Pathophysiology of hypnic headache

Abstract

Background: Hypnic headache (HH) is a rare primary headache disorder that is characterized by strictly sleep related headache attacks.

Purpose: The underlying pathophysiology of HH is mainly enigmatic but some clinical characteristics such as circadian rhythmicity and caffeine responsiveness may point toward possible underlying mechanisms.

Method: Current 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.

Conclusion: HH 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.

Keywords: Hypnic headache; caffeine; hypothalamus; indomethacin; sleep.