Chronic severe nocturnal hypnic headaches

Posted by taterjoy @taterjoy, Aug 29, 2016

I am looking for anyone else who has been diagnosed and treated for chronic, severe nocturnal hypnic headaches. I have had them for about 12 years, and on treatment, but not optimal treatment. I am interested in hearing how others with this rare diagnosis are being told to treat them safely.

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Profile picture for gussie @gussie

When I awoke with my usual headache last night I went downstairs and made myself a cup of coffee full caffeine. The headache went away. I've tried doing that before bed but it didn't work for me. Do any of you take caffeine pills instead of black coffee. I wonder is it's better for your gut as I have gastritis.

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Caffeine does help me with those, but it is better to eat something before you take it, like a piece of bread, yogurt, or a glass of milk or even water. (this isn't medical advice, just my experience). I also had great response with butalbital - that is now a controlled substance though, but in my opinion works great

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When I awoke with my usual headache last night I went downstairs and made myself a cup of coffee full caffeine. The headache went away. I've tried doing that before bed but it didn't work for me. Do any of you take caffeine pills instead of black coffee. I wonder is it's better for your gut as I have gastritis.

REPLY
Profile picture for taterjoy @taterjoy

I am glad he helped your husband with a difficult diagnosis and hope your husband is getting excellent care at UCSF. I was not going to mention the Headache Specialists name but you nailed it. After driving to San Fran monthly to visit him for six months, he was able to discern that my headache was inflammatory, severe, and occurred at exactly the same four intervals every night. I had brought diaries each of those six visits and telling him EVERY night its the same, living h--l. At month six when he said "if this new combo does work we'll try something else next time." I told him there would not be a next time because I could no longer live like that, and put my husband through it. He actually then took a look at my diaries, and had an A-ha moment, saying "EXACTLY the same time every night! I think we can actually make this headache go away with ONE pill (indomethacin). " He said it was called a rare "Alarm Clock headache." I googled ACH and read everything that was published about them--they were also called Hypnic Headaches. Treating it and migraines have been totally separate endeavers. I hope you find some relief for your headaches, and I hope the prices of CGRPs comes down when/if generic versions can become available. Eli Lilly offers a discount card for Emgality, and they now offer home delivery. It helped prevent my migraines very well, but was still more expensive for me than Ajovy being covered by my insurer. I am not promoting it, but noticed their manufacturer is making an effort to help patients with the discount program and with direct delivery.

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I have two questions. I know you went to Mayo for help. Did you need a referral and which one did you go to? I had to stop the Qulipta because of the side effects and the headaches are back. I had a lot of hair loss, terrible constipation and weight gain but it did help. I can't afford the $550.00 a month that I would have to pay and the Pharma will only cover it til the end of the year anyway. Medicare doesn't cover any of the new migraine drugs very much. They don't have a deal with big pharma like the private insurance companies do.

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Profile picture for shaylala @shaylala

It’s been a while (thankfully) but I remember waking with the first one in September and didn’t happen again for a few nights but after a couple of weeks they hit every night between 2 and 3am. I had noticed the severity would decline after 6am (when I’d get a cup of coffee) but didn’t make the caffeine association until I found this support group. I was shocked that heavy hitter prescription pain meds did not help at all but caffeine provided some relief. The problem, on top of the pain, was the lack of sleep, which caffeine didn’t help. I began to dread going to bed since I knew what was coming. This went on for 4 months and several different medications after ruling out the life threatening possibilities with MRI’s and CAT scans. So, fortunately my Neurologist thought to hit it with Prednisone after trying several other meds that many others on this site had tried. I think it was 10 days or so of the prednisone where you start with a higher dose and gradually taper off. Within a couple of days the timing of the headaches was disrupted and only had one more headache after finishing the meds. My neurologist was Meredith Snapp in Charlotte, NC. My thoughts and prayers for you and all who suffer with these terrible headaches.

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Thank you ! i will discuss it with my neuro , but if im not mistaken before the prednisone you were dealing with these type of headaches for months not years right? The fact that it helped solve the problem rather than coming back full force when you stopped the prednisone is interesting.

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Profile picture for Avion @benchi300

thank for the reply , how long did you take the prednisone for your hypnic headaches ? and since that round they havent returned? how long were you dealing with that type of headache? Thank you. Me too started with waking up at a specific time but then became more of a chronic form not as quite severe...

Jump to this post

It’s been a while (thankfully) but I remember waking with the first one in September and didn’t happen again for a few nights but after a couple of weeks they hit every night between 2 and 3am. I had noticed the severity would decline after 6am (when I’d get a cup of coffee) but didn’t make the caffeine association until I found this support group. I was shocked that heavy hitter prescription pain meds did not help at all but caffeine provided some relief. The problem, on top of the pain, was the lack of sleep, which caffeine didn’t help. I began to dread going to bed since I knew what was coming. This went on for 4 months and several different medications after ruling out the life threatening possibilities with MRI’s and CAT scans. So, fortunately my Neurologist thought to hit it with Prednisone after trying several other meds that many others on this site had tried. I think it was 10 days or so of the prednisone where you start with a higher dose and gradually taper off. Within a couple of days the timing of the headaches was disrupted and only had one more headache after finishing the meds. My neurologist was Meredith Snapp in Charlotte, NC. My thoughts and prayers for you and all who suffer with these terrible headaches.

