook of Headache Syndromes, 2020
    Co-Authors: Dagny Holle, David W Dodick
    Abstract:

    Hypnic Headache (HH) is a rare primary Headache disorder. Its main clinical features are strict sleep-related Headache attacks that awaken patients from sleep. As Headache attacks often occur at the same time at night, HH has also been referred to as ‘alarm clock Headache’. Currently, 225 cases have been reported in the literature. Patients are generally older than 50 years of age at Headache onset, but occurrence in younger patients and even children has been described. More women than man are affected. The Headache may be bilateral or unilateral. Some migrainous features, such as nausea or photophobia, or mild cranial autonomic symptoms, such as lacrimation, may accompany HH and create diagnostic uncertainty. While most patients display some motor activity during the Headache attacks, the agitation and motor restlessness that is characteristic of cluster Headache does not appear. The pathophysiology of HH is still enigmatic. Hypothalamic involvement has been considered on the basis of the circadian rhythmicity, relationship with sleep, and imaging evidence of a decrease in grey matter volume within the posterior hypothalamus. Caffeine, lithium carbonate, and indomethacin may be effective for the prevention of attacks, but randomized, placebo-controlled trials are not yet available.

  • no pattern alteration in single nocturnal melatonin secretion in patients with Hypnic Headache a case control study
    Headache, 2017
    Co-Authors: Steffen Naegel, Mark Obermann, Hanschristoph Diener, Charly Gaul, Janaisabel Huhn, Dagny Holle
    Abstract:

    Objective To investigate Headache-related serum melatonin levels and melatonin excretion rhythmicity in patients with Hypnic Headache (HH). Background Strict sleep dependency of Headache attacks is a pathognomonic feature of HH. Changes in melatonin levels, a marker for circadian rhythm, are assumed to play a pivotal role in the pathophysiology of HH. Methods Serum melatonin levels were acquired in nine patients with HH and nine age- and gender-matched healthy controls over a 20-hour time period (12 pm, 4 pm, 7 pm, 10 pm, time of Headache, and 8 am). Results No significant changes of melatonin levels could be detected comparing HH patients and healthy controls. Melatonin excretion rhythmicity was not significantly altered in patients with HH (Mean melatonin level in ng/mL ± SD, patients vs controls at 12 pm: 21.5 ± 9.5 vs 13.6 ± 6.3 [P = .077], 4 pm: 18.4 ± 8.4 vs 14.0 ± 4.7 [P = .222], 7 pm: 19.4 ± 5.1 vs 15.1 ± 4.5 [P = .094], 10 pm: 59.5 ± 45.0 vs 29.4 ± 12.7 [P =.136], Headache time: 96.9 ± 68.3 vs 49.1 ± 22.8 [P = .94], and 8 am: 31.6 ± 18.3 vs 26.7 ± 15.6 [P = .489]). Conclusion This study is not able to confirm a significant role of melatonin concentration changes in the pathophysiology of HH and vetoes that melatonin deficiency plays a major role in the pathophysiology of the disorder.

  • was wissen wir uber den Hypnic Headache nachgehakt bei pd dr dagny holle
    Journal Club Schmerzmedizin, 2015
    Co-Authors: Dagny Holle
    Abstract:

    Die Pathophysiologie des Hypnic Headache ist noch weitgehend unbekannt. Neurologen der Universitatsklinik Essen haben daher die verfugbare Literatur zusammengefasst, um das Krankheitsbild genauer zu verstehen 1 . Die Experten diskutieren u. a. Daten zu zerebraler Bildgebung, Schlaf, Elektrophysiologie und der Wirkung von Medikamenten. Wir haben nachgefragt bei der Erstautorin der Studie, PD Dr. Dagny Holle.

  • pathophysiology of Hypnic Headache
    Cephalalgia, 2014
    Co-Authors: Dagny Holle, Steffen Naegel, Mark Obermann
    Abstract:

    BackgroundHypnic Headache (HH) is a rare primary Headache disorder that is characterized by strictly sleep related Headache attacks.PurposeThe underlying pathophysiology of HH is mainly enigmatic but some clinical characteristics such as circadian rhythmicity and caffeine responsiveness may point toward possible underlying mechanisms.MethodCurrent studies that deal with the pathophysiology of HH are summarized. Data on cerebral imaging, sleep, electrophysiology studies, effectiveness of drugs, and symptomatic Headache types are discussed to illuminate underlying pathophysiologic mechanisms.ConclusionHH can be clearly differentiated by its clinical presentation as well as imaging and electrophysiological study results from other primary Headaches such as migraine or cluster Headache. The underlying pathophysiology is still enigmatic but a hypothalamic involvement seems to be likely.

