Hypnic headache: clinical course and treatment.

OPINION STATEMENT: Thus far, no data from randomized placebo-controlled clinical trials are available for hypnic headache, so current treatment recommendations are based on single case reports and smaller open case series. In the predominantly elderly patient population affected by this disease, tolerability of the substances used is at least as important as their efficacy. Caffeine is the preferable first-line therapy for both acute treatment (i.e., a cup of strong coffee when awaking with headache) and prophylaxis (a cup of strong coffee before going to bed). Sleep problems should be considered as substantial side effects of this therapy, although they seem to occur far less than expected. For acute treatment, analgesics containing caffeine are also effective, but they may carry the risk of medication-overuse headache. Treatments that not effective for acute pain relief include nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, 100% oxygen, and acetaminophen Triptans may be effective in single cases. For prophylaxis, lithium should be tried as a second treatment option if caffeine intake is not effective or tolerated. Lithium has been reported to be effective in many patients, but it was often discontinued because of side effects. Indomethacin may be a viable option for third-line prophylactic therapy.