What is a hypnotic headache?

Also known as “alarm clock headaches,” hypnotic headaches are a rare disorder in which the headache occurs only while you are sleeping. Episodes of this condition vary in intensity, disrupt sleep, last up to four hours after waking, and occur frequently: 10 or more times per month.

Diagnosis of sleep-onset headache can be challenging, and treatments vary. Try caffeine often at night, as well as medications like lithium and Tivorbex (indomethacin). Read on to learn more about the disease, including how to recognize and manage it, and what you can do to deal with it.

hypnotic headache symptoms

As a primary headache disorder, hypnotic headache occurs independently of other health conditions. Several characteristics define them, including:

  • Headache attacks start at night and during sleep (usually between 2 and 4 am), disrupting sleep.
  • Attack durations ranged from 5 minutes to 12 hours, with most resolved within three hours.
  • Attacks occurred 10 or more times per month for more than three months.
  • There were no cranial autonomic symptoms (stuffed, runny nose, and swollen eyes) or restlessness at the time of the attack.

Severity difference

Often the sensation is bilateral (both sides of the head)—though some people are unilateral (one side only)—and the intensity of pain during a sleep-onset headache can vary widely. Often, the pain is described as similar to a tension headache, with dull or moderate pain.

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

When an attack occurs — an average of 21 a month — people not only wake up, but become active, walking around, snacking, or taking a shower. Other reported symptoms include:

  • head pressure
  • drowsiness
  • hunger
  • yawn
  • feeling of indifference
  • pupil dilation (in rare cases)
  • Depression, anxiety, or other mood disorders


Because this is a rare condition, the cause of hypnotic headaches is not fully understood. However, some researchers believe that this type of headache may be a variant of migraine because it shares many of the same mechanisms. Since the aggression only occurs during sleep, the condition may be related to a disruption of the circadian rhythm (your natural sleep-wake cycle) due to disease in the hypothalamic region of the brain.

Since patients are usually over 50 years old, age-related degeneration in this area is suspected. Several causes of sleep-onset headaches have been proposed, such as:

  • Hypothalamic hyperactivity disorder: Irregular activity in a brain region that regulates pain processing, body temperature, thirst and hunger is associated with sleep and headache problems. Headaches are more likely to occur when you are overactive.
  • Vasodilation: Another theory is that sleep headaches are caused by the dilation (dilation) of the blood vessels in the hypothalamus due to hypocapnia or excess carbon dioxide (CO2) in the blood during sleep. This increases pressure on the meninges (the layers of tissue surrounding the brain and spinal cord), which can lead to headaches.
  • Reduced gray matter: A 2011 study using neuroimaging found that people with lethargic headaches had slightly less gray matter (a key neuron that regulates many central nervous system functions) in the pain center of the hypothalamus.

risk factor

In general, sleep-onset headaches are very rare, with an estimated incidence between 0.07% and 0.3% of the population. Several health factors are associated with sleep-onset headaches, increasing the chance of an attack. Here’s a quick breakdown:

  • Age: This type of headache is rare in infants, children, teens, and young adults, and usually affects people over the age of 50.
  • Gender: Cis-sex women are 3 times more likely to have this condition than men.
  • History of headache disorders: 30%–60% of people with this disorder report having migraine or other headache disorders.

Diagnosing hypnotic headaches

Given that few people experience a sleep-onset headache — and its symptoms can vary widely — identifying this condition can be challenging. The main goal of a diagnosis is for a neurologist or headache specialist to rule out other types of headaches or other health problems that may be causing the pain. This may require a series of tests and assessments, including:

  • Symptom Evaluation: Your reported medical condition, medical history, and symptoms will be evaluated to determine if they do not qualify for other types of primary headaches. Sleep headaches differ from conditions such as tension headaches and migraines in that they occur only during sleep, often when the patient is older.
  • Neuroimaging: Imaging techniques of the brain, such as magnetic resonance imaging (MRI) or computed tomography (CT), used to make sure that cancerous growths, benign tumors (adenomas), or other problems do not cause headaches.
  • Blood pressure monitoring: Nocturnal headaches are sometimes caused by nocturnal headache-hypertensive syndrome, in which blood pressure becomes dangerously high overnight. Monitoring blood pressure over a 24-hour period can be used to detect this condition.
  • Screen for obstructive sleep apnea: Interruption of breathing during sleep, called obstructive sleep apnea (OSA), can also cause nighttime headaches. Screening methods include multiple latency sleep testing, polysomnography, and nocturnal oximetry. However, OSA and sleep-onset headache may co-occur.
  • Medication evaluation: This is to rule out medication overuse headache (also called rebound headache), which occurs when people take too much pain medication. A headache specialist needs to know what you are taking and how often.


