Exploding head syndrome

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Exploding head syndrome
Other namesEpisodic 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]
DurationShort [2]
CausesUnknown [3]
Differential diagnosis Nocturnal epilepsy, hypnic headaches, nightmare disorder, PTSD [2]
TreatmentReassurance, clomipramine, calcium channel blockers [2]
Prognosis Good [2]
Frequency~10% of people [2]

Exploding head syndrome (EHS) is an abnormal sensory perception during sleep in which a person experiences auditory hallucinations that are loud and of short duration when falling asleep or waking up. [2] [4] The noise may be frightening, typically occurs only occasionally, and is not a serious health concern. [2] People may also experience a flash of light. [5] Pain is typically absent. [2]

Contents

The cause is unknown. [3] Potential organic explanations that have been investigated but ruled out include ear problems, temporal lobe seizure, nerve dysfunction, or specific genetic changes. [2] Potential risk factors include psychological stress. [2] It is classified as a sleep disorder or headache disorder. [2] [5] People often go undiagnosed. [5]

There is no high-quality evidence to support treatment. [2] Reassurance may be sufficient. [2] Clomipramine and calcium channel blockers have been tried. [2] While the frequency of the condition is not well studied, some have estimated that it occurs in about 10% of people. [2] Women are reportedly more commonly affected. [5] The condition was initially described at least as early as 1876. [2] The current name came into use in 1988. [5]

Signs and symptoms

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. [2] 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. [4] [6] [7] [8]

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

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:

Exploding head syndrome was first described in the 19th century, [2] and may have first been mentioned in the 17th century. [9]

Diagnosis

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. [10] [11]

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). [12] [13]

Treatment

As of 2018, 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. [4] There is some evidence that individuals with EHS rarely report episodes to medical professionals. [8]

Epidemiology

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. [14]

History

Case reports of EHS have been published since at least 1876, which Silas Weir Mitchell described as "sensory discharges" in a patient. [14] 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. [9] The phrase "snapping of the brain" was coined in 1920 by the British physician and psychiatrist Robert Armstrong-Jones. [14] A detailed description of the syndrome and the name "exploding head syndrome" was given by British neurologist John M. S. Pearce in 1989. [15] 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

Related Research Articles

Psychosis is a condition of the mind or psyche that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are disorganized thinking and incoherent speech and behavior that is inappropriate for a given situation. There may also be sleep problems, social withdrawal, lack of motivation, and difficulties carrying out daily activities. Psychosis can have serious adverse outcomes.

<span class="mw-page-title-main">Hallucination</span> Perception that only seems real

A hallucination is a perception in the absence of an external stimulus that has the compelling sense of reality. They are distinguishable from several related phenomena, such as dreaming, which does not involve wakefulness; pseudohallucination, which does not mimic real perception, and is accurately perceived as unreal; illusion, which involves distorted or misinterpreted real perception; and mental imagery, which does not mimic real perception, and is under voluntary control. Hallucinations also differ from "delusional perceptions", in which a correctly sensed and interpreted stimulus is given some additional significance.

<span class="mw-page-title-main">Alice in Wonderland syndrome</span> Neurological disorder that distorts perception of objects size and distance

Alice in Wonderland Syndrome (AIWS), also known as Todd's Syndrome or Dysmetropsia, is a neurological disorder that distorts perception. People with this syndrome may experience distortions in their visual perception of objects, such as appearing smaller (micropsia) or larger (macropsia), or appearing to be closer (pelopsia) or farther (teleopsia) than they are. Distortion may also occur for senses other than vision.

<span class="mw-page-title-main">Sleep paralysis</span> Sleeping disorder

Sleep paralysis is a state, during waking up or falling asleep, in which a person is conscious but in a complete state of full-body paralysis. During an episode, the person may hallucinate, which often results in fear. Episodes generally last no more than a few minutes. It can recur multiple times or occur as a single episode.

<span class="mw-page-title-main">Cluster headache</span> Neurological disorder

Cluster headache is a neurological disorder characterized by recurrent severe headaches on one side of the head, typically around the eye(s). There is often accompanying eye watering, nasal congestion, or swelling around the eye on the affected side. These symptoms typically last 15 minutes to 3 hours. Attacks often occur in clusters which typically last for weeks or months and occasionally more than a year.

A hypnic jerk, hypnagogic jerk, sleep start, sleep twitch, myoclonic jerk, or night start is a brief and sudden involuntary contraction of the muscles of the body which occurs when a person is beginning to fall asleep, often causing the person to jump and awaken suddenly for a moment. Hypnic jerks are one form of involuntary muscle twitches called myoclonus.

<span class="mw-page-title-main">Night terror</span> Sleep disorder causing feelings of panic or dread

Night terror, also called sleep terror, is a sleep disorder causing feelings of panic or dread and typically occurring during the first hours of stage 3–4 non-rapid eye movement (NREM) sleep and lasting for 1 to 10 minutes. It can last longer, especially in children. Sleep terror is classified in the category of NREM-related parasomnias in the International Classification of Sleep Disorders. There are two other categories: REM-related parasomnias and other parasomnias. Parasomnias are qualified as undesirable physical events or experiences that occur during entry into sleep, during sleep, or during arousal from sleep.

Visual release hallucinations, also known as Charles Bonnet syndrome or CBS, are a type of psychophysical visual disturbance in which a person with partial or severe blindness experiences visual hallucinations.

Cataplexy is a sudden and transient episode of muscle weakness accompanied by full conscious awareness, typically triggered by emotions such as laughing, crying, or terror. Cataplexy is the first symptom to appear in about 10% of cases of narcolepsy, caused by an autoimmune destruction of hypothalamic neurons that produce the neuropeptide hypocretin, which regulates arousal and has a role in stabilization of the transition between wake and sleep states. Cataplexy without narcolepsy is rare and the cause is unknown.