Steffen Naegel - One of the best experts on this subject based on the ideXlab platform.

  • no pattern alteration in single nocturnal melatonin secretion in patients with Hypnic Headache a case control study
    Headache, 2017
    Co-Authors: Steffen Naegel, Mark Obermann, Hanschristoph Diener, Charly Gaul, Janaisabel Huhn, Dagny Holle
    Abstract:

    Objective To investigate Headache-related serum melatonin levels and melatonin excretion rhythmicity in patients with Hypnic Headache (HH). Background Strict sleep dependency of Headache attacks is a pathognomonic feature of HH. Changes in melatonin levels, a marker for circadian rhythm, are assumed to play a pivotal role in the pathophysiology of HH. Methods Serum melatonin levels were acquired in nine patients with HH and nine age- and gender-matched healthy controls over a 20-hour time period (12 pm, 4 pm, 7 pm, 10 pm, time of Headache, and 8 am). Results No significant changes of melatonin levels could be detected comparing HH patients and healthy controls. Melatonin excretion rhythmicity was not significantly altered in patients with HH (Mean melatonin level in ng/mL ± SD, patients vs controls at 12 pm: 21.5 ± 9.5 vs 13.6 ± 6.3 [P = .077], 4 pm: 18.4 ± 8.4 vs 14.0 ± 4.7 [P = .222], 7 pm: 19.4 ± 5.1 vs 15.1 ± 4.5 [P = .094], 10 pm: 59.5 ± 45.0 vs 29.4 ± 12.7 [P =.136], Headache time: 96.9 ± 68.3 vs 49.1 ± 22.8 [P = .94], and 8 am: 31.6 ± 18.3 vs 26.7 ± 15.6 [P = .489]). Conclusion This study is not able to confirm a significant role of melatonin concentration changes in the pathophysiology of HH and vetoes that melatonin deficiency plays a major role in the pathophysiology of the disorder.

  • pathophysiology of Hypnic Headache
    Cephalalgia, 2014
    Co-Authors: Dagny Holle, Steffen Naegel, Mark Obermann
    Abstract:

    BackgroundHypnic Headache (HH) is a rare primary Headache disorder that is characterized by strictly sleep related Headache attacks.PurposeThe underlying pathophysiology of HH is mainly enigmatic but some clinical characteristics such as circadian rhythmicity and caffeine responsiveness may point toward possible underlying mechanisms.MethodCurrent studies that deal with the pathophysiology of HH are summarized. Data on cerebral imaging, sleep, electrophysiology studies, effectiveness of drugs, and symptomatic Headache types are discussed to illuminate underlying pathophysiologic mechanisms.ConclusionHH can be clearly differentiated by its clinical presentation as well as imaging and electrophysiological study results from other primary Headaches such as migraine or cluster Headache. The underlying pathophysiology is still enigmatic but a hypothalamic involvement seems to be likely.

  • Hypnic Headache.
    Cephalalgia : an international journal of headache, 2013
    Co-Authors: Dagny Holle, Steffen Naegel, Mark Obermann
    Abstract:

    Hypnic Headache (HH) is a rare primary Headache disorder that is characterised by strictly sleep-related Headache attacks. Because of the low prevalence of this Headache disorder, disease information is mainly based on case reports and small case series. This review summarises current knowledge on HH in regard to clinical presentation, pathophysiology, symptomatic causes and therapeutic options. We review all reported HH cases since its first description in 1988 by Raskin. Broadened diagnostic criteria were applied for patient selection that slightly deviate from the current ICHD-II criteria. Patients were allowed to describe the Headache character to be other than dull. Additionally, accompanying mild trigemino-autonomic symptoms were permitted. Mainly elderly patients are affected, but younger patients and even children might also suffer from HH. Headache attacks usually last between 15 and 180 minutes, but some patients report Headache attacks up to 10 hours. Almost all patients report motor activity during Headache attacks. Cerebral MRI and 24-hour blood pressure monitoring should be performed in the diagnostic work-up of HH. Other primary Headache disorders such as migraine and cluster Headache may also present with sleep-related Headache attacks and should be considered first. Caffeine taken as a cup of strong coffee seems to be the best acute and prophylactic treatment option.

