Exploding Head Syndrome: A Case Series of Underdiagnosed Hypnic Parasomnia
Abdul Rouf Pirzada1, Aljohara S Almeneessier1,2, Ahmed Salem BaHammam1
1The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Case Reports in Neurology
|November 11, 2020
Summary
Exploding head syndrome (EHS) is a recognized sleep disorder causing loud head noises during sleep onset. Treatment involves managing comorbid sleep issues or amitriptyline for persistent EHS cases.
Area of Science:
- Neurology
- Sleep Medicine
- Parasomnias
Background:
- Exploding head syndrome (EHS) is an under-recognized parasomnia.
- Characterized by sudden, loud noises or explosions perceived in the head, typically at sleep onset.
Observation:
- A case series of 6 patients (4 men, 2 women; mean age 44.2 years) diagnosed with EHS via clinical interview and video-polysomnography (vPSG).
- Episodes varied in sound (firecracker, gunshot) and were internal, causing distress but no pain.
- Five patients had comorbid sleep disorders, with EHS symptoms linked to these conditions.
Findings:
- vPSG recordings were unremarkable in 5 patients; one documented EHS during N2 sleep.
- Three patients improved with reassurance and treatment of comorbid sleep disorders.
- Three patients responded well to amitriptyline (10-50 mg).
Implications:
- EHS is a well-characterized, underrecognized hypnic parasomnia with a generally benign course.
- Amitriptyline appears effective for persistent EHS.
- Further research into EHS pathophysiology and treatment is warranted.
Related Concept Videos
01:07Narcolepsy
333
Narcolepsy is a chronic sleep disorder characterized by pervasive, uncontrolled sleepiness and other sleep disturbances. One of its hallmark symptoms is an abrupt transition to REM sleep upon falling asleep, which causes symptoms typically associated with this phase to occur unexpectedly during wakefulness. These include the following symptoms, which typically last from a minute or two to half an hour.
333
01:17Sleepwalking and Sleep Talking
532
Somnambulism, commonly known as sleepwalking, involves individuals engaging in activities ranging from simple walking to more complex behaviors such as driving. Sleepwalking typically occurs during the slow-wave sleep stages 3 and 4 early in the night when the person is not dreaming, contradicting the myth that sleepwalkers are acting out their dreams.
Factors that increase the likelihood of sleepwalking include sleep deprivation and alcohol consumption. Contrary to common beliefs, it is safe...
Factors that increase the likelihood of sleepwalking include sleep deprivation and alcohol consumption. Contrary to common beliefs, it is safe...
532
01:24Sleep-Wake Cycles
2.5K
Sleep is an essential physiological process vital to maintaining overall well-being. The reticular activating system (RAS), a network of neurons in the brainstem, regulates wakefulness and sleep. While it may seem passive, sleep consists of distinct cycles, each with its unique characteristics and functions. Two key sleep phases are non-rapid eye movement (NREM) and rapid eye movement (REM).
NREM Sleep
NREM sleep comprises four progressive stages that seamlessly merge:
NREM Sleep
NREM sleep comprises four progressive stages that seamlessly merge:
2.5K
01:18Nightmares and Night Terrors
285
Nightmares and night terrors represent two distinct types of sleep disturbances that differ in timing, characteristics, and the sleeper's recall of the event. Nightmares are vivid, disturbing dreams that usually awaken the sleeper from REM sleep, a stage of sleep where brain activity is high, and dreams are most frequent. Upon awakening, individuals often have detailed recollections of their nightmares, which can include themes of threats to survival, security, or self-esteem.
Nightmares...
Nightmares...
285
01:15REM Sleep Behavior Disorder
942
REM Sleep Behavior Disorder (RBD) is a sleep disorder characterized by the absence of muscle paralysis that normally occurs during the REM phase of sleep. This absence allows individuals to physically act out their dreams, which are often vivid and disturbing. Common behaviors exhibited during episodes include kicking, punching, and yelling. These actions can be dangerous, potentially leading to injuries for the person with RBD or their bed partner.
RBD is significantly associated with...
RBD is significantly associated with...
942
01:27Restless Leg Syndrome and Night Terrors
347
Restless Leg Syndrome (RLS), also known as Willis-Ekbom disease, is a neurological disorder characterized by an uncontrollable urge to move the legs due to uncomfortable sensations. These sensations typically occur during periods of rest or inactivity, particularly when lying down or sitting, and can severely disrupt sleep.
The exact cause of RLS is not fully understood, but it is believed to involve dopamine, a neurotransmitter that helps regulate muscle movement. Imbalances in dopamine levels...
The exact cause of RLS is not fully understood, but it is believed to involve dopamine, a neurotransmitter that helps regulate muscle movement. Imbalances in dopamine levels...
347