Editing Exploding head syndrome

{{short description|Syndrome where people perceive loud imagined noises when falling asleep or waking up}}
{{Redirect-distinguish-text|Exploding Head Syndrome|the album by the band [[The Telescopes]]}}
{{Infobox medical condition (new)
| name            =  Exploding head syndrome
| synonyms        = Episodic cranial sensory shock,<ref name=Go2015/> snapping of the brain,<ref name=Shar2014/> auditory sleep start<ref name=Blom2015/>
| image           =
| width           =
| alt             =
| caption         = Artistic depiction of flash seen from exploding head syndrome
| pronounce       =
| field           = [[Sleep medicine]]
| symptoms        = Hearing loud noises when falling asleep or waking up<ref name=Shar2014/>
| complications   =
| onset           =
| duration        = Short<ref name=Shar2014/>
| types           =
| causes          = Unknown<ref name=Blom2015/>
| risks           =
| diagnosis       =
| differential    = Nocturnal [[epilepsy]], [[hypnic headaches]], [[nightmare disorder]], [[post-traumatic stress disorder|PTSD]]<ref name=Shar2014/>
| prevention      =
| treatment       = Reassurance, [[clomipramine]], [[calcium channel blockers]]<ref name=Shar2014/>
| medication      =
| prognosis       = Good<ref name=Shar2014/>
| frequency       = ~10% of people<ref name=Shar2014/>
| deaths          =
}}
<!-- Definition and symptoms -->
'''Exploding head syndrome''' ('''EHS''') is an [[parasomnia|abnormal sensory perception during sleep]] in which a person experiences [[Auditory hallucination|auditory hallucinations]] that are loud and of short duration when falling [[asleep]] or [[waking up]].<ref name=Shar2014>{{cite journal|last1=Sharpless|first1=Brian A.|title=Exploding head syndrome|journal=Sleep Medicine Reviews|date=December 2014|volume=18|issue=6|pages=489–493|doi=10.1016/j.smrv.2014.03.001|pmid=24703829}}</ref><ref name=Cep2014>{{cite journal|last1=Frese|first1=A.|last2=Summ|first2=O.|last3=Evers|first3=S.|title=Exploding head syndrome: Six new cases and review of the literature|journal=Cephalalgia|date=6 June 2014|volume=34|issue=10|pages=823–827|doi=10.1177/0333102414536059|pmid=24907167|s2cid=31675696}}</ref> The noise may be frightening, typically occurs only occasionally, and is not a serious health concern.<ref name=Shar2014/> People may also experience a flash of light.<ref name=Cer2018/> Pain is typically absent.<ref name=Shar2014/>

<!-- Cause and diagnosis -->
The cause is unknown.<ref name=Blom2015>{{cite book | author = Blom JD | title = The Human Auditory System - Fundamental Organization and Clinical Disorders | year = 2015 | chapter = Auditory hallucinations | journal = Handb Clin Neurol | volume = 129 | pages = 433–55 | doi = 10.1016/B978-0-444-62630-1.00024-X | pmid = 25726283 | series = Handbook of Clinical Neurology | isbn = 9780444626301 | s2cid = 6192827 }}</ref> Potential organic explanations that have been investigated but ruled out include ear problems, [[temporal lobe seizure]], nerve dysfunction, or specific [[Mutation|genetic changes]].<ref name=Shar2014/> Potential risk factors include [[psychological stress]].<ref name=Shar2014/> It is classified as a [[sleep disorder]] or [[headache disorder]].<ref name=Shar2014/><ref name=Cer2018/> People often go undiagnosed.<ref name=Cer2018>{{cite journal |last1=Ceriani |first1=CEJ |last2=Nahas |first2=SJ |title=Exploding Head Syndrome: a Review. |journal=Current Pain and Headache Reports |date=30 July 2018 |volume=22 |issue=10 |pages=63 |doi=10.1007/s11916-018-0717-1 |pmid=30062616|s2cid=51876942 }}</ref>

<!-- Treatment, epidemiology and history -->
There is no high-quality evidence to support treatment.<ref name=Shar2014/> Reassurance may be sufficient.<ref name=Shar2014/> [[Clomipramine]] and [[calcium channel blockers]] have been tried.<ref name=Shar2014/> While the frequency of the condition is not well studied, some have estimated that it occurs in about 10% of people.<ref name=Shar2014/> Women are reportedly more commonly affected.<ref name=Cer2018/> The condition was initially described at least as early as 1876.<ref name=Shar2014/> The current name came into use in 1988.<ref name=Cer2018/>