  • nociceptive blink reflex and pain related evoked potentials in Hypnic Headache
    Cephalalgia, 2011
    Co-Authors: Dagny Holle, Steffen Naegel, Hanschristoph Diener, Zaza Katsarava, Charly Gaul, Sarah Krebs, H Kaube, Mark Obermann
    Abstract:

    Background: Central facilitation of trigeminal pain processing and deficient habituation was observed in different Headache and facial pain disorders. This overactivation seems to be primarily associated with chronic pain states.Objective: To investigate the function of the trigeminal nociceptive system in patients with Hypnic Headache (HH).Methods: Fifteen HH patients according International Classification of Headache Disorders II criteria and 15 age- and gender-matched healthy controls were investigated using the nociceptive blink reflex (nBR) and trigeminal pain-related evoked potentials (PREP).Results: nBR and PREP responses showed no significant differences comparing HH patients and healthy controls. Moreover, no habituation deficit was detected in HH patients.Conclusion: Central facilitation and change in habituation do not seem to be a crucial part in the pathophysiology of HH despite the chronic nature of this disease. Facilitation or habituation deficit does not seem to be exclusively related to ...

  • hypothalamic gray matter volume loss in Hypnic Headache
    Annals of Neurology, 2011
    Co-Authors: Dagny Holle, Steffen Naegel, Hanschristoph Diener, Zaza Katsarava, Charly Gaul, Sarah Krebs, Elke R Gizewski, Mark Obermann
    Abstract:

    Objective Hypnic Headache (HH) is a rare primary Headache disorder characterized by strictly nocturnal Headache attacks that mostly occur at the same time at night. The pathophysiology of this disease is poorly understood, but hypothalamic involvement was suspected as the hypothalamus represents the cerebral management center of sleep regulation and pain control. Methods Fourteen patients with HH and 14 age-matched and gender-matched healthy controls were investigated using magnetic resonance imaging–based voxel-based morphometry. Results We detected gray matter volume decrease in the posterior hypothalamus of HH patients. Additional gray matter decrease was observed in brain areas known to be associated with cerebral pain processing, including the cingulate cortex, operculum, and frontal lobe, as well as in the temporal lobe. Interpretation Our data confirm the hypothesized involvement of the posterior hypothalamus in the pathophysiology of HH and emphasize the importance of this structure for sleep regulation and pain control. ANN NEUROL 2010

Hanschristoph Diener - One of the best experts on this subject based on the ideXlab platform.

  • no pattern alteration in single nocturnal melatonin secretion in patients with Hypnic Headache a case control study
    Headache, 2017
    Co-Authors: Steffen Naegel, Mark Obermann, Hanschristoph Diener, Charly Gaul, Janaisabel Huhn, Dagny Holle
    Abstract:

    Objective To investigate Headache-related serum melatonin levels and melatonin excretion rhythmicity in patients with Hypnic Headache (HH). Background Strict sleep dependency of Headache attacks is a pathognomonic feature of HH. Changes in melatonin levels, a marker for circadian rhythm, are assumed to play a pivotal role in the pathophysiology of HH. Methods Serum melatonin levels were acquired in nine patients with HH and nine age- and gender-matched healthy controls over a 20-hour time period (12 pm, 4 pm, 7 pm, 10 pm, time of Headache, and 8 am). Results No significant changes of melatonin levels could be detected comparing HH patients and healthy controls. Melatonin excretion rhythmicity was not significantly altered in patients with HH (Mean melatonin level in ng/mL ± SD, patients vs controls at 12 pm: 21.5 ± 9.5 vs 13.6 ± 6.3 [P = .077], 4 pm: 18.4 ± 8.4 vs 14.0 ± 4.7 [P = .222], 7 pm: 19.4 ± 5.1 vs 15.1 ± 4.5 [P = .094], 10 pm: 59.5 ± 45.0 vs 29.4 ± 12.7 [P =.136], Headache time: 96.9 ± 68.3 vs 49.1 ± 22.8 [P = .94], and 8 am: 31.6 ± 18.3 vs 26.7 ± 15.6 [P = .489]). Conclusion This study is not able to confirm a significant role of melatonin concentration changes in the pathophysiology of HH and vetoes that melatonin deficiency plays a major role in the pathophysiology of the disorder.

