Exploding head syndrome
| Exploding head syndrome | |
|---|---|
| Other names | Episodic cranial sensory shock,[1] snapping of the brain,[2] auditory sleep start[3] |
| Specialty | Sleep medicine |
| Symptoms | Hearing loud noises when falling asleep or waking up[2] |
| Duration | Short[2] |
| Causes | Unknown[3] |
| Differential diagnosis | Nocturnal epilepsy, hypnic headaches, nightmare disorder, PTSD[2] |
| Treatment | Reassurance, clomipramine, calcium channel blockers[2] |
| Prognosis | Good[2] |
| Frequency | ~10% of people[2] |
Exploding head syndrome (EHS) is classified as a sleep disorder or headache disorder. It occurs when someone falls asleep or wakes up to loud auditory hallucinations. These noises don’t tend to last long, but they can still be frightening. While in general EHS is a rare occurrence, some people hear the loud noises multiple times a night. Other symptoms of EHS include seeing a light flash, feeling a tingling sensation run through the body, and suddenly feeling hot. EHS is typically painless and is generally not considered a serious health concern.
While the cause of EHS is unclear, links between ear problems, temporal lobe seizures, nerve dysfunction, sleep position, supernatural beliefs, specific genetic changes, and EHS have been investigated.[4][5] One potential risk factor for EHS is psychological stress. People often go undiagnosed or misdiagnosed.[4]
There is generally no reason to treat EHS since it is not usually a serious health condition.[5] There is also no high-quality evidence to support treatment of EHS, though several treatment methods have been studied. Clomipramine, calcium channel blockers and anticonvulsants were tried as a method to alleviate EHS symptoms. In some cases, these treatments did see positive results, but those results could have been due to something else. Another possibility for reducing the occurrence of EHS is treating other sleep problems before treating EHS. A non-medical treatment route could be making sure EHS patients know the condition is generally not medically concerning.
While the percentage of the population with EHS is not well studied, some have estimated that it occurs in about 10% of people.[4] Women may be more commonly affected, and the median age of EHS patients is in the 50s. [5]
Signs and symptoms
[edit]Individuals with exploding head syndrome hear or experience loud imagined noises as they are falling asleep or are waking up, have a strong, often frightened emotional reaction to the sound, and do not report significant pain; around 10% of people also experience visual disturbances like perceiving visual static, lightning, or flashes of light. Some people may also experience heat, strange feelings in their torso, or a feeling of electrical tingling that ascends to the head before the auditory hallucinations occur.[4] With the heightened arousal, people experience distress, confusion, myoclonic jerks, tachycardia, sweating, and a feeling that they have stopped breathing and need to make a conscious effort to breathe again.[6][7][8][9]
The pattern of the auditory hallucinations is variable. Some people report having a total of two or four attacks followed by a prolonged or total remission, having attacks over the course of a few weeks or months before the attacks spontaneously disappear, or the attacks may even recur irregularly every few days, weeks, or months for much of a lifetime.[2]
Causes
[edit]The cause of EHS is unknown.[3] A number of hypotheses have been put forth with the most common being dysfunction of the reticular formation in the brainstem responsible for transition between waking and sleeping.[2]
Other theories into causes of EHS include:
- Minor seizures affecting the temporal lobe[2]
- Ear dysfunctions, including sudden shifts in middle ear components or the Eustachian tube, or a rupture of the membranous labyrinth or labyrinthine fistula[2]
- Stress and anxiety
- Variable and broken sleep, associated with a decline in delta sleep
- Antidepressant discontinuation syndrome[2]
- Temporary calcium channel dysfunction[2]
- PTSD
Exploding head syndrome was first described in the 19th century,[2] and may have first been mentioned in the 17th century.[10]
Diagnosis
[edit]Exploding head syndrome is classified under other parasomnias by the 2014 International Classification of Sleep Disorders (ICSD, 3rd.Ed.) and is an unusual type of auditory hallucination in that it occurs in people who are not fully awake.[11][12]
According to ICD-10 and DSM-5 EHS is classified as either other specified sleep-wake disorder (codes:780.59 or G47.8) or unspecified sleep-wake disorder (codes: 780.59 or G47.9).[13][14]
Treatment
[edit]As of 2018[update], no clinical trials had been conducted to determine what treatments are safe and effective; a few case reports had been published describing treatment of small numbers of people (two to twelve per report) with clomipramine, flunarizine, nifedipine, topiramate, carbamazepine.[2] Studies suggest that education and reassurance can reduce the frequency of EHS episodes.[6] There is some evidence that individuals with EHS rarely report episodes to medical professionals.[9]
Epidemiology
[edit]There have not been sufficient studies to make conclusive statements about how common or who is most often affected.[2] One study found that 14% of a sample of undergrads reported at least one episode over the course of their lives, with higher rates in those who also have sleep paralysis.[15]
History
[edit]Case reports of EHS have been published since at least 1876, which Silas Weir Mitchell described as "sensory discharges" in a patient.[15] However, it has been suggested that the earliest written account of EHS was described in the biography of the French philosopher René Descartes in 1691.[10] The phrase "snapping of the brain" was coined in 1920 by the British physician and psychiatrist Robert Armstrong-Jones.[15] A detailed description of the syndrome and the name "exploding head syndrome" was given by British neurologist John M. S. Pearce in 1989.[16] More recently, Peter Goadsby and Brian Sharpless have proposed renaming EHS "episodic cranial sensory shock"[1] as it describes the symptoms more accurately and better attributes to Mitchell.
