Clinical Characteristics in Adults

Abstract

Most of the semiologic features of hypnic headache are not part of the diagnostic criteria established in ICHD-3. Hypnic headache diagnosis does not depend on complementary exams but on the knowledge of its clinical characteristics. In this chapter, clinical features were based on reports of 345 cases described over the past 34 years. Hypnic headache patients took a few years from the onset of pain to see a specialist. Diagnosis was made, on average, 7 years and 7 months after headache onset. Nocturnal headache attacks occurred after the patient falls asleep, distributed in the following percentages and times: 27.6%, before 2 o’clock in the morning; 51.1% between 2 and 4 h; and 16.1%, after 4 h Headache attacks generally lasted from 10 to 600 mins, with an average of 90 mins. In 94.5% of patients, headache attacks occurred for more than 10 headache days per month, averaging 21 days. The pain had a dull or pressure quality in 74.4% of the patients; throbbing or pulsatile, in 18.3%; and stabbing or burning, in 7.3%. Pain intensity was mild in 5.5%; moderate, in 61.5%; severe, in 32.5%; and very severe, in 0.8%. Pain was bilateral in 55.5% of patients; unilateral, in 30.3%; and holocranial or diffuse, in 14.2%. Associated symptoms were absent in 62.6% of the patients. Autonomic manifestations were present in only 7.6% of the patients, with a predominance of tearing. No triggering factors have been identified.

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Louis Scutenaire (1905–1987)