CLINICAL CORRESPONDENCE

Exploding head syndrome: report of two new cases

A Chakravarty

Department of Neurology, Vivekananda Institute of Medical Sciences, Calcutta, India

Ambar Chakravarty, 59 Beadon Street, Calcutta 700006, India. e-mail:saschakra@yahoo.com Received 15 August 2007, accepted 11 October 2007

The exploding head syndrome (EHS) is a rare,generally nocturnal event and was first describedin 1920 by Armstrong-Jones as a ‘snapping of the brain’ (1). The term EHS was coined by Pearce (2)in 1989 when he described 50 patients with thisdisorder. Patients generally complain of a sensationof sudden explosive noise in the head (not really aheadache) usually while going off to sleep, whichwakes them up from sleep. The sensation lastsfor a few seconds only and disappears completelywhen awake, although it may recur on furtherattempts at sleeping. The noise had been variouslydescribed as a ‘loud bang’, ‘shot-gun’ or ‘bomb-likeexplosion’ and 10% have reported a simultaneousflash of light (2). Although there is no actual head-ache, the syndrome is often so terrifying that suf-ferers cannot be certain about the benign nature ofthe problem and concern may be raised that asubarachnoid haemorrhage may have occurred (3).The onset is usually over the age of 50 years, as inhypnic headache, and the condition has a slightfemale preponderance (2). The attacks occur withvariable frequency (up to a maximum of seven inone night) for a few weeks or months. Pearcestressed the benign nature of the syndrome andsuggested no specific drug therapy (2).The present report describes two new cases ofEHS, one with some unusual features.

Case 1

A 48-year-old man was seen in December 2006.For the past several months about three to fourtimes a month, he had been having attacks of apeculiar sensation in the head likened to the noiseof an exploding bomb only at night while goingoff to sleep. The ‘explosion’ would wake him upand disappear completely the moment he wokeup. There was no headache and no associatedsymptoms such as nausea, vomiting or any visualsensation. For the past 3 months, the frequency ofthese sensations had increased and had beenoccurring nearly daily at the time of consultation.The noise occurred only once during every night,after which he could go off to sleep. His pastmedical history had been unremarkable and hehad never suffered from any signiﬁcant headacheproblem. General physical and neurological exami-nation had been unremarkable. Magnetic reso-nance imaging (MRI) of brain with contrast had been normal. He was prescribed Flunarazine10 mg daily. At 6 months’ follow-up he had muchimproved and noticed the exploding head sym-ptom only on two occasions.

Case 2

A 65-year-old man was seen in February 2007. Hewas hypertensive and diabetic (both well controlledon oral medication) and had been having infre-quent attacks of International Headache Societymigraine headache (every 2–4 months) withoutaura since the age of 15 years. For the past 4 monthsprior to consultation, every 2–3 weeks, he had beenawakened while going off to sleep only duringtaking a daytime nap by a sudden exploding (likea bomb bursting) noise in his head lasting for onlyfew moments.This noise was always accompanied with jerkyelevation of his right arm and a queer sensationin the right side of his chest (not arm) and againlasting only momentarily. He felt quite well onwaking up and could go off to sleep again. Thesewere never accompanied by any visual ﬂashes andnever occurred during sleep at night. These sensa-tions were very different from his migraine head-aches, which lasted for several hours and the noiseswere not accompanied by any nausea or vomiting.Physical examination was normal and his bloodpresswure in the clinic was 136/80 mmHg. He hadalready had a MRI of brain with contrast, MRangiography of brain and two interictal sleep EEGrecordings performed before consultation with theauthor, all of which were normal. A video EEG with

doi:10.1111/j.1468-2982.2007.01522.x

399© Blackwell Publishing Ltd

Cephalalgia

, 2007,

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