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Sleep Disorders

Quick Head Pain

12/18/2008

Question:

Within the last month I have had a quick sharp pain in the back of my head that will wake me up. It only happens just as I am falling asleep. Never any other time, and it is either on the right side or the left side at the back of my head. I have had it on both. but not at the same time. The weird thing about it is I will jump up but as soon as am awake good within a few seconds it is gone with no futher symptoms. I never get headaches at all and this is really not a headache, just a stabing ice pick sort of pain that only last a second are two and then am awake and it is gone. Sometimes it also feels like it might have a little electrial shock to it. Weird! Can you help me understand this?

Jim

Answer:

There are many types of headaches that are associated with sleep. You describe your headache well enough, but the description does not seem to fit any of the typical known types of sleep-related headaches. I can however offer some suggestions that may be of benefit. First I will describe the types of headaches that have been associated with sleep:

Migraine headaches: throbbing attacks last a few hours, occur on one side of the face or head, and are associated with nausea, vomiting, visual field defects, and multiple neurological manifestations.

Cluster Headaches: severe abrupt attacks of sharp pain lasting 2 hours or less, that occur on one side of the face or head, around the eyes and the temples, and are associated with congestion.

Chronic Paroxysmal Hemicrania: severe one sided pain usually waking up the patient at the same hour each night. These attacks are associated with congestion of the eye and the nose.

Hypnic headache: these diffuse (all over the head) attacks last 1-2 hours and have no congestive or neurological symptoms associated.

Clock-like hemicrania: very rare one sided headaches that last 15 minutes and occur day and night every 60 minutes with clocklike precision. There are no associated congestive signs.

Exploding head syndrome: a terrifying abrupt flashing light and noise that is perceived inside the head, lasts only a few seconds, but is NOT associated with pain. This usually occurs with sleep onset.

Headaches upon awakening can be caused by several other underlying disorders including sleep apnea syndrome, systemic hypertension, depression, alcohol intoxication, and sinus inflammation. Bruxism, or clenching and grinding of teeth, and temporomandibular joint stress occasionally leads to headaches upon awakening. Although brain tumors rarely cause any pain, some 5% of patients with tumors develop a dull headache in the middle of the night that resolves with assuming an upright position. None of these scenarios appear to relate to your case.

Your symptoms seem to be as brief as the episodes of exploding head syndrome, although in the case of this syndrome, pain is not a prominent feature. Chronic Paroxysmal Hemicrania is another possibility, although the pain in this disorder typically occurs during dream sleep and not at sleep onset.

There is still one possibility. Upon sleep onset, hypnic jerks (normal occurrences of muscle spasms) may result in significant muscle contraction that can cause pain similar to the one you describe. If this is the case, then muscle contractions are the cause of your pain. These episodes are normal and don't need any treatment, although a careful examination of the neck should be done to rule out musculoskeletal problems.

All the above disorders can be managed with a combination of medications that treat headaches, or with management of the underlying condition that may be contributing to the headaches.

You should discuss your problem with your doctor. A referral to a Sleep Specialist or Neurologist may be indicated to help diagnose the problem. Often, using a combination of clinical examination and sleep testing, a diagnosis can be made and effective treatment can be initiated.

The American Academy of Sleep Medicine website contains a list of Sleep Centers across the country so you can locate one near you. I encourage you to seek help if the problem persists. Good luck and I wish you best of sleep.

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Response by:

Ziad  Shaman, MD Ziad Shaman, MD
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University