4.9.1 Probable hypnic headache

A 67-year-old retired seamstress reports headaches that trouble her exclusively at night. She explains that the pain only ever starts once she is properly asleep and drags her back into wakefulness every time, without exception. Each occurrence lingers for just over four hours before it finally lifts. She keeps a simple diary and has logged eleven headache days over the past month. She stays calm and motionless in bed while the pain runs its course, denying any restlessness or agitation. There is no lacrimation, conjunctival redness, drooping eyelid or nasal discharge on the affected side during attacks, and she reports no evidence of accompanying cranial autonomic features.