Exploding head syndrome: symptoms, causes and treatment.

A summary of the characteristics of exploding head syndrome, an unusual parasomnia.

In recent years parasomnias, known to belong to a group of sleep disorders, have been diagnosed more frequently, being more common in childhood and adolescence, although several cases have been found in which they have persisted into adulthood, so it is advisable to continue research in this field of sleep disorders.

The exploding head syndrome is a type of parasomnia that is characterized by a sudden awakening in which the person is experiencing an intense headache and also perceives a loud sound in his head. At the same time it is also common to experience bright flashes in the vision.

In this article we will explain in more detail the exploding head syndrome and various relevant factors associated with this parasomnia.The causes of this parasomnia and also if there is any kind of treatment.

What is exploding head syndrome?

The syndrome of the exploding head is a parasomnia less recognized at diagnostic level than others such as sleepwalking, night terrors or bruxism, among others, so it also has a smaller number of investigations and also is not classified within the most important diagnostic manuals on mental disorders such as DSM-5 or ICD-11. However, in recent years it has been gaining greater interest among researchers in the field of disorders related to sleep and rest.

Exploding head syndrome is a rare parasomnia in the population that was first diagnosed in 1988 to a patient who frequently experienced unpleasant and loud sounds inside his own head (e.g., a rumble or an explosion). (e.g., a rumble or an explosion) as if it really came from there, being an auditory hallucination. On the other hand, one of the most frequent symptoms of this parasomnia is the experience of a kind of electric shock in the head.

Also flashes of the bright ones can also be experienced at visual level or even tingling sensations all over the body.. All this is common that generates in the person nervousness and anxiety, being able to get to experience tachycardia. Such attacks are usually experienced when patients are trying to sleep or when they have just woken up, and there are usually continuous fluctuations over time, in the sense that sometimes the symptoms decrease and sometimes they increase again, and there may be periods of time when these symptoms have completely subsided.

When patients experience the symptoms associated with exploding head syndrome they also often suffer from high levels of anxiety and a marked increase in Heart rate due to the fear of not knowing what is happening to them or what these symptoms may trigger, as well as the helplessness of the patient.The fear of not knowing what is happening to them or what these symptoms could trigger, as well as the helplessness felt during and after suffering them.

In spite of the discomfort it generates, the exploding head syndrome has generally not been considered a very serious disorder.The symptoms do not tend to disable the sufferers in their daily life and the symptoms do not persist throughout the day, although there have been cases in which the symptoms have negatively affected the daily life of the sufferers, so there may be different degrees of severity with respect to this parasomnia.

This syndrome related to sleep disorders is most often diagnosed in adults and is more prevalent in adults. and tends to be more prevalent in women than in men.

Exploding head syndrome in adolescents

Exploding head syndrome is a parasomnia that, unlike the rest of parasomnias, tends to develop more frequently in people over the age of 50; however, research found that it can also affect adolescents.

In this research, 211 adolescents were surveyed about the symptoms experienced when suffering from exploding head syndrome. The results showed that 18% of the sample stated that they had experienced these symptoms at least once. In some cases, they had come to experience these symptoms more frequently and had even caused them severe discomfort that negatively affected their routine activities..

In other cases, this parasomnia occurred with a comorbidity with another disorder, such as sleep paralysis, so that these people in addition to suffering the symptoms associated with exploding head syndrome also experienced an inability for a certain time to perform any kind of movement voluntarily during the transition period between sleep and wakefulness.

Causes

The causes or etiology of exploding head syndrome are currently unknown; however, some research has hypothesized that this parasomnia may be closely correlated with extreme fatigue or prolonged stress. could be closely correlated with the fact of suffering extreme fatigue or being under prolonged stress..

The mechanism at the physiological level of this parasomnia is also not known with certainty, although there are several theories such as the hypothesis that exploding head syndrome could be caused by a sudden movement of the Eustachian tube or the middle ear. There is also another hypothesis that considers that it is a parasomnia produced as a consequence of some attack at cerebral level and, more specifically, in the area of the temporal lobe, part in which the cells of the central nervous system associated with hearing are located.

Since there is no reference theory to determine the causes and predisposing factors for the development of exploding head syndrome, more research is needed and there is still a long way to go.

Is there a treatment for exploding head syndrome?

A clinical trial conducted in 2018 about treatments that might be most effective in addressing exploding head syndrome found that psychological treatment might help decrease the frequency of episodes related to this syndrome if it was aimed at reducing symptoms of anxiety and fear about the episodesThe most important psychological techniques for the treatment of exploding head syndrome included relaxation techniques (e.g., Jacobson's progressive muscle relaxation or autonomic training) for anxiety symptoms, as well as a psychoeducational intervention providing all relevant information regarding this parasomnia and a series of self-care guidelines to be followed by the patients.

Among the most prominent psychological techniques for the treatment of exploding head syndrome, relaxation techniques (e.g., Jacobson's progressive muscle relaxation or autonomic training) for anxiety symptoms and tachycardias, as well as therapies that help to manage stress, due to the correlation that stress has been postulated to have with exploding head syndrome (e.g., systematic desensitization), stand out, systematic desensitization); treatment with mindfulness or any meditation modality for stress and anxiety could also be tried.

For patient self-care, it would be important to help the patient with a series of guidelines to improve his or her sleep hygiene (p. e.g., keeping a fixed bedtime, avoiding the consumption and/or excess of caffeine, trying to avoid alcohol consumption, not doing physical exercise at late hours, not having copious dinners that hinder a restful rest, etc.).

Some benefits have also been found in terms of reducing the symptoms associated with exploding head syndrome through pharmacological treatment through the administration of some antidepressants (amitriptyline, clomipramine), calcium blockers (flunarizine, nifedipine), antiepileptics (topiramate) or anticonvulsants (carbamazepine).

A good intervention plan for exploding head syndrome could be the combination of psychological and pharmacological treatment, although more studies are still needed to demonstrate its efficacy, as is the case with research into the causes of this parasomnia.