4.9.1 Probable hypnic headache

History of Present Illness: The patient reports episodes of headache for approximately 6 months. The attacks occur exclusively during sleep, usually between 2 AM and 4 AM, waking her up. The pain is described as moderate to severe, pulsatile, bilateral, lasting 30 to 60 minutes. There is no associated aura, nausea, vomiting, or photophobia. The patient denies obvious triggering factors such as stress or dietary changes. She notes that consuming coffee before bedtime seems to reduce the intensity of the pain. Past Medical History: Controlled systemic arterial hypertension with losartan. Knee osteoarthritis. No previous history of chronic headaches or migraine. Medications in Use: Losartan 50 mg/day. Paracetamol 500 mg (sporadically for joint pain). Physical Examination: General: Good general condition, conscious, oriented. Neurological: Examination without focal deficits, cranial nerves intact, normal reflexes, preserved muscle strength, stable gait. Other systems: No significant alterations. Complementary Exams: Cranial CT scan: Normal. Brain MRI: No structural alterations. Polysomnography: No evidence of sleep apnea or other significant alterations.