University of Duisburg-Essen, Germany.
Cephalalgia. 2010 Dec;30(12):1435-42. doi: 10.1177/0333102410375727. Epub 2010 Jun 15.
Hypnic headache (HH) is a rare primary headache disorder that is characterized by exclusively sleep-related headache attacks. Because of its low prevalence, clinical features and therapeutic options are widely unknown or under discussion.
Twenty patients with HH were examined and interviewed using a standardized questionnaire in regard to their clinical characteristics and effective treatment regimens. Data were evaluated according to current International Headache Society (IHS) diagnostic criteria. Individual treatment history and effective treatment options were compared with expected efficacy based on current literature.
In conflict to current IHS criteria, 15% of patients reported trigemino-autonomic symptoms. All patients showed distinct motor behavior during their headache attacks. In acute pain attacks caffeine was most effective. Lithium, topiramate, melatonin, amitriptyline and indomethacin were sometimes useful prophylactic treatment options but were often associated with side effects.
Our results underline the need for modification of the IHS diagnostic criteria of HH to better reflect the actual clinical characteristics of this headache. Caffeine should be considered as first-line acute therapy. Prophylactic medical treatment should be carefully evaluated in regard to side effects in this aged patient population, as this seems to be a major concern of patients apart from pure pain reduction.
Hypnic headache（HH）是一种罕见的原发性头痛障碍，其特征为仅与睡眠相关的头痛发作。由于其发病率低，临床特征和治疗选择广泛未知或存在争议。
使用标准化问卷对 20 例 HH 患者进行检查和访谈，以了解其临床特征和有效治疗方案。根据当前的国际头痛协会（IHS）诊断标准评估数据。个体治疗史和有效治疗选择与基于当前文献的预期疗效进行比较。
与当前的 IHS 标准相反，15%的患者报告有三叉神经自主症状。所有患者在头痛发作时均表现出明显的运动行为。在急性疼痛发作时，咖啡因最有效。锂、托吡酯、褪黑素、阿米替林和吲哚美辛有时是有用的预防治疗选择，但常伴有副作用。
我们的结果强调需要修改 HH 的 IHS 诊断标准，以更好地反映这种头痛的实际临床特征。咖啡因应被视为一线急性治疗药物。在这个老年患者群体中，应仔细评估预防性药物治疗的副作用，因为除了单纯减轻疼痛外，这似乎是患者的一个主要关注点。
