Hypnic or “Alarm Clock” Headache. 

This is also called “alarm clock” headache in that it wakes patients out of sleep, usually at a consistent time each night. A new report shows that the average age of headache onset is 62 years and that 8 out of 10 patients were women. About 60% also had migraine. In two-thirds of patients, the headache was bilateral, severe in intensity, and sharp in quality. Taking caffeine at bedtime as well as at the time of awakening led to a complete response in about 30% of patients and a moderate response in another 30%. Lithium, used most commonly in bipolar illness, led to a complete response in 70% and a moderate response in 20%. Lithium seems to work for other disorders such as cluster headache, which often awakens patients from sleep and is cyclical, varying with the seasons and with the circadian sleep cycle. About a third of patients also noted that physical activity / exercising immediately upon awakening with the headache reduced the intensity.
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Jack Florin, MD

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