Headache Just At Night – Try Indomethacin

Hyponic (night only) solely headaches are uncommon. In some ways they are distinct from migraines as the drug of choice is Indomethacin 50 mg twice daily. Neurologia. 2015 May;30(4):195-200. doi: 10.1016/j.nrl.2013.12.012. Description of series of 10 patients with hypnic headache: Discussion of the diagnostic criteria. Escudero Martínez I(1), González-Oria C(2), Bernal Sánchez-Arjona M(1), Jiménez Hernández MD(1). http://www.ncbi.nlm.nih.gov/pubmed/24953414 Standard criteria include: hypnic

  • All VAS >8
  • Character – 6 patients (60%)  dull and oppressive, 3  stabbing (30%), and one  pulsating (10%).
  • Location –  bilateral in 6 cases (60%) ;  hemicranial in 4 cases (40% )
  • Mean duration of headache – 169 minutes (10-480)
  • 70% phonophobia(noise bother) 50% photophobia (light bother)
  • 2/10 trouble getting to sleep
  • Onset more common during REM sleep
  • dysfunction of brainstem implicated
  • Suggested endogenous circadian rhythms disorder of suprachiasmatic nucleus
  • loss of grey-matter seen in posterior hypothalamus in one study
  • Indomethacin 50 mg bid decreased headaches by >50%
  • Flunarizine, verapamil, amitriptyline, and topiramate helpful in selected cases in literature
  •  mentions to rule out hypertension and sleep apnea

Comment – besides sleep apnea, I have seen bruxism as a cause – unfortunately secondary to antidepressants.  A bad neck can cause headaches at night and a water fill pillow (mediflow) might help. Restless legs can be a cause of sleep issues involved. golden goose golden goose

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