Hypnic headache

A type of headache that only occurs when you are sleeping

What is hypnic headache?

Hypnic headache is a rare type of headache. It only occurs when you are sleeping and will cause you to wake up. It is often referred to as ‘alarm clock’ headache because it happens at the same time several nights of the week. Some people experience it every night.

It is more common in older people, most often people over 60. It is also more common in women than men.


The main symptom of hypnic headache is a headache that wakes you up. The head pain can be described as dull, throbbing, pulsating, stabbing or burning.  It can occur on one side of the head or both sides. One in three people with hypnic headache experience severe headache attacks.

The headache can last between 15 minutes and three hours. Most people have between one and two attacks a night, although some people will have more. For a lot of people, the headache occurs between 2am – 4am.

Some people experience teary eyes, drooping eyelids or a blocked nose alongside the headache. A lot of people get up during an attack and do activities such as reading or eating. Around three in ten people will experience migraine symptoms including nausea (feeling sick), sensitivity to light or sound.

One in three people with hypnic headache have a history of migraine. For most people their last migraine attack was years before the hypnic headache started.

What causes hypnic headache?

We don’t fully understand what causes hypnic headache. It’s likely that it involves the hypothalamus. The hypothalamus is the part of the brain that is responsible for a range of bodily functions including body temperature, thirst, sleep cycles, blood pressure and heart rate. There is a need for more research into the causes of hypnic headache.

Diagnosing hypnic headache

Diagnosing hypnic headache involves ruling out other conditions. Your doctor will usually:

  • ask you about your symptoms and history of headache. It can be helpful to keep a headache diary detailing your symptoms.
  • perform a neurological examination.
  • send you for further tests including a brain scan to rule out other conditions.

They will also want to rule out other headache disorders. Some other headache disorders can be sleep-related including migraine and cluster headache.

The official diagnostic criteria for hypnic headache include:

  • Recurrent headache
  • Developing only during sleep and causing you to wake up
  • Occurs on more than 10 days of the month, for at least three months.
  • Lasts 15 minutes to four hours.

Treatment options for hypnic headache

The treatment for hypnic headache is based on what has been found to work by doctors. However, there is limited information on the best treatment.

Caffeine in the form of a strong cup of coffee before bed seems effective as both an acute and preventive treatment. If you’ve been told to try this you may be worried about it causing you not to sleep. The evidence suggests this rarely occurs and caffeine is an effective treatment option.

Lithium carbonate can be used as a preventive treatment. The evidence suggests it’s effective in around 1 in 3 people. However, side effects are often a problem (especially in older people) and can lead to treatment being stopped.

Indomethacin (a NSAID) has been shown to be effective for some people. However, some people find the side effects too much and need to stop treatment.

There is some limited evidence that topiramate may be effective as a preventive for some people.

Some people find painkillers with added caffeine can be a good acute treatment. However, you should limit how often you take these due to the possibility of medication overuse headache and other complications from regular use of painkillers.