Waking Up Because of a Headache? Learn About Hypnic Headache

Medically reviewed by: Regina Krel, MD

What is Hypnic Headache?

Hypnic headache is a rare headache disorder that occurs only during sleep and causes a person to wake up.¹ They occur on at least 10 days per month for at least three months.¹

Other names include “alarm clock” headache, clockwise headache, and hypnic headache syndrome.^1,2

What are the Symptoms of Hypnic Headache?

Attacks are described as a dull, throbbing, or pulsing pain felt on one or both sides of the head.² For most, the pain intensity is mild to moderate.¹ These headaches only happen during sleep and cause a person to wake up.¹ After waking, the headache can last 15 minutes up to 4 hours.¹ Most have attacks that last less than two hours.³ They can happen more than once per night. Most people get out of bed and move around when the pain wakes them up. 

While rare, some people have other symptoms, such as sensitivity to light or sound, or nausea.^1,2

Autonomic symptoms such as tearing of the eye, nasal congestion, or a runny nose do not occur and can help differentiate hypnic headache from another headache type, known as cluster headache, which can also have a circadian pattern.

Who Gets Hypnic Headaches?

Hypnic headache is considered rare.² It is more common in women and people over 50.² People with migraine or high blood pressure are more likely to develop hypnic headache.² 

Children can also be diagnosed with hypnic headache, but it is extremely rare. The average age is 10, but it can range from 3 to 15.⁴ They tend to have fewer and shorter attacks than adults. It may continue into adulthood for some people.⁴

Treatment Options to Manage Hypnic Headache

Caffeine and lithium are considered first-line treatments for hypnic headache. Indomethacin and melatonin can also be effective for some. A clinician may recommend using a combination of treatments, such as:^1,2

• Caffeine: A cup of coffee (around 200 mg) or a small amount of caffeine (about 40 to 60 mg) may help stop a hypnic headache. Caffeine before bed may help prevent an attack.
• Lithium: Lithium may be used as a preventive treatment for hypnic headaches. An effective dose ranges between 150 and 600 mg per day. Lab tests are typically done regularly to monitor drug levels. Lithium can have significant side effects and drug interactions, so it is not a safe option for everyone. 
• Indomethacin: This nonsteroidal anti-inflammatory drug (NSAID) is used as a preventive treatment before bed. A typical dose ranges from 25 to 150 mg at night. Be sure to talk to your healthcare provider about protecting your stomach when taking NSAIDS regularly.
• Melatonin: Both kids and adults with hypnic headache can use melatonin. 2 to 5 mg at night is generally recommended.⁵ Lithium can increase melatonin levels.⁵

Research is mixed on other treatments. Other preventive options may include:²

• Flunarizine (not available in the United States)
• Verapamil
• Topiramate

Research on treating children with hypnic headache is limited.² Melatonin appears to be the best option.²

Ruling Out Other Conditions

It’s important for healthcare providers to rule out other conditions that can cause headaches during sleep, such as:¹

• Sleep apnea
• Medication adaptation headache
• Low blood sugar (hypoglycemia)
• High blood pressure during sleep (nocturnal hypertension)

Clinicians will also want to make sure the headache is not caused by another underlying brain condition, such as a brain tumor or other structural problem. To help rule out these conditions, your healthcare provider may recommend tests such as a sleep study, MRI, or CT scan.²

Since some symptoms overlap with other primary headache disorders. Migraine, cluster headache, tension headache, SUNCT, and SUNA should also be ruled out.¹

Getting Help

While hypnic headache is rare, it is painful and can significantly affect daily life for those who live with it. Talk to your healthcare provider if you are waking up at night because of a headache. A clinician specializing in headache medicine can help identify the correct diagnosis and develop a treatment plan that’s right for you.

References

1. https://ichd-3.org/other-primary-headache-disorders/4-9-hypnic-headache/
2. https://www.ncbi.nlm.nih.gov/books/NBK557598/
3. https://journals.sagepub.com/doi/10.1177/03331024231218389?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC10457117/
5. https://journals.sagepub.com/doi/10.1177/03331024221148659

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