What Is Hypnic Headache?

Table of Contents
View All
Table of Contents

Also known as “alarm clock headache,” hypnic headache is a rare disorder in which headaches arise only while you’re sleeping. Varying in intensity, attacks of this condition disrupt sleep, last up to four hours after waking, and occur often: 10 or more times a month.

The diagnosis of hypnic headaches can be challenging, and treatment approaches vary. Caffeine at night is often tried, as are medications, such as lithium and Tivorbex (indomethacin), among others. Read on to find out more about this disorder, including how it’s identified and managed, as well as what you can do to cope with it.

Portrait of sickness woman sitting alone on the bed in the bedroom, self isolation herself during coronavirus pandemic outbreak. - stock photo

Boy_Anupong / Getty Images

Hypnic Headache Symptoms

As a primary headache disorder, hypnic headaches arise independently of other health conditions. Several features define them, including:

  • Headache attacks begin overnight and during sleep (usually between 2 a.m. and 4 a.m.), disrupting sleep.
  • Duration of attack ranges from five minutes to 12 hours, with most resolving within three hours.
  • Attacks occur 10 or more times a month, for over three months.
  • Attacks are without cranial autonomic symptoms (nasal congestion, runny nose, and eye swelling) or restlessness.  

Differences in Severity

Typically felt bilaterally (on both sides of the head)—though some experience it unilaterally (on only side)—the intensity of pain during hypnic headache attacks can vary significantly. Usually, pain is described as similar to a tension headache, with dull or moderate pain.

In about 20% of cases, the pain may be sharp, stabbing, and severe. More severe hypnic headaches can also cause migraine-like symptoms, such as nausea, vomiting, and sensitivity to light (photophobia) and sound (phonophobia).

When attacks happen—something that occurs, on average, 21 times a month—people not only wake up, but become active, walking around, snacking, or bathing. Additional reported symptoms include:

  • Head pressure
  • Drowsiness
  • Hunger
  • Yawning
  • Feelings of apathy
  • Pupil dilation (in rare cases)
  • Depression, anxiety, or other mood disorders

Causes

Because it's a rare condition, hypnic headache causes aren’t entirely understood. However, some researchers believe this type of headache may be a variant of migraines since it shares many of the same mechanisms. Since attacks only occur during sleep, this condition may be linked to disruptions of the circadian rhythm (your natural sleep-wake cycle) due to disorders of the hypothalamus region of the brain.

Since patients are generally over age 50, age-related degradation of this region is suspected. Several causes for hypnic headache have been proposed, such as:

  • Hyperactivity in the hypothalamus: Irregular activity in this region of the brain, which regulates pain processing, body temperature, thirst, and hunger, has been linked with sleep and headache problems. When overactive, there’s a higher chance of headaches arising.  
  • Vasodilation: Another theory is that hypnic headaches arise due to the dilation (expansion) of blood vessels in the hypothalamus because of hypocapnia, or excessive carbon dioxide (CO2) in the blood, during sleep. This increases pressure on the meninges (the layers of tissue surrounding the brain and spinal cord), leading to headaches.
  • Reduced gray matter: A 2011 study using neuroimaging found that people with hypnic headache have slightly less gray matter—critical neurons that regulate many central nervous system functions—in pain centers of the hypothalamus.

Risk Factors

In general, hypnic headache is very rare, with an incidence estimated to be between 0.07 and 0.3% of the population. Several health factors have been linked to hypnic headaches, increasing the chances of attacks. Here’s a quick breakdown:

  • Age: This type of headache is rare in infants, children, adolescents, and younger adults, generally affecting those over 50.
  • Sex: Cisgender women are 3 times as likely as men to experience the condition.
  • History of headache disorders: A robust 30%–60% of those with this condition report having had migraines or other headache disorders.

Diagnosing Hypnic Headache

Given how few people experience hypnic headaches—and the fact that its symptoms can vary significantly—identification of this condition can be challenging. The main goal of diagnosis is for neurologists or headache specialists to rule out other kinds of headaches, or other health issues that may be causing pain. This may entail a range of tests and assessments, including:

  • Assessment of symptoms: Medical status, medical history, and the symptoms that you report will be assessed to see if they don’t qualify as other types of primary headache. What sets hypnic headache apart from conditions like tension headache and migraine is their exclusive occurrence during sleep, and, usually, an older age of patients.
  • Neuroimaging: Imaging techniques of the brain, such as magnetic resonance imaging (MRI) or computerized tomography (CT), are used to make sure cancerous growths, benign tumors (adenomas), or other issues aren’t causing the headaches.
  • Blood pressure monitoring: Nighttime headaches are sometimes caused by nocturnal headache-hypertension syndrome, in which blood pressure becomes dangerously elevated overnight. Monitoring blood pressure over a 24-hour period is used to detect this condition.
  • Screening for obstructive sleep apnea: Disruptions of breathing while you sleep, called obstructive sleep apnea (OSA), may also cause nighttime headaches. Screening methods include multiple latency sleep testing, polysomnography, overnight oximetry, among others. However, OSA and hypnic headaches can co-occur.
  • Medication assessment: This is to rule out medication overuse headaches (also known as rebound headache), which can occur when people take too many painkilling drugs. A headache specialist will need to know what you’re taking and how often you’re taking it.

