Exploding head syndrome

Last updated
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 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 the 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

<span class="mw-page-title-main">Sleep disorder</span> Medical disorder of a persons sleep patterns

A sleep disorder, or somnipathy, is a medical disorder of an individual's sleep patterns. Some sleep disorders are severe enough to interfere with normal physical, mental, social and emotional functioning. Sleep disorders are frequent and can have serious consequences on patients’ health and quality of life. Polysomnography and actigraphy are tests commonly ordered for diagnosing sleep disorders.

<span class="mw-page-title-main">Hallucination</span> Perception in the absence of external stimulation that has the qualities of real perception

A hallucination is a perception in the absence of an external stimulus that has the qualities of a real perception. Hallucinations are vivid, substantial, and are perceived to be located in external objective space. Hallucination is a combination of two conscious states of brain wakefulness and REM sleep. 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">Sleep paralysis</span> Sleeping disorder

Sleep paralysis is a state, during waking up or falling asleep, in which one is conscious but in a complete state of full-body paralysis. During an episode, one 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">Rapid eye movement sleep behavior disorder</span> Medical condition

Rapid eye movement sleep behavior disorder or REM behavior disorder (RBD) is a sleep disorder in which people act out their dreams. It involves abnormal behavior during the sleep phase with rapid eye movement (REM) sleep. The major feature of RBD is loss of muscle atonia during otherwise intact REM sleep. The loss of motor inhibition leads to sleep behaviors ranging from simple limb twitches to more complex integrated movements that can be violent or result in injury to either the individual or their bedmates.

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

Cluster headache (CH) 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.

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.

<span class="mw-page-title-main">Visual snow syndrome</span> Visual impairment

Visual snow syndrome (VSS) is a form of visual hallucination that is characterized by the perception of small, flickering dots throughout the entire visual field. It is present in all conditions of illumination. The dots remain individual and do not clump together or change in size. Visual snow exists in one of two forms: the pulse type and the broadband type.

<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 a 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.

Phantosmia, also called an olfactory hallucination or a phantom odor, is smelling an odor that is not actually there. This is intrinsically suspicious as the formal evaluation and detection of relatively low levels of odour particles is itself a very tricky task in air epistemology. It can occur in one nostril or both. Unpleasant phantosmia, cacosmia, is more common and is often described as smelling something that is burned, foul, spoiled, or rotten. Experiencing occasional phantom smells is normal and usually goes away on its own in time. When hallucinations of this type do not seem to go away or when they keep coming back, it can be very upsetting and can disrupt an individual's quality of life.

The International Classification of Sleep Disorders (ICSD) is "a primary diagnostic, epidemiological and coding resource for clinicians and researchers in the field of sleep and sleep medicine". The ICSD was produced by the American Academy of Sleep Medicine (AASM) in association with the European Sleep Research Society, the Japanese Society of Sleep Research, and the Latin American Sleep Society. The classification was developed as a revision and update of the Diagnostic Classification of Sleep and Arousal Disorders (DCSAD) that was produced by both the Association of Sleep Disorders Centers (ASDC) and the Association for the Psychophysiological Study of Sleep and was published in the journal Sleep in 1979. A second edition, called ICSD-2, was published by the AASM in 2005. The third edition, ICSD-3, was released by the AASM in 2014. A text revision of the third edition (ICSD-3-TR) was published in 2023 by the AASM.

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) describes 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 falsified. Other symptoms include feeling as if one's environment is lacking in spontaneity, emotional coloring, and depth. 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. The source of these hallucinations are derived from underlying psychotic illness or hearing impairment. These hallucinations are often rare and are followed by mental decline. 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>

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.

Further reading

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.