Hypnic headache: a descriptive study of 25 new cases in Brazil.

abstract Article history:Received 30 August 2013Received in revised form 19 November 2013Accepted 26 December 2013Available online 4 January 2014Keywords:Hypnic headachePrimary headacheNocturnal headacheDiagnostic criteriaClinical characteristicsLithium carbonate Our aim was to show the clinical characteristics of 25 patients with hypnic headache. We reviewed the medicalrecords of 11,360 patients who complained of headache and selected those with hypnic headache, according tothe criteria of the International Classification of Headache Disorders-2. Twenty-five patients (20 women and 5men) were diagnosed with hypnic headache. The average age at the headache onset was 65.6 ± 11.4 years(95% CI 61.1–70.1), ranging from 51 to 89 years. The diagnosis of hypnic headache was made 3.0 ± 2.7 years(95% CI 1.9–4.0) after the headache started. Fourteen patients (56.0%) were awakened between 4:00 and6:00 a.m. The headache lasted for more than 2 h in 16 (64.0%) patients. The headache was bilaterally localized(16/25; 64.0%), had a dull character (18/25; 72.0%) and a moderate intensity (17/25; 68.0%). The frequencywas greater than 15 days per month (14/25; 56.0%). Associated symptoms were reported by 7 patients: nausea(71.4%)andphonophobia(28.6%).Therewassuccessfultreatmentwithlithiumcarbonatein16/22(72.7%)ofthepatients. Hypnic headache occurs exclusively during sleep in the elderly and especially in women. Lithium is aneffective drug for its treatment.© 2014 Elsevier B.V. All rights reserved.