See also
[edit]- Hypnic jerk – Involuntary twitching while falling asleep
- Myoclonus – Involuntary, irregular muscle twitch
- Periodic limb movement disorder – Sleep disorder
- Sleep paralysis – Sleeping disorder
References
[edit]- ^ a b Goadsby, Peter J.; Sharpless, Brian A. (2016-11-01). "Exploding head syndrome, snapping of the brain or episodic cranial sensory shock?". J Neurol Neurosurg Psychiatry. 87 (11): 1259–1260. doi:10.1136/jnnp-2015-312617. ISSN 0022-3050. PMID 26833175. S2CID 30697559.
- ^ a b c d e f g h i j k l m n o p Sharpless, Brian A. (December 2014). "Exploding head syndrome". Sleep Medicine Reviews. 18 (6): 489–493. doi:10.1016/j.smrv.2014.03.001. PMID 24703829.
- ^ a b c Blom JD (2015). "Auditory hallucinations". The Human Auditory System - Fundamental Organization and Clinical Disorders. Handbook of Clinical Neurology. Vol. 129. pp. 433–55. doi:10.1016/B978-0-444-62630-1.00024-X. ISBN 9780444626301. PMID 25726283. S2CID 6192827.
{{cite book}}:|journal=ignored (help) - ^ a b c d Sharpless, Brian A. (2014-12-01). "Exploding head syndrome". Sleep Medicine Reviews. 18 (6): 489–493. doi:10.1016/j.smrv.2014.03.001. ISSN 1087-0792.
- ^ a b c Alkhateeb, Wasef; Krishnaraj, Abhinaya; Saini, Vishal (2023-08). "Single Patient Multiple Explosions: A Case Report on Exploding Head Syndrome". Cureus. 15 (8): e44437. doi:10.7759/cureus.44437. ISSN 2168-8184. PMC 10543998. PMID 37791153.
{{cite journal}}: Check date values in:|date=(help)CS1 maint: article number as page number (link) - ^ a b Frese, A.; Summ, O.; Evers, S. (6 June 2014). "Exploding head syndrome: Six new cases and review of the literature". Cephalalgia. 34 (10): 823–827. doi:10.1177/0333102414536059. PMID 24907167. S2CID 31675696.
- ^ Blom, Jan Dirk (2009-12-08). A Dictionary of Hallucinations. Springer Science & Business Media. ISBN 9781441912237.
- ^ Larner, Andrew J.; Coles, Alasdair J.; Scolding, Neil J.; Barker, Roger A. (2011-01-19). A-Z of Neurological Practice: A Guide to Clinical Neurology. Springer Science & Business Media. ISBN 9781848829947.
- ^ a b Sharpless, Brian A (2017-04-06). "Characteristic symptoms and associated features of exploding head syndrome in undergraduates". Cephalalgia. 38 (3): 595–599. doi:10.1177/0333102417702128. PMID 28385085. S2CID 4033153.
- ^ a b Otaiku AI (2018). "Did René Descartes have Exploding Head Syndrome?". J. Clin. Sleep Med. 14 (4): 675–8. doi:10.5664/jcsm.7068. PMC 5886445. PMID 29609724.
- ^ International Classification of Sleep Disorders. Darien, IL: American Academy of Sleep Medicine. 2014.
- ^ Thorpy, Michael J. (2012-10-01). "Classification of Sleep Disorders". Neurotherapeutics. 9 (4): 687–701. doi:10.1007/s13311-012-0145-6. ISSN 1933-7213. PMC 3480567. PMID 22976557.
- ^ World Health Organization. International Statistical Classification of Diseases and Related Health Problems. 10th ed. Geneva, Switzerland: World Health Organization; 2008.
- ^ American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Arlington, VA: American Psychiatric Association; 2013.
- ^ a b c Sharpless BA (2015). "Exploding head syndrome is common in college students". Journal of Sleep Research. 24 (4): 447–9. doi:10.1111/jsr.12292. PMID 25773787. S2CID 34157227.
- ^ Thorpy MJ, Plazzi G (2010). The Parasomnias and Other Sleep-Related Movement Disorders. Cambridge University Press. p. 231. ISBN 978-0-521-11157-7. Retrieved 2011-03-18.
Further reading
[edit]- Møller, Aage R.; Langguth, Berthold; DeRidder, Dirk; Kleinjung, Tobias (2010-11-16). Textbook of Tinnitus. Springer Science & Business Media. ISBN 9781607611455.