Posted by Paco (204.111.23.152) on February 10, 2002 at 19:10:08:
In Reply to: Well - How about some interpretation? posted by Jack on February 10, 2002 at 18:04:15:
...shit out of me, Jacko. I have classic clusters. Here's some more poop from your favorite cut and paste man:
HYPNIC HEADACHE SYNDROME
The hypnic headache syndrome is a rare primary headache disorder that first was described by Raskin in 1988,[85] then by
Newman et al in 1990.[65] The initial description of the syndrome consisted of a bilateral, throbbing headache without
associated autonomic features lasting 15 to 60 minutes, recurring one to three times nightly, often during REM sleep. At the
time of this writing, 37 patients with the disorder have been described. The disorder has a female predominance (26 women,
11 men), with a sex ratio of 2.36:1.[25] [32] [33] [42] [60] [65] [66] [81] [85] Although most patients are elderly, the age of onset ranges
from 40 to 82 years (mean, 66 years; median, 66 years). Headaches occur at a consistent time each night, usually between
1:00 and 3:00 A.M., and rarely may occur during a daytime nap.[25] The headaches begin abruptly, are diffuse and throbbing,
and spontaneously resolve in 15 to 180 minutes. In 10 patients (27%), the headache was hemicranial.[25] [33] [42] [60] No
associated autonomic symptoms accompany the pain, but nausea, photophobia, and phonophobia rarely may be present.
Treatment
All patients have been treated successfully with bedtime doses of lithium carbonate, 300 to 600 mg, although many patients
could not tolerate the side effects. Bedtime doses of caffeine (5 patients); flunarizine (2 patients); indomethacin (1 patient);
atenolol (1 patient); and combination of ergotamine tartrate, belladonna, and caffeine (1 patient) have been reported to treat
this syndrome (Morales-Asin et al, 1998; Dodick et al, 1998; Ivanez et al, 1998). One patient treated with prednisone,
vincristine, and cyclophosphamide for an unrelated illness experienced headache resolution (Newman et al, 1991). The
accompanying box lists suggested criteria for hypnic headache.
Box 3. Suggested Criteria for Hypnic Headache *
A.Headaches occur at least 15 times per month for at
least 1 month
B.Headaches awaken patients from sleep
C.Attack duration of 5-60 minutes
D.Pain is generalized or bilateral (or unilateral)*
E.Pain is not associated with autonomic features
F.At least one of the following
1.There is no suggestion of one of the disorders
listed in groups 5-11
2.Such a disorder is suggested but excluded by
appropriate investigations
3.Such a disorder is present, but the first
headache attacks do not occur in temporal
relation to the disorder
Note: A rapid clinical response to lithium at bedtime usually
is expected.
From Goadsby PJ, Lipton RB: A review of paroxysmal
hemicranias, SUNCT syndrome and other short-lasting
headaches with autonomic feature, including new cases.
Brain 120:193-209, 1997; with permission.