<span class="mw-page-title-main">Aura (symptom)</span> Symptom of epilepsy and migraine

An aura is a perceptual disturbance experienced by some with epilepsy or migraine. An epileptic aura is actually a minor seizure.

Parasomnias are a category of sleep disorders that involve abnormal movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep. Parasomnias are dissociated sleep states which are partial arousals during the transitions between wakefulness, NREM sleep, and REM sleep, and their combinations.

Rhythmic movement disorder (RMD) is a neurological disorder characterized by repetitive movements of large muscle groups immediately before and during sleep often involving the head and neck. It was independently described first in 1905 by Zappert as jactatio capitis nocturna and by Cruchet as rhythmie du sommeil. The majority of RMD episodes occur during NREM sleep, although REM movements have been reported. RMD is often associated with other psychiatric conditions or mental disabilities. The disorder often leads to bodily injury from unwanted movements. Because of these incessant muscle contractions, patients' sleep patterns are often disrupted. It differs from restless legs syndrome in that RMD involves involuntary muscle contractions before and during sleep while restless legs syndrome is the urge to move before sleep. RMD occurs in both males and females, often during early childhood with symptoms diminishing with age. Many affected individuals also have other sleep related disorders, like sleep apnea. The disorder can be differentially diagnosed into small subcategories, including sleep related bruxism, thumb sucking, hypnagogic foot tremor, and rhythmic sucking, to name a few. In order to be considered pathological, the ICSD-II requires that in the sleep-related rhythmic movements should “markedly interfere with normal sleep, cause significant impairment in daytime function, or result in self-inflicted bodily injury that requires medical treatment ”.

An auditory hallucination, or paracusia, is a form of hallucination that involves perceiving sounds without auditory stimulus. While experiencing an auditory hallucination, the affected person hears a sound or sounds that did not come from the natural environment.

Hypnopompia is the state of consciousness leading out of sleep, a term coined by the psychical researcher Frederic Myers. Its mirror is the hypnagogic state at sleep onset; though often conflated, the two states are not identical and have a different phenomenological character. Hypnopompic and hypnagogic hallucinations are frequently accompanied by sleep paralysis, which is a state wherein one is consciously aware of one's surroundings but unable to move or speak.

Musical ear syndrome (MES) is a condition seen in people who have hearing loss and subsequently develop auditory hallucinations. "MES" has also been associated with musical hallucinations, which is a complex form of auditory hallucinations where an individual may experience music or sounds that are heard without an external source. It is comparable to Charles Bonnet syndrome and some have suggested this phenomenon could be included under this diagnosis.

Derealization is an alteration in the perception of the external world, causing those with the condition to perceive it as unreal, distant, distorted or in other words falsified. Other symptoms include feeling as if one's environment is lacking in spontaneity, emotional coloring, and depth. Described as "Experiences of unreality or detachment with respect to surroundings in the DSM-5, it is a dissociative symptom that may appear in moments of severe stress.

A pseudohallucination is an involuntary sensory experience vivid enough to be regarded as a hallucination, but which is recognised by the person experiencing it as being subjective and unreal. By contrast, a "true" hallucination is perceived as entirely real by the person experiencing it.

Musical hallucinations describes a neurological disorder in which the patient will hallucinate songs, tunes, instruments and melodies. These hallucinations are not correlated with psychotic illness. A majority of patients who have symptoms of musical hallucinations are older and have onset conditions predisposing them to the disease. While there is no set form of treatment, research has discovered medications and alternative therapies to be successful in alleviating the hallucinations.

<span class="mw-page-title-main">Tactile hallucination</span> Hallucination involving perception of tactile input

Tactile hallucination is the false perception of tactile sensory input that creates a hallucinatory sensation of physical contact with an imaginary object. It is caused by the faulty integration of the tactile sensory neural signals generated in the spinal cord and the thalamus and sent to the primary somatosensory cortex (SI) and secondary somatosensory cortex (SII). Tactile hallucinations are recurrent symptoms of neurological diseases such as schizophrenia, Parkinson's disease, Ekbom's syndrome and delirium tremens. Patients who experience phantom limb pains also experience a type of tactile hallucination. Tactile hallucinations are also caused by drugs such as cocaine and alcohol.

Classification of sleep disorders comprises systems for classifying medical disorders associated with sleep. Systems have changed, increasingly using technological discoveries to advance the understanding of sleep and recognition of sleep disorders.

References

  1. 1 2 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.
  2. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 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.
  3. 1 2 3 4 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)
  4. 1 2 3 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.
  5. 1 2 3 4 5 Ceriani, CEJ; Nahas, SJ (30 July 2018). "Exploding Head Syndrome: a Review". Current Pain and Headache Reports. 22 (10): 63. doi:10.1007/s11916-018-0717-1. PMID   30062616. S2CID   51876942.
  6. ↑ Blom, Jan Dirk (2009-12-08). A Dictionary of Hallucinations. Springer Science & Business Media. ISBN   9781441912237.
  7. ↑ 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.
  8. 1 2 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.
  9. 1 2 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.
  10. ↑ International Classification of Sleep Disorders. Darien, IL: American Academy of Sleep Medicine. 2014.
  11. ↑ 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.
  12. ↑ World Health Organization. International Statistical Classification of Diseases and Related Health Problems. 10th ed. Geneva, Switzerland: World Health Organization; 2008.
  13. ↑ American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Arlington, VA: American Psychiatric Association; 2013.
  14. 1 2 3 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.
  15. ↑ 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.

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