WASHINGTON (FRONTLINE MEDICAL NEWS) – Lithium is the best treatment option for patients with hypnic headaches, according to a retrospective, cross-sectional study presented by Dr. Nauman Tariq of the Cleveland Clinic at the annual meeting of the American Headache Society.

The study, which looked at a series of 40 patients, is the largest to date from a single institution and examined treatment of hypnic headache, defined as a primary headache disorder characterized by onset during sleep that causes waking.

Seven patients were excluded for having active chronic migraine, and one who was taking lithium was excluded after developing renal side effects. Dr. Tariq and his associates studied the efficacy of 13 different treatments on the 32 remaining patients, between October 2008 and September 2014 using ICD-9 codes and the International Classification of Headache Disorders II and III–beta criteria for diagnosis.

Lithium had the highest positive response rate of all treatments, with 70% of study subjects experiencing complete response and 20% experiencing moderate response, defined as more than a 50% improvement in the frequency and intensity of hypnic headache episodes.

The researchers reported that the second-best treatment option was caffeine taken before bedtime, which induced complete response in 29% of subjects and moderate response in 33% of subjects. Dr. Tariq also stated that consuming caffeine upon awakening can also help alleviate symptoms. One patient on the lithium regimen was removed from the study after experiencing renal side effects.

Of the 32 patients included in the study, 86% were women, with a mean headache onset age of 62 years and a range of 44 to 83 years of age. More than half (59%) of subjects had a previous history of migraine prior to the study, and 90% experienced hypnic headaches between 1:00 a.m. and 5:00 a.m. Mean duration of these episodes was 193 minutes – with a range of 45-720 minutes. The mean number of days per month subjects were awakened due to hypnic headache was 21 days, with 20% of subjects experiencing headaches lasting longer than 4 hours.

Dr. Tariq did not report any relevant financial disclosures.