There is no set treatment for hypnotic headaches because they are very rare and poorly understood. Treatments for sleep-onset headaches include medications to treat symptoms after an attack (abortion medications) as well as medications to prevent attacks (preventive medications). In addition, some lifestyle changes and other non-drug treatments have been reported to help.

Abortion drugs

Some abortion or rescue medications may be used to treat hypnotic headaches after they start. These include:

  • Caffeine: Caffeine, like the caffeine in coffee, some teas, and supplements, can both trigger and relieve headaches. For many people, having a cup of coffee after a headache can help, and multiple studies show that it does. However, there are concerns that this method can lead to insomnia.
  • Pain relievers: Medications that combine caffeine with aspirin or acetaminophen, such as Excedrin and Anacin Advanced Headache, have been shown to help relieve sleep-onset headaches. Anecdotal evidence suggests that other pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil or Motrin (ibuprofen), alone Tylenol (acetaminophen), and Cafergot (ergotamine) may also help.
  • Triptans: Also used for migraine and other primary headache disorders, triptans such as sumatriptan and rizatriptan, etc. These stimulate the activity of serotonin (5-HTP) brain receptors, which stimulate the release of serotonin, a neurotransmitter involved in the regulation of mood and pain. The nasal spray of this medication is especially fast.

preventive medicine

Because sleep-onset headaches are, by definition, characterized by recurring attacks, treatment usually involves taking medication to prevent them from happening. A variety of drugs and methods can be tried, including:

  • Lithium: a psychiatric drug commonly used in 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 aids in the sleep-wake cycle, often used as a dietary supplement to support sleep
  • Amitriptyline: Antidepressants and nerve pain relievers
  • Anticonvulsants: antiepileptic drugs

There is limited evidence that certain medications used for chronic migraines may help, such as:

  • beta-blockers, such as Inderal LA (propanol) and Betimol (timolol)
  • Botox injections (Botox)
  • calcium channel blockers, such as Sibelium (flunarizine) and Verelan (verapamil)
  • Benzodiazepinessuch as Ativan (lorazepam) and Valium (diazepam)
  • Glucocorticoids (Steroid)
  • Diamox (acetazolamide)

non-drug methods

Several non-drug methods have been tried, including:

  • Nerve stimulation: In chronic cases, mild electrical or magnetic waves from specialized equipment are transmitted through the skin of the head and temples.
  • Nerve blocks: Strategic injection of anesthetic drugs into the nerves of the neck and head to block pain messages in chronic headache cases.
  • Oxygen therapy: Studies have shown that oxygen therapy, inhaling 100 percent oxygen through a mask, is effective for some types of headaches.
  • Physical activity: Case reports suggest that engaging in some physical activity can help relieve flare-ups after a flare-up.

Prognosis and coping

While headaches themselves are benign and not damaging to the brain, sleep-onset headaches can certainly be a burden. They can be unpredictable and disrupt sleep. However, the good news is that this condition usually responds to treatment.

Chronic headaches can be unbearable for some people and are associated with mood disorders such as anxiety and depression. Strategies that can help you cope include:

  • Work with a therapist or counselor
  • Find a support group for people with chronic pain or headaches
  • Stay social and connect with family and friends
  • Participate in relaxation activities
  • Stick to fitness and diet

Tips for coping with headaches


Sleep headaches are a very rare disorder in which headaches occur only during sleep, causing people to wake up. Often associated with tension headache symptoms, frequent episodes are sometimes accompanied by nausea, vomiting, and sensitivity to light and sound.

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

While there is no set treatment, caffeine, certain analgesics, and triptans can treat symptoms of sleep-onset headache, and lithium and indomethacin are most commonly used as prophylactics.

VigorTip words

There’s no denying that hypnotic headaches can be devastating and debilitating. Disrupted sleep and then waking up with pain can be frustrating and difficult. However, there are several treatment options and they can usually be successful in addressing this problem.

If you suspect you have a hypnotic headache or any type of headache disorder, be proactive: Talk to your healthcare provider and get the help you need.

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