Exploding Head Syndrome

What Causes Exploding Head Syndrome?

Scientists don’t know the precise cause of EHS; the cause may vary from case to case, and possible contributing factors include:

• Temporary problems with the production of brain chemicals called neurotransmitters, resulting in brief overactivity in nerve cells associated with sensory perception
• Brief epileptic seizures
• Structural issues or dysfunction of the inner ear
• Temporary problems with the brain circuitry that controls attention during the transition between sleep and wakefulness
• Migraines
• Side effects of discontinuation of certain antidepressant or anti-anxiety medications

Some factors may increase the risk of EHS, including:

• Insomnia, sleep deprivation, or sleep disruptions
• Stress
• Other sleep disorders such as sleep paralysis
• Family history of sleep disorders

Is Exploding Head Syndrome Hereditary?

Most of the time, EHS is caused by external factors, medical disorders, or other underlying conditions aside from genetics. However, EHS episodes are common in people who experience other sleep disorders, such as sleep paralysis, that may have an inherited component. Some research has suggested that people with a family history of sleep paralysis are more likely to experience the condition themselves. This suggests that a genetic component may play at least some role in the condition.

Researchers have not yet identified any specific gene or genetic mutation associated with EHS.

How Is Exploding Head Syndrome Detected?

EHS is harmless for most people, but episodes that cause you anxiety, leave you tired and unwell during the day, or occur frequently, could be a reason to consult a doctor. EHS or sleep paralysis that lasts for a long time and does not respond to lifestyle changes can be a cause for concern.

How Is Exploding Head Syndrome Diagnosed?

Doctors may take several different diagnostic steps when a patient is experiencing recurrent EHS.

• Physical and neurological exams. These basic exams will screen for indications of medical conditions that could be causing sleep problems.
• Sleep history questionnaires. These questionnaires will ask the patient about their sleep habits and their experiences of EHS.
• Imaging scans such as magnetic resonance imaging (MRI) may be used to look for structural indications of brain problems.
• Electroencephalogram (EEG). This test measures the brain’s electrical activity and looks for signs of epileptic seizures.
• Polysomnogram. This test involves monitoring the patient’s brain activity, heart rate, muscle activity, and eye movement as they sleep. The test is conducted during an overnight stay at a medical sleep center.

PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.

How Is Exploding Head Syndrome Treated?

Most cases of EHS do not require treatment. Instead, doctors rely on patient education to assure the person that EHS is a common and typically harmless experience. Often, this reassurance is sufficient to relieve anxiety surrounding the episodes.

When EHS is causing significant distress or is resistant to treatment with lifestyle changes, the disorder may be treated with medications, including clomipramine, amitriptyline, topiramate, duloxetine hydrochloride, or nifedipine.

How Does Exploding Head Syndrome Progress?

EHS usually doesn’t cause long-term complications. For most people, the episodes are infrequent or may happen only once. However, the episodes may cause emotional distress in some people, especially those who also experience other sleep disorders, such as sleep paralysis. About 10% of people who experience recurrent sleep paralysis feel significant distress associated with the episodes. As a result, they may be reluctant to sleep, leading to sleep disruptions or sleep deprivation. The loss of adequate sleep can itself lead to serious complications, including:

• Problems at work or school
• Relationship difficulties
• Accidents caused by fatigue or mental fogginess
• Anxiety or depression
• Substance abuse
• Weight gain
• Diabetes
• High blood pressure
• Heart disease

How Is Exploding Head Syndrome Prevented?

There is no known way to prevent EHS. Doctors generally encourage good sleep habits and a healthy lifestyle to lessen EHS risk. Steps you can take to ensure better sleep include:

• Stick to a regular sleep schedule (even on weekends)
• Don’t eat or drink close to bedtime
• Avoid stimulating activities (e.g., watching TV, using electronics) 30 minutes before bedtime
• Use your bedroom only for sleep
• Keep your bedroom dark and cool
• Get plenty of exercise
• Limit consumption of caffeine and alcohol
• Quit smoking
• Try meditation or relaxation techniques

Exploding Head Syndrome Caregiver Tips

Some people with EHS also suffer from other brain and mental health-related issues, a condition called co-morbidity. Here are a few of the disorders commonly associated with EHS:

• EHS and sleep paralysis are commonly co-morbid.
• People with EHS often also experience insomnia.
• Anxiety and stress are often associated with EHS.

Exploding Head Syndrome Brain Science

The brain-related causes of EHS can vary from case to case, but research has suggested a strong association between EHS and sleep paralysis, a condition in which a person experiences a brief period, typically as they are waking up or falling asleep, during which they are unable to move. One study of college students found that 18% had experienced EHS, and of those, more than a third had also experienced sleep paralysis. This association suggests that there may be a common cause between the two conditions, at least in some cases.

Scientists are not sure what causes sleep paralysis, but it is likely the result of a problem related to brain chemicals called neurotransmitters. Neurotransmitters allow nerve cells to send signals to each other. Some increase cell-to-cell signals and others inhibit signaling, preventing unwanted or unnecessary signals from traveling from cell to cell.

During sleep, a part of the brain called the ventromedial medulla, and the spinal cord increase their output of inhibitory neurotransmitters. The resulting high level of these chemicals prevents nerve-cell signaling and effectively paralyzes the skeletal muscles, creating a state called atonia.

Sleep paralysis and EHS may be caused by a disruption in this process, creating an imbalance of inhibitory and excitatory neurotransmitters. However, scientists are not yet sure what part of the brain the imbalance originates from or precisely which neurotransmitters are involved.

Exploding Head Syndrome Research

Title: Feasibility Study of Personalized Trials to Improve Sleep Quality

Stage: Recruiting

Principal investigator: Karina Davidson, PhD, MASc

Northwell Health

New York, NY 

The purpose of this pilot study is to assess the feasibility of using N-of-1 methods in a virtual research study; to remotely recruit and enroll participants; to assess the feasibility of using a placebo and to determine the feasibility of the proposed methods used to collect and assess participant adherence and response to a wellness strategy (in this case, melatonin for poor sleep quality). This pilot will help determine if an N-of-1 study design, or what has been termed ‘Personalized Trials,’ can have widespread use in future research and clinical practice to address high public health burdens with a high heterogeneity of response. This pilot study will assess the feasibility using a Personalized Trials model to evaluