August 5, 2019 e-Pearl of the Week: Exploding head syndrome

Exploding head syndrome

Exploding head syndrome (EHS) presents with the perception of an explosive sound during the sleep-wake transition. It causes a fearful arousal, tachycardia and muscle spasms, despite being painless. The proposed mechanism is delay in switching off the reticular activating system2. Polysomnographic studies show an increase in EMG activity prior to the event. EHS has a prevalence of 10 percent in general population, however middle-aged women with psychological stress are the most commonly affected subgroup. Lack of recognition often causes delays in diagnosis1. Differential diagnoses include hypnic headache, nightmare disorder and chronic paroxysmal hemicrania. Treatment is avoidance of sleeping supine; a few cases have benefitted from benzodiazepines, hypnotics and TCAs2. 

References

1. Sharpless BA. Exploding head syndrome: Sleep Med Rev 2014;18:489-493.

2. Ceriani CEJ, Nahas SJ. Exploding Head Syndrome: a Review. Curr Pain Headache Rep 2018;22:63.

Submitted by Naveed Ahmad, MBBS, Professional Trainee, Psychiatry Department, University of Texas, Houston, and Faisal Khan MD, DABSM, Consultant Neurologist, Sugar Land Sleep and Neurology.

Naveed Ahmad and Dr. Khan report no disclosures.