  • Hypnic Headache: Clinical Course and Treatment
    Current Treatment Options in Neurology, 2012
    Co-Authors: Hanschristoph Diener, Mark Obermann, Dagny Holle
    Abstract:

    Thus far, no data from randomized placebo-controlled clinical trials are available for Hypnic Headache, so current treatment recommendations are based on single case reports and smaller open case series. In the predominantly elderly patient population affected by this disease, tolerability of the substances used is at least as important as their efficacy. Caffeine is the preferable first-line therapy for both acute treatment (i.e., a cup of strong coffee when awaking with Headache) and prophylaxis (a cup of strong coffee before going to bed). Sleep problems should be considered as substantial side effects of this therapy, although they seem to occur far less than expected. For acute treatment, analgesics containing caffeine are also effective, but they may carry the risk of medication-overuse Headache. Treatments that not effective for acute pain relief include nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, 100% oxygen, and acetaminophen Triptans may be effective in single cases. For prophylaxis, lithium should be tried as a second treatment option if caffeine intake is not effective or tolerated. Lithium has been reported to be effective in many patients, but it was often discontinued because of side effects. Indomethacin may be a viable option for third-line prophylactic therapy.

  • nociceptive blink reflex and pain related evoked potentials in Hypnic Headache
    Cephalalgia, 2011
    Co-Authors: Dagny Holle, Steffen Naegel, Hanschristoph Diener, Zaza Katsarava, Charly Gaul, Sarah Krebs, H Kaube, Mark Obermann
    Abstract:

    Background: Central facilitation of trigeminal pain processing and deficient habituation was observed in different Headache and facial pain disorders. This overactivation seems to be primarily associated with chronic pain states.Objective: To investigate the function of the trigeminal nociceptive system in patients with Hypnic Headache (HH).Methods: Fifteen HH patients according International Classification of Headache Disorders II criteria and 15 age- and gender-matched healthy controls were investigated using the nociceptive blink reflex (nBR) and trigeminal pain-related evoked potentials (PREP).Results: nBR and PREP responses showed no significant differences comparing HH patients and healthy controls. Moreover, no habituation deficit was detected in HH patients.Conclusion: Central facilitation and change in habituation do not seem to be a crucial part in the pathophysiology of HH despite the chronic nature of this disease. Facilitation or habituation deficit does not seem to be exclusively related to ...

  • hypothalamic gray matter volume loss in Hypnic Headache
    Annals of Neurology, 2011
    Co-Authors: Dagny Holle, Steffen Naegel, Hanschristoph Diener, Zaza Katsarava, Charly Gaul, Sarah Krebs, Elke R Gizewski, Mark Obermann
    Abstract:

    Objective Hypnic Headache (HH) is a rare primary Headache disorder characterized by strictly nocturnal Headache attacks that mostly occur at the same time at night. The pathophysiology of this disease is poorly understood, but hypothalamic involvement was suspected as the hypothalamus represents the cerebral management center of sleep regulation and pain control. Methods Fourteen patients with HH and 14 age-matched and gender-matched healthy controls were investigated using magnetic resonance imaging–based voxel-based morphometry. Results We detected gray matter volume decrease in the posterior hypothalamus of HH patients. Additional gray matter decrease was observed in brain areas known to be associated with cerebral pain processing, including the cingulate cortex, operculum, and frontal lobe, as well as in the temporal lobe. Interpretation Our data confirm the hypothesized involvement of the posterior hypothalamus in the pathophysiology of HH and emphasize the importance of this structure for sleep regulation and pain control. ANN NEUROL 2010

  • serial polysomnography in Hypnic Headache
    Cephalalgia, 2011
    Co-Authors: Dagny Holle, T Wessendorf, Sebastian Zaremba, Steffen Naegel, Hanschristoph Diener, Zaza Katsarava, Charly Gaul, Mark Obermann
    Abstract:

    Background: Hypnic Headache (HH) is a rare primary Headache disorder characterized by strictly sleep-related Headache attacks. Most patients are over the age of 50 and usually awake at the same tim...

David W Dodick - One of the best experts on this subject based on the ideXlab platform.

