4.9.1 Probable hypnic headache

A 46-year-old administrative assistant reports nocturnal headache episodes that have continued for several months. She describes a headache that begins only while she is asleep and reliably wakes her, usually two to three hours after going to bed. Each attack lasts a little over two hours before settling, and she now counts roughly nine days a month on which the headache occurs. During the episodes she lies still and quiet rather than pacing, and she reports no restlessness or agitation. She also reports no watering or redness of the eye, no nasal blockage and no drooping eyelid, so cranial autonomic features are absent. There is no nausea, vomiting or visual disturbance accompanying the pain.