== Signs and symptoms ==
Individuals with exploding head syndrome hear or experience loud imagined noises as they are falling asleep or are waking up, have a strong, often frightened emotional reaction to the sound, and do not report significant pain; around 10% of people also experience visual disturbances like perceiving visual static, lightning, or flashes of light.  Some people may also experience heat, strange feelings in their torso, or a feeling of electrical tingling that ascends to the head before the auditory hallucinations occur.<ref name=Shar2014/>  With the heightened arousal, people experience distress, confusion, [[myoclonic jerk]]s, [[tachycardia]], sweating, and a feeling that they have stopped breathing and need to make a conscious effort to breathe again.<ref name="Cep2014" /><ref>{{Cite book|title = A Dictionary of Hallucinations|url = https://books.google.com/books?id=KJtQptBcZloC&q=auditory%2520sleep%2520starts.%2520definition&pg=PA48|publisher = Springer Science & Business Media|date = 2009-12-08|isbn = 9781441912237|first = Jan Dirk|last = Blom}}</ref><ref>{{Cite book|title = A-Z of Neurological Practice: A Guide to Clinical Neurology|url = https://books.google.com/books?id=94wgLsDk2TUC&q=exploding%2520head%2520syndrome&pg=PA248|publisher = Springer Science & Business Media|date = 2011-01-19|isbn = 9781848829947|first1 = Andrew J.|last1 = Larner|first2 = Alasdair J.|last2 = Coles|first3 = Neil J.|last3 = Scolding|first4 = Roger A.|last4 = Barker}}</ref><ref name=":1">{{Cite journal|last=Sharpless|first=Brian A|date=2017-04-06|title=Characteristic symptoms and associated features of exploding head syndrome in undergraduates|journal=Cephalalgia|volume=38|issue=3|pages=595–599|language=en|doi=10.1177/0333102417702128|pmid=28385085|s2cid=4033153}}</ref>

The pattern of the auditory hallucinations is variable. Some people report having a total of two or four attacks followed by a prolonged or total remission, having attacks over the course of a few weeks or months before the attacks spontaneously disappear, or the attacks may even recur irregularly every few days, weeks, or months for much of a lifetime.<ref name=Shar2014/>

== Causes ==
The cause of EHS is unknown.<ref name="Blom2015"/> A number of hypotheses have been put forth with the most common being dysfunction of the [[reticular formation]] in the [[brainstem]] responsible for transition between waking and sleeping.<ref name=Shar2014/>

Other theories into causes of EHS include:
* Minor [[Epileptic seizure|seizures]] affecting the [[temporal lobe]]<ref name=Shar2014/>
* Ear dysfunctions, including sudden shifts in [[middle ear]] components or the [[Eustachian tube]], or a rupture of the [[membranous labyrinth]] or [[labyrinthine fistula]]<ref name=Shar2014/>
* Stress and anxiety
* Variable and broken sleep, associated with a decline in [[delta sleep]]
* [[Antidepressant discontinuation syndrome]]<ref name=Shar2014/>
* Temporary [[calcium channel]] dysfunction<ref name=Shar2014/>
* [[PTSD]]

Exploding head syndrome was first described in the 19th century,<ref name=Shar2014/> and may have first been mentioned in the 17th century.<ref name="Otaiku2018"/>

==Diagnosis==

Exploding head syndrome is classified under other [[parasomnia]]s by the 2014 International Classification of Sleep Disorders (ICSD, 3rd.Ed.) and is an unusual type of [[auditory hallucination]] in that it occurs in people who are not fully awake.<ref>{{Cite book|title=International Classification of Sleep Disorders|publisher=American Academy of Sleep Medicine|year=2014|location=Darien, IL}}</ref><ref name=Class2012>{{Cite journal|title = Classification of Sleep Disorders|journal = Neurotherapeutics|date = 2012-10-01|issn = 1933-7213|pmc = 3480567|pmid = 22976557|pages = 687–701|volume = 9|issue = 4|doi = 10.1007/s13311-012-0145-6|first = Michael J.|last = Thorpy}}</ref>

According to [[ICD-10]] and [[DSM-5]] EHS is classified as either other specified sleep-wake disorder (codes:780.59 or G47.8) or unspecified sleep-wake disorder (codes: 780.59 or G47.9).<ref>World Health Organization. International Statistical Classification of Diseases and Related Health Problems. 10th ed. Geneva, Switzerland: World Health Organization; 2008.</ref><ref>American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Arlington, VA: American Psychiatric Association; 2013.</ref>

== Treatment ==
{{as of|2018}}, no [[Clinical trial|clinical trials]] had been conducted to determine what treatments are safe and effective; a few case reports had been published describing treatment of small numbers of people (two to twelve per report) with [[clomipramine]], [[flunarizine]], [[nifedipine]], [[topiramate]], [[carbamazepine]].<ref name="Shar2014" /> Studies suggest that education and reassurance can reduce the frequency of EHS episodes.<ref name="Cep2014" />  There is some evidence that individuals with EHS rarely report episodes to medical professionals.<ref name=":1" />

==Epidemiology==
There have not been sufficient studies to make conclusive statements about how common or who is most often affected.<ref name="Shar2014" /> One study found that 14% of a sample of undergrads reported at least one episode over the course of their lives, with higher rates in those who also have [[sleep paralysis]].<ref name="Sharpless2015" />

==History==
Case reports of EHS have been published since at least 1876, which [[Silas Weir Mitchell (physician)|Silas Weir Mitchell]] described as "sensory discharges" in a patient.<ref name="Sharpless2015">{{cite journal | author = Sharpless BA | year = 2015 | title = Exploding head syndrome is common in college students | journal = Journal of Sleep Research | volume =  24| issue = 4| pages =  447–9| doi = 10.1111/jsr.12292 | pmid = 25773787 | s2cid = 34157227 }}</ref> However, it has been suggested that the earliest written account of EHS was described in the biography of the French philosopher [[René Descartes]] in 1691.<ref name="Otaiku2018">{{cite journal | author = Otaiku AI | year = 2018 | title = Did René Descartes have Exploding Head Syndrome? | journal = J. Clin. Sleep Med. | volume =  14| issue = 4| pages =  675–8| doi = 10.5664/jcsm.7068 | pmid = 29609724 | pmc = 5886445 }}</ref>  The phrase "snapping of the brain" was coined in 1920 by the British physician and psychiatrist [[Robert Armstrong-Jones]].<ref name=Sharpless2015/>  A detailed description of the syndrome and the name "exploding head syndrome" was given by British neurologist [[John M. Pearce|John M. S. Pearce]] in 1989.<ref name=torpy_plazzi2010>{{cite book |vauthors=Thorpy MJ, Plazzi G |page=231 |title=The Parasomnias and Other Sleep-Related Movement Disorders |publisher=Cambridge University Press |year=2010 |url=https://books.google.com/books?id=bCh5vsI4AjcC&pg=PA231 |access-date=2011-03-18 |isbn=978-0-521-11157-7 }}</ref> More recently, [[Peter Goadsby]] and Brian Sharpless have proposed renaming EHS "episodic cranial sensory shock"<ref name=Go2015 >{{Cite journal|last1=Goadsby|first1=Peter J.|last2=Sharpless|first2=Brian A.|date=2016-11-01|title=Exploding head syndrome, snapping of the brain or episodic cranial sensory shock?|url=http://jnnp.bmj.com/content/87/11/1259|journal=J Neurol Neurosurg Psychiatry|language=en|volume=87|issue=11|pages=1259–1260|doi=10.1136/jnnp-2015-312617|issn=0022-3050|pmid=26833175|s2cid=30697559|url-access=subscription}}</ref> as it describes the symptoms more accurately and better attributes to Mitchell.

==See also==
* {{annotated link|Hypnic jerk}}
* {{annotated link|Myoclonus}}
* {{annotated link|Periodic limb movement disorder}}
* {{annotated link|Sleep paralysis}}

==References==
{{Reflist}}

== Further reading ==
* {{Cite book|title = Textbook of Tinnitus|url = https://books.google.com/books?id=YStcWFsxQZEC&q=exploding%2520head%2520syndrome&pg=PA25|publisher = Springer Science & Business Media|date = 2010-11-16|isbn = 9781607611455|first1 = Aage R.|last1 = Møller|first2 = Berthold|last2 = Langguth|first3 = Dirk|last3 = DeRidder|first4 = Tobias|last4 = Kleinjung}}

==External links==
{{Medical resources
| ICD10          = {{ICD10CM|G47.59}}
| ICD9           = <!-- {{ICD9|xxx}}  -->
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| DiseasesDB     =
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{{SleepSeries2}}

{{DEFAULTSORT:Exploding Head Syndrome}}
[[Category:Sleep disorders]]
[[Category:Sleep physiology]]
[[Category:Lucid dreams]]
[[Category:Neurological disorders]]
[[Category:Hallucinations]]
[[Category:Syndromes of unknown causes]]
[[Category:Parasomnias]]
[[Category:Syndromes affecting the nervous system]]
[[Category:Wikipedia medicine articles ready to translate]]