Treatment

There’s no set therapy for hypnic headaches because they are so rare and poorly understood. Treatment approaches for hypnic headache include medications to manage symptoms after onset (abortive medications) as well as those that work to prevent attacks (preventive medications). In addition, some lifestyle changes have been reported to help as well as other nonpharmacologic medical treatments.

Abortive Medications

A number of abortive, or rescue, medications may be prescribed to take on hypnic headaches after they’ve set on. These include:

  • Caffeine: Caffeine, as in coffee, certain teas, and supplements, can both set off headaches and relieve them. For many, a cup of coffee after headache onset helps, and several studies have shown that to be the case. There are concerns about insomnia with this approach, however.
  • Analgesic drugs: Drugs that combine caffeine with aspirin or acetaminophen, such as Excedrin and Anacin Advanced Headache, have been shown to help with hypnic headache. Anecdotal evidence has shown other pain killers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil or Motrin (ibuprofen), Tylenol (acetaminophen) on its own, and Cafergot (ergotamine) may also help.   
  • Triptans: Also used for migraines and other primary headache disorders, triptans like sumatriptan and rizatriptan, among others. These spur the activity of 5-hydroxytryptamine (5-HTP) brain receptors, spurring the release of serotonin, a neurotransmitter associated with mood and pain regulation. Nasal spray versions of this drug are particularly fast-acting.    

Preventive Medications

Since, by definition, hypnic headache is characterized by recurrent attacks, therapy often involves taking medicine to prevent their onset. A wide range of medications and approaches may be attempted, including:

  • Lithium: Psychiatric medication often used for bipolar disorder
  • Caffeine (usually a cup of coffee before bed)
  • Tivorbex (indomethacin): A nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation
  • Melatonin: A hormone released by the body that helps with the sleep-wake cycle, often used as a dietary supplement to support sleep
  • Amitriptyline: An antidepressant and nerve pain medication
  • Anticonvulsants: Anti-seizure medications

There is limited evidence that some drugs used for chronic migraine may help, such as:

Non-Pharmaceutical Approaches

There are several non-pharmaceutical approaches have been attempted, including:

  • Neurostimulation: For use in chronic cases, mild electric or magnetic waves emitted from specialized devices are transmitted through the skin of the head and temples.
  • Nerve block: Strategic injections of anesthetic medications to nerves in the neck and head work to block pain messaging in chronic headache cases.
  • Oxygen therapy: Studies have shown oxygen therapy, inhaling 100% oxygen through a facemask, to be effective for certain kinds of headaches.
  • Physical activity: Case reports have shown that engaging in some physical activity can help relieve attacks after onset.

Prognosis and Coping

Though the headaches, themselves, are benign and don’t cause damage to the brain, hypnic headaches can certainly be a burden. They can be unpredictable and disrupt sleep. The good news, however, is that this condition is usually responsive to treatment.

Some may struggle to live with chronic headache conditions, and they are associated with mood disorders such as anxiety and depression. Strategies that may help you cope include:

  • Working with a therapist or counselor
  • Finding support groups for chronic pain or headache sufferers
  • Staying socially engaged, reaching out to family and friends
  • Taking part in relaxing activities
  • Keeping up with fitness and diet

Summary

Hypnic headache is a very rare disorder in which headaches arise only during sleep, causing people to wake up. Generally associated with tension headache symptoms, frequent attacks are sometimes accompanied by nausea, vomiting, as well as light and sound sensitivity.

Diagnosis involves ruling out other causes of nighttime headaches, which may entail imaging, blood pressure testing, and screening for sleep apnea.

Though there’s no set treatment, caffeine, certain analgesics, and triptans treat symptoms of hypnic headache, and lithium and indomethacin are most frequently prescribed as preventive medications.

A Word From Verywell

There’s no denying that hypnic headaches are disruptive and debilitating. It can be frustrating and difficult to have sleep disrupted and then wake up with pain. However, there are several treatment options, and they are generally successful in resolving this issue.

If you suspect you have hypnic headaches—or any kind of headache disorder—be proactive: Talk to your healthcare provider and get the help you need.

Was this page helpful?
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. International Headache Society. 4.9 hypnic headache. ICHD-3.

  2. American Migraine Foundation. Hypnic headache.

  3. George DeMaagd T. An introduction to hypnic headache. US Pharm. 2021;46(1):17-20.

  4. Kesserwani H. Hypnic headache responds to topiramate: a case report and a review of mechanisms of action of therapeutic agents. Cureus. 2021;13(3):e13790. doi:10.7759/cureus.13790

  5. Holle D, Naegel S, Krebs S, et al. Hypothalamic gray matter volume loss in hypnic headacheAnn Neurol. 2011;69(3):533-539. doi:10.1002/ana.22188

  6. Dissanayake K, Wanniarachchi D, Ranawaka U. Case report of hypnic headache: a rare headache disorder with nocturnal symptoms. BMC Res Notes. 2017;10(1)

  7. American Psychological Association. Coping with chronic pain.