Department of Neurology, TD MCH, Alappuzha, Kerala, India.
Department of Neurology, PVS Memorial Hospital, Kochi, Kerala, India.
Neurol India. 2021 Sep-Oct;69(5):1277-1281. doi: 10.4103/0028-3886.329541.
Hypnic headache (HH) is a rare primary headache syndrome first described by Raskin in 1988.
To describe the occurrence of HH in Indian patients and compare its clinicoepidemiological features to those published in the literature and attempt to trace some of the evolving concepts regarding its etiology and clinical features since it was first described.
Patients attending the neurology outpatient department of a tertiary referral teaching hospital from 01-05-2011 to 30-04-2016 who were identified to have HH as per ICHD 3 beta criteria were included in the study. A meticulous history of the headache and comorbidities, clinical examination, Epworth Sleepiness Scale, blood counts, blood biochemistry, magnetic resonance imaging (MRI) scans of the brain and polysomnography (in selected patients) were done and the results were compared to selected international literature.
A total of 11 patients with HH were identified during the study period, of which 8 (72.72%) were males and 3 (27.27%) were females. The age of the patients varied from a minimum of 53 years to a maximum of 78 years (Mean: 63.36, SD: 8.09). The frequency of attacks per month ranged from 5 to 46(Mean: 20.36, SD: 11.67). The duration of each headache episode ranged from a minimum of 30 minutes to a maximum of 4 hours (Mean: 1.93, SD: 1.23). The occurrence of the headaches was maximum during the time periods of 0.00-2.00am and 2.00-4.00am (38% and 36%, respectively). The pain was dull in a majority of patients, 7 (63.63%). Trigeminal autonomic features such as lacrimation, ptosis, or rhinorrhea were not recorded from our cohort. Motor activity was noted in 7 (63.63%) cases. Two (18.18%) patients had associated migraine headaches whereas 3 (27.27%) had associated tension-type headaches. None of the patients in our series had chronic obstructive pulmonary disease. Four (36.36%) patients had systemic hypertension and 1 patient (9.09%) had diabetes mellitus. Two (18.18%) patients had symptoms of obstructive sleep apnea syndrome. Three (27.27%) patients had symptoms of excessive daytime sleepiness according to the Epworth Sleepiness Scale. Blood examinations and MRI were normal in all patients, except for the findings of a few lacunar infarcts and nonspecific T2 weighted hyperintensities in 3 patients (27.27%).
Our study proves the existence of the newly described primary headache syndrome called HH in the Indian population. On comparing our results with the international literature, the similarities are much greater than the differences. MRI voxel-based morphometry to demonstrate the loss of gray matter in the posterior hypothalamus may prove to be a reliable test to diagnose primary HH in the future.
Hypnic headache (HH) 是一种罕见的原发性头痛综合征，于 1988 年由 Raskin 首次描述。
描述印度患者中 HH 的发生情况，并将其临床流行病学特征与文献中发表的特征进行比较，并尝试追踪自首次描述以来其病因和临床特征的一些演变概念。
从 2011 年 5 月 1 日至 2016 年 4 月 30 日，在一家三级转诊教学医院的神经病学门诊就诊的患者中，根据 ICHD 3 beta 标准被确定为 HH。详细记录头痛和合并症的病史、临床检查、Epworth 嗜睡量表、血细胞计数、血液生化、脑部磁共振成像 (MRI) 扫描和多导睡眠图（在选定的患者中），并将结果与选定的国际文献进行比较。
在研究期间共发现 11 例 HH 患者，其中 8 例（72.72%）为男性，3 例（27.27%）为女性。患者年龄从最低 53 岁到最高 78 岁不等（平均：63.36，标准差：8.09）。每月发作次数从 5 次到 46 次不等（平均：20.36，标准差：11.67）。每次头痛发作的持续时间从最短的 30 分钟到最长的 4 小时不等（平均：1.93，标准差：1.23）。头痛发作的发生时间主要在凌晨 0 点至 2 点和凌晨 2 点至 4 点之间（分别为 38%和 36%）。大多数患者的头痛为钝痛，7 例（63.63%）。我们的队列中未记录到三叉自主神经特征，如流泪、眼睑下垂或流涕。7 例（63.63%）患者有运动活动。2 例（18.18%）患者有偏头痛头痛，3 例（27.27%）有紧张性头痛。我们系列中的没有患者患有慢性阻塞性肺病。4 例（36.36%）患者有高血压，1 例（9.09%）患者有糖尿病。2 例（18.18%）患者有阻塞性睡眠呼吸暂停综合征的症状。根据 Epworth 嗜睡量表，3 例（27.27%）患者有日间过度嗜睡的症状。除了 3 例（27.27%）患者存在腔隙性梗死和非特异性 T2 加权高信号的发现外，所有患者的血液检查和 MRI 均正常。
我们的研究证明了在印度人群中存在一种新描述的原发性头痛综合征，称为 HH。将我们的结果与国际文献进行比较，相似之处远多于差异。基于体素的磁共振成像体积形态测量法来证明后下丘脑灰质的丢失可能被证明是未来诊断原发性 HH 的可靠测试。
