Treatment successes for hypnic headache?

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DIAGNOSE YOUR HEADACHE OR FACIAL PAIN Forums Hypnic Headache Treatment successes for hypnic headache?

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    • #3729

      The typical first line treatments for hypnic headache are caffeine before bed (if tolerated), or upon waking with hypnic headache. Indomethacin before bed also shows benefit for some patients. However, if it is frequent enough, a daily preventive is often used. Lithium has been shown to be helpful in hypnic headache, although there is some evidence for a variety of other preventives as well (typically medications often used for migraine prevention). What successful treatments have you used?

    • #3917
      ketanjhunjhunwala
      Participant

      How do you caffeine? Is it over the counter tablets? Generally, they are 200 mg tablets. I have 2 70-year-old patients who fit the pattern of hypnic headache. They tried caffeine but had ringing in ears. Do you also rule out the possibility of cervicogenic headaches in these patients?

    • #3940

      Hello, typical caffeine doses used in most of the literature suggest and show evidence for benefit between 40 mg and 100 mg of caffeine on average. Starting out with just a cup of coffee (regular coffee which isn’t high potency is typically 40-60 mg or so) is the easiest thing to do. The dose can be titrated up as needed, and as the patient is tolerating it. Pill forms of caffeine can also be used just as easily, but I wouldn’t start too high. They may have had too high of a dose if there was ringing in the ears. If they develop insomnia, than that excludes that option. The caffeine is most commonly taken before bed, but it can also be used as an abortive strategy when the patient wakes with it to try to shorten the duration.

      Cervicogenic tends to be a different clinical entity than hypnic headache. Cervicogenic headache typically will not wake the patient up in sleep and by criteria tends to be unilateral. Hypnic headache tends to have the opposite of these characteristics. However, if they have a lot of neck pain, a lot of tenderness over the occipital nerves (which sometimes can wake the patient with pain predominantly in the suboccipital/occipital region), then it could certainly be a consideration.

    • #3944
      ketanjhunjhunwala
      Participant

      Thank you for the explanation.

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