Abstract Details

Title Hypnic Headache: Characteristics and Treatment Modalities in An Academic Headache Center

Topic Headache

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 13-022

Objective

We reviewed the clinical characteristics of and interventions chosen for patients diagnosed with hypnic headache in our institution.

Background Hypnic headache (HH) is a rare primary headache disorder that has so far largely been described in care reports or small case series. Criteria include that the headache causes wakening from sleep, lasts between 15 minutes – 240 minutes, is not associated with cranial autonomic symptoms. Indomethacin, lithium, caffeine, and melatonin have been reported as helpful.

Design/Methods This retrospective analysis used the Leaf research database to analyze hypnic headache patients treated at the University of Washington between 2015-2018. Their demographics, comorbid headache diagnoses, headache characteristics, and treatments prescribed were recorded.

Results

Ten patients met all ICHD-3 criteria for HH. Eight were female and two were male. The average age at onset of HH was 57.7 years with a standard deviation of 8.8 years. Seven reported their headache was unilateral. Many had a comorbid headache diagnosis. Migraine was the most common comorbidity (6/10). There was significant variability in first-line agents selected, including melatonin, caffeine, indomethacin, lithium, TCAs, gabapentin, and other supplements either in isolation or combination. The most commonly used agents over duration of treatment were caffeine (6/10), melatonin (5/10), and lithium (3/10). The most effective agents were caffeine (effective in 5/6 patients) and lithium (effective in 3/3 patients). Indomethacin was used in one patient and was effective.

Conclusions Other headache comorbidities may be seen with hypnic headache; further research is necessary to determine if this could contribute to a delay in diagnosis. In contrast to prior series, the majority of patients described their headache as unilateral. The most effective agents were caffeine and lithium. There was significant variability in first-line agent used, suggesting additional education for headache and non-headache providers and development of a treatment protocol may be helpful for treatment of this headache subtype.

Authors/Disclosures
Jennifer Wax, MD (Confluence Health) PRESENTER	No disclosure on file
Anusha Mannava, MD	No disclosure on file
	No disclosure on file
Daniel Krashin, MD (Seattle VA)	Dr. Krashin has nothing to disclose.
Natalia Murinova, MD, FAAN (University Of Washington)	Dr. Murinova has nothing to disclose.

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