October 24, 2000
BY JOEL SAPER
SOMETIMES THE MOST AWFUL symptom can be entirely harmless.
Such is the case with certain types of headache conditions that produce severe and intolerable pain but carry no dangerous implication. The same is true with a rare condition called exploding head syndrome.
More than 55 cases have been reported in the medical literature. But it is likely that hundreds, if not thousands, of patients have experienced this phenomenon.
The condition is characterized by a terrifying sense of explosive noise in the head, and it typically occurs within an hour or two after falling asleep. Individuals report that they are awakened by a startling and frightening massive sound that they can clearly distinguish from a dream. It occurs exclusively at night and is unaccompanied by any pain.
The sound has been described as an "explosion," "enormous roar" and "so loud it could kill me."
Activities prior to retiring at bedtime do not appear to have any relationship to the sound, although three physicians, who themselves suffered from these attacks, report that the incidents occur during periods of personal stress or when they are particularly tired and overworked. The attacks may develop at any time during life, even in childhood. Women are slightly more likely to experience these events than men.
Sometimes two or more attacks may occur over a period of days or weeks, followed by total remission. One individual reported up to seven attacks in one night, only to have them vanish for several months. Some individuals experience only one such attack during a lifetime. A family history of similar attacks has been reported by a few individuals, and some report a history of migraine or epilepsy.
After the attack, patients often feel a sense of terror, rapid heartbeat and anxiety.
A 73-year-old physically and mentally normal woman who experienced attacks of migraine throughout her life began to experience, at age 67, a different type of attack that would occur 2-3 times per week, exclusively during sleep. The attacks were characterized by "being awakened by a sudden bang in my head, as if my head were bursting, with a flash of light in both eyes, and after which I would feel dazed for a split second." The individual reported that she was terrified and experienced "heart thumping" after the attack. No pain was experienced. Her examination was normal, and the patient remained healthy.
No underlying cause has been identified to explain the condition, which was first reported in 1988. Some authorities have suggested that it may have something to do with a sudden movement of a middle ear component or a "springing open" of the eustachian tube. Others have suggested that it may be related to a minor seizure in the temporal lobe that contains the nerve cells for hearing.
All agree, however, that exploding head syndrome is an entirely benign condition, is not caused by psychological disturbances and is very real and frightening.
DR. JOEL SAPER is director of the Michigan Head Pain & Neurological Institute in Ann Arbor
