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Reader's Mail: Consult Specialist for Continuous Headache

Q. My husband has been diagnosed with hypnic headache; however, his headaches do not awaken him. He has a headache every hour he is awake. He also has suffered from bleeding ulcers several times so cannot take nonsteroidal anti-inflammatory medications. Do you have any suggestions?

A. I am sorry that your husband is having difficulty. Unfortunately, I do not believe—based on what you have related—that he has received the correct diagnosis. If he does have hypnic headache, he most likely has another type of headache also.

Hypnic headache (also known as alarm clock headache) typically occurs at the same time, each night, during sleep. People awaken with the headache, not because of it. The duration of these attacks may range from minutes or up to 3 hours and are rarely reported upward of 6 hours. The attack usually resolves with movement and caffeine consumption. Other acute treatments include aspirin, rizatriptan, and sumatriptan. Prevention of hypnic headache has been demonstrated with lithium, caffeine, indomethacin, verapamil, and melatonin.

A continuous headache while awake makes me suspicious of new daily persistent headache, chronic migraine, medication overuse headache, low pressure headache, or obstructive sleep apnea. Considering these possibilities, I believe it would be most appropriate if your husband were evaluated in a dedicated headache clinic.

ReadyDuren Michael Ready, MD
Baylor, Scott & White
Temple, Texas

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