A woman has bilateral headache that worsens with emotional stress; she has two children, both doing badly in school; diagnosis is (AIPG 10)
Hypnic Headache (Ref. Hari-18th ed. Pg 128)
1. This headache syndrome typically begins a few hours after sleep onset.
2. The headaches last from 15 to 30 min and are typically moderately severe and generalized, although they may be unilateral and can be throbbing.
3. Headaches are bilateral in most, but may be unilateral.
4. Patients may report falling back to sleep only to be awakened by a further attack a few hours later; up to three repetitions of this pattern occur through the night.
5. Daytime naps can also precipitate head pain. Most patients are female, and the onset is usually after age 60.
6. Photophobia or phonophobia and nausea are usually absent.
7. The major secondary consideration in this headache type is poorly controlled hypertension; 24-h blood pressure monitoring is recommended to detect this treatable condition.