Case: New Headache
Severe New “Headache Syndrome”
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Mrs. B is a 74-year-old, right-handed, female who presented to the clinic with a history of severe new “headache syndrome.” She does describe increased stress related to the care of her daughter who has significant learning disabilities and who lives with her. Mrs. B has become more worried about what will happen to her daughter if she is unable to continue caring for her daughter. Mrs. B also has had chronic depression but otherwise has enjoyed relatively good health. She does have a history of migraine headaches which have been stable.
She presents with an episode 3 days prior to admission that awakened her from sleep around 2:00 to 3:00 a.m., described as a sensation of a bright white flashing light in one or both eyes and an extremely loud pop like an explosion inside her head which awoke her abruptly. This apparently only lasted momentarily and she had no associated pain. On awakening, she found no evidence of anything that would have caused this sound or the like flash. Mrs. B had a second episode the next night between 1:00 and 2:00 a.m. with a loud explosion-like sound like a gunshot going off; again, abruptly awakening her without any other associated symptoms or actual pain of any kind. She had no numbness, no residual visual abnormalities, weakness, or other associated symptoms or signs. She did not have a headache and otherwise felt well. She comes in for evaluation. Fundoscopic and neurological exams are completely normal.
Published on February 8, 2011
Updated on February 15, 2011
Updated on August 1, 2011
Discussion
We want to thank everyone for their responses. And congratulations to the individual who responded on February 8th with “This is exploding head syndrome…” See below for the survey results. Now on to the doctor’s response.
This case was an example of a benign primary headache condition described in the literature as “exploding head syndrome.” The key points of the history are that there is really no associated pain and only a very momentary sensation of something exploding in the head and abrupt awakening during the twilight hours of sleep with no other associated symptomatology and with normal physical examination. There are some more recent cases where this has been associated with sleep apnea but throughout the literature it mostly has not been related to any particular known secondary cause. It has been felt to be a benign symptom; seemingly more common during stressful periods.
The following is the reference to a review article of 50 cases. This particular case was initially seen and reassured. She did however go on to see a neurologist who did an MRI/MRA, both of which were entirely normal and no treatment or recurrence of symptoms ensued. She is working on stress management.
J. Kent Dexter, MD
Published on February 9, 2011
Source: Pearce JM. Clinical features of the exploding head syndrome. J Neurol Neurosurg Psychiatry.
Department of Neurology, Hull Royal Infirmary, UK. PMID: 2769286 [PubMed - indexed for MEDLINE] 1989;52(7):907-10.
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