REPLY
Profile picture for shaylala @shaylala

I found the old post and will paste it here. I hope your doctor feels it’s worth a try. It was such a desperate time and I hate that anyone suffers from these awful headaches. :

lisalucier – I started the Prednisone taper on 11 December. 42 tabs 10mg. I'll complete dosing on 22 December. Prior to starting the Prednisone I think the other meds had thrown off the timing of the headaches, so rather than waking me at a specific time, they were more random and not quite as severe, but was feeling generally achy along with a constant feeling of shakiness. I have tolerated Prednisone pretty well in the past, when taken for extreme cases of poison ivy and a lengthy battle with hives following a surgery. This round, after day 2, the headaches completely ceased and I've felt much better with the exception of the shakiness, a little fluid retention and elevated blood pressure. I expect the fluid retention and blood pressure will return to normal after I complete the dosage and, if true to form, I expect a week or 2 of feeling generally lousy while my body takes back over to produce cortisol.

After completing the dosage, I remember waking with a headache once more, a few weeks later, but not as severe. They haven’t returned since. Mine were always left side of head and mind blowing severe. Caffeine helped with the pain but no other pain meds helped at all. I wish you success🙏

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thank for the reply , how long did you take the prednisone for your hypnic headaches ? and since that round they havent returned? how long were you dealing with that type of headache? Thank you. Me too started with waking up at a specific time but then became more of a chronic form not as quite severe...

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Profile picture for gussie @gussie

I bet you saw Dr. Goldstein. I went to him for over 30 years. He is quite an unusual man. He fired me about 5 years ago because I was his only private patient left in his practice. He only does testing for big pharma now and I didn't want to be part of his test groups. I will say he diagnosed my husband's Cerebral Angioma when he had symptoms and I didn't know where else to bring him. He is since in the care of UCSF neuro dept.

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I am glad he helped your husband with a difficult diagnosis and hope your husband is getting excellent care at UCSF. I was not going to mention the Headache Specialists name but you nailed it. After driving to San Fran monthly to visit him for six months, he was able to discern that my headache was inflammatory, severe, and occurred at exactly the same four intervals every night. I had brought diaries each of those six visits and telling him EVERY night its the same, living h--l. At month six when he said "if this new combo does work we'll try something else next time." I told him there would not be a next time because I could no longer live like that, and put my husband through it. He actually then took a look at my diaries, and had an A-ha moment, saying "EXACTLY the same time every night! I think we can actually make this headache go away with ONE pill (indomethacin). " He said it was called a rare "Alarm Clock headache." I googled ACH and read everything that was published about them--they were also called Hypnic Headaches. Treating it and migraines have been totally separate endeavers. I hope you find some relief for your headaches, and I hope the prices of CGRPs comes down when/if generic versions can become available. Eli Lilly offers a discount card for Emgality, and they now offer home delivery. It helped prevent my migraines very well, but was still more expensive for me than Ajovy being covered by my insurer. I am not promoting it, but noticed their manufacturer is making an effort to help patients with the discount program and with direct delivery.

REPLY
Profile picture for Avion @benchi300

i cant find your old post but did you mention the round of prednisone stopped it for good? did you take it for a while and at high dose? I will discuss that option with my neurologist if you found relief, she had already mention something about that med. thanks

Jump to this post

I found the old post and will paste it here. I hope your doctor feels it’s worth a try. It was such a desperate time and I hate that anyone suffers from these awful headaches. :

lisalucier – I started the Prednisone taper on 11 December. 42 tabs 10mg. I'll complete dosing on 22 December. Prior to starting the Prednisone I think the other meds had thrown off the timing of the headaches, so rather than waking me at a specific time, they were more random and not quite as severe, but was feeling generally achy along with a constant feeling of shakiness. I have tolerated Prednisone pretty well in the past, when taken for extreme cases of poison ivy and a lengthy battle with hives following a surgery. This round, after day 2, the headaches completely ceased and I've felt much better with the exception of the shakiness, a little fluid retention and elevated blood pressure. I expect the fluid retention and blood pressure will return to normal after I complete the dosage and, if true to form, I expect a week or 2 of feeling generally lousy while my body takes back over to produce cortisol.

After completing the dosage, I remember waking with a headache once more, a few weeks later, but not as severe. They haven’t returned since. Mine were always left side of head and mind blowing severe. Caffeine helped with the pain but no other pain meds helped at all. I wish you success🙏

REPLY
Profile picture for shaylala @shaylala

Thankful the headaches have never returned.

Jump to this post

i cant find your old post but did you mention the round of prednisone stopped it for good? did you take it for a while and at high dose? I will discuss that option with my neurologist if you found relief, she had already mention something about that med. thanks

REPLY
Profile picture for taterjoy @taterjoy

Never tried imitrex prior to bedtime to prevent the headaches, nor treatment with estrogen. The regimen I am on (Indomethacin plus caffiene) was started by a headache specialist in San Fran,CA. Other meds for "hypnic" headaches did not work for me. While my regimen usually worked, my Mayo MD is hoping to ween me off Indomethacin since its not safe for long-term use (GI bleeding risk). I do take an additoinal med to help prevent GI bleeds called pantoprazole. I hope you can find safe treatments that are effective.

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I've used estrogen for my hypnic headaches and it worked great. The only problem is that it gave me diverticulosis/diverticulitits - so I had to discontinue. If I can figure out a way to take estrogen that doesn't go through my intestines, then that might work. I don't think that rectal or vaginal meds would do the trick for the headaches though.

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