  • Hypnic Headache
    Oxford Textbook of Headache Syndromes, 2020
    Co-Authors: Dagny Holle, David W Dodick
    Abstract:

    Hypnic Headache (HH) is a rare primary Headache disorder. Its main clinical features are strict sleep-related Headache attacks that awaken patients from sleep. As Headache attacks often occur at the same time at night, HH has also been referred to as ‘alarm clock Headache’. Currently, 225 cases have been reported in the literature. Patients are generally older than 50 years of age at Headache onset, but occurrence in younger patients and even children has been described. More women than man are affected. The Headache may be bilateral or unilateral. Some migrainous features, such as nausea or photophobia, or mild cranial autonomic symptoms, such as lacrimation, may accompany HH and create diagnostic uncertainty. While most patients display some motor activity during the Headache attacks, the agitation and motor restlessness that is characteristic of cluster Headache does not appear. The pathophysiology of HH is still enigmatic. Hypothalamic involvement has been considered on the basis of the circadian rhythmicity, relationship with sleep, and imaging evidence of a decrease in grey matter volume within the posterior hypothalamus. Caffeine, lithium carbonate, and indomethacin may be effective for the prevention of attacks, but randomized, placebo-controlled trials are not yet available.

  • Indomethacin-responsive Headache syndromes
    Current Pain and Headache Reports, 2004
    Co-Authors: David W Dodick
    Abstract:

    Indomethacin-responsive Headache syndromes represent a unique group of primary Headache disorders characterized by a prompt and often complete response to indomethacin to the exclusion of other nonsteroidal anti-inflammatory drugs and medications usually effective in treating other primary Headache disorders. Because these Headache disorders can easily be overlooked in clinical practice, they likely are more common than previously recognized. Indomethacin-responsive Headache syndromes can be divided into several distinct categories: a select group of trigeminal-autonomic cephalgias, valsalva-induced Headaches, and primary stabbing Headache (ice-pick Headache or jabs and jolts syndrome). Each category can be differentiated clinically and by the extent to which the individual Headache disorders respond to indomethacin. The paroxysmal and continuous hemicranias invariably respond in an absolute manner to indomethacin, whereas valsalvainduced and ice-pick Headaches may respond in an equally dramatic, but somewhat less consistent fashion. Hypnic Headache recently has been described as another primary Headache disorder that may respond to indomethacin.

  • Hypnic Headache another indomethacin responsive Headache syndrome
    Headache, 2000
    Co-Authors: David W Dodick, Michael J Jones, David J Capobianco
    Abstract:

    Hypnic Headache syndrome is a benign, recurrent, late-onset Headache disorder that occurs exclusively during sleep. Lithium has been reported to be an effective treatment, but the side effects of this medication are sometimes prohibitive, particularly in the elderly. Other drugs have been reported to be effective in this disorder, including caffeine, flunarizine, and verapamil. Recently, indomethacin has been reported to effectively suppress Hypnic Headaches. We report the response of seven patients with Hypnic Headache who were treated with indomethacin. Hypnic Headache syndrome appears to represent yet another Headache disorder in which there is sometimes an impressive response to indomethacin.

  • polysomnography in Hypnic Headache syndrome
    Headache, 2000
    Co-Authors: David W Dodick
    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.

  • the Hypnic alarm clock Headache syndrome
    Cephalalgia, 1998
    Co-Authors: David W Dodick, A Mosek, J K Campbell
    Abstract:

    Hypnic Headache syndrome is a rare, sleep-related, benign Headache disorder. We report 19 new eases (84% females) with follow-up data. The mean age at Headache onset was 60.5 ± 9 years (range 40–73 years). Headache awakened the patients from the night's sleep at a consistent time, usually between 1.00 and 3.00 a.m. (63%); three patients (16%) reported that identical Headaches could occur also during daytime naps. Headache frequency was high, occurring more than 4 nights/week in 68% of the patients. Headache resolution occurred within 2 h in 68% of patients. Neurologic examination, laboratory studies, and brain imaging were unrevealing at the time of diagnosis. Headache severity largely remains unchanged or attenuates over time, but frequency may vary in either direction. Only one patient had spontaneous relief from Headache. Four patients (24%) achieved permanent suppression of Headache with medication, and two were able to abort individual Headache attacks. Caffeine in a tablet or beverage was helpful in four patients. Lithium carbonate therapy caused side effects requiring cessation of treatment in four patients.