A 48-year-old male presents with a two-month history of nighttime headaches that are becoming more frequent. The pain awakens him at night. He has no other somatic complaints and no other significant medical history. What are your initial diagnosis, differential diagnosis, and treatment plan?

A 48-year-old male presents with a two-month history of nighttime headaches that are becoming more frequent. The pain awakens him at night. He has no other somatic complaints and no other significant medical history. What are your initial diagnosis, differential diagnosis, and treatment plan?

A 48-year-old male presents with a two-month history of nighttime headaches that are becoming more frequent. The pain awakens him at night. He has no other somatic complaints and no other significant medical history. What are your initial diagnosis, differential diagnosis, and treatment plan?

Case Study: Hypnic Headaches

This week’s case discussion is about a 48-year-old male presenting with a two-month history of frequent night-time headaches with no other significant complaints. The purpose of this paper is to discuss more questions that would be asked to elucidate more history, physical exam elements, further tests to be performed, working diagnosis, differential diagnosis, and the treatment plan.

ORDER A PLAGIARISM-FREE PAPER HERE ON;A 48-year-old male presents with a two-month history of nighttime headaches that are becoming more frequent. The pain awakens him at night. He has no other somatic complaints and no other significant medical history. What are your initial diagnosis, differential diagnosis, and treatment plan?

Questions that I  Would have Asked

• When did the headache start?
• For how long have you had the headache?
• How did the headache start? Was it gradual or sudden?
• Can you show me by pointing where you feel the headache?
• Can you describe the nature and character of the headache?
• Does the headache radiate to any other part of the body?
• Are there any other somatic complaints that are tied to the headache? Is there vomiting, excessive salivation, or tearing?
• Is there a variation in the timing of the headache? Is it more severe during the day or at night? Does it occur only during sleep?
• What makes the headache feel more terrible?
• What soothes the headache?
• Have you lost weight since the headache started? If yes, how much?

Physical exam elements

The general exam includes the general appearance of the patient, hydration status, presence of lymphadenopathy, presence, and degree of pallor. Vital signs such as  temperature, blood pressure, respiratory rate, oxygen saturation, and pulse rate. Neck exam- any pain in flexion of the neck, any pain or discomfort in neck movement. Examination of the scalp. Full neurological exam- orientation of the patient to person, place and time, reflexes, muscle power, pupillary reflexes, ptosis, proptosis, pupil sizes, visual field defects, and fundoscopy.

Further Tests and Diagnoses

Imaging studies such as Magnetic Resonance Imaging of the head, Computed Tomography of the Head and sinuses. Laboratory studies such as Complete Blood Count, Acute Phase Reactants such as Erythrocyte Sedimentation Rate, Cerebrospinal fluid analysis such as biochemical  analysis, cytology, and culture. My working diagnosis is hypnic Headache. Differential diagnoses include migraine, sinusitis, aneurysmal headache, cluster Headaches

Treatment Plan

Complementary treatment

Caffeine is regarded as the most potent treatment for hypnic headaches (Al Khalili & Chopra, 2021). One to two cups of strong coffee is recommended just before bed. It is also thought that adequate sleeping time and a regular sleep schedule works to reduce the symptoms.

Pharmacologic treatment.

Over the Counter medication for hypnic headaches include the use of NSAIDs such as Ibuprofen and ketorolac (Steiner et al., 2019). Acetaminophen is also used. These drugs only have a slight relief on hypnic headaches and are not as effective (Rosenthal & Burchum, 2020). Opioid analgesics like tramadol have also gained tread in usage for hypnic headaches. Caffeine tablets of 40-60 mg at bed time is the first line. Lithium is a second-line treatment after caffeine. Lithium dosage is 150-600 mg per day. Indomethacin 25 mg to 150 mg is taken at bedtime and flunarizine can also be used (Al Khalili & Chopra, 2021). These drugs have adverse side effects hence they are not widely used in management.

Conclusion

Hypnic headache is a rare type of primary headache disorders. These headaches occur exclusively during sleep with prevalence increasing above the age of fifty years. It is a major cause of disability.

References

Al Khalili, Y., & Chopra, P. (2021). Hypnic Headache. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK557598/

International Headache Society. (2018). Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia, 38(1), 1–211. https://doi.org/10.1177/0333102417738202

McCance, K. L., & Huether, S. E. (2018). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Mosby.

Steiner, T. J., Jensen, R., Katsarava, Z., Linde, M., MacGregor, E. A., Osipova, V., Paemeleire, K., Olesen, J., Peters, M., & Martelletti, P. (2019). Aids to management of headache disorders in primary care (2nd edition). The Journal of Headache and Pain, 20(1). https://doi.org/10.1186/s10194-018-0899-2

Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals and other team members needed to complete patient care.
(Case study)
A 48-year-old male presents with a two-month history of nighttime headaches that are becoming more frequent. The pain awakens him at night. He has no other somatic complaints and no other significant medical history. What are your initial diagnosis, differential diagnosis, and treatment plan?