Typical features:

• Usually begins after the age of 50 years.
• Headache occurs during sleep and causes the person to wake up.
• Commonly occurs at a similar time every night.
• Pain is usually dull or throbbing, and may be mild to moderate.
• It can affect one or both sides of the head.
• Attacks typically last 15 minutes to several hours.
• May occur several times per week or almost every night.
• Nausea, vomiting, or prominent autonomic symptoms are usually absent.

Diagnosis:
Diagnosis is mainly clinical. Because headaches that begin during sleep can have secondary causes, particularly in older patients, brain imaging and appropriate evaluation may be needed to exclude other conditions.

Treatment:
Common preventive treatments include low-dose lithium, caffeine at bedtime, or indomethacin, depending on the patient's age, medical history, kidney function, medications, and contraindications. Treatment should be prescribed by a physician.

Important: A new headache that repeatedly wakes someone from sleep, especially after age 50, should be medically evaluated rather than assumed to be hypnic headache.