Nocturnal headache
Nocturnal headache
A nocturnal headache can already be present before falling asleep and may be due to many factors: stress, excessive psychophysical fatigue, a heavy dinner to digest, a drink too much, a tension headache arising during the day and not yet come to an end.
But there is also a specific form of nocturnal headache, which arises only after one has fallen asleep, causing a rude awakening: as if an alarm ringed in the head. This variant of nocturnal headache, officially included in the International Headache Society (IHS) classification only in 2004, is called "hypnic headache" and is considered a primary headache, i.e. not due or linked to other identifiable external diseases or factors.
Characteristics of nocturnal "hypnic" headache
The nocturnal "hypnic" headache is a typical headache of adult and old age. Generally, it begins to appear after the age of 50 (although occasional early beginnings are possible) and, like many other forms of nocturnal or diurnal headaches, tends to affect mostly women (around 70% of cases). The dull/heavy pain can affect both sides of the head, but more often only one (67% of cases), almost always the same.
Generally, after waking up after a few hours of sleep, this form of nocturnal headache persists for periods of time ranging from 30 minutes to three hours, rarely exceeding four hours. Pain intensity is almost always moderate (45% of cases) or severe (approximately 30% of cases), but generally no other signs or symptoms are present. Only nausea can occur in one in five people.
The nocturnal "hypnic" headache can cause a decrease in the quality of life of those affected because the attacks recur frequently, on average 10 to 15 nights a month. This means that, in addition to repeated hours of pain, this nocturnal headache is also associated with a significant debt of sleep, with all that follows in terms of residual fatigue during the day, decline in physical and intellectual performance, tension, irritability and not optimal mood.
The causes of nocturnal "hypnic" headaches are currently unknown. The prevailing hypothesis is that it is somehow related to the rapid eye movement that occurs during REM sleep (the phase of deep sleep in which one dreams) or that is due to a disturbance of the biological clock. An alternative possibility is that the nocturnal "hypnic" headache is a sort of evolution of migraine, since many people suffer from these two forms of headache in succession (migraine in young age and nocturnal "hypnic" headache after 50).
How to treat nocturnal headaches
If nocturnal headache means an occasional headache already present before going to bed, the symptomatic treatment of the painful attack with a non-opioid analgesic, such as ibuprofen arginine salt (Spididol®), or acetylsalicylic acid or paracetamol, is usually the simplest, most effective and most tested solution, but care must be taken not to abuse it.
If, instead, nocturnal headache means the nocturnal "hypnic" headache, the strategy changes, because the onset of the attack during sleep prevents the symptomatic drug from being taken before the pain is consolidated, and also because the frequent repetition of the attacks requires the use of a prophylactic treatment, which must be identified by a headache specialist.
It must be said that against nocturnal "hypnic" headaches, currently, there is no well-codified therapy. The drugs that could be proposed by the doctor to prevent attacks are lithium, indomethacin, flunarizine and some antiepileptic drugs, and should be chosen according to the individual characteristics and the response of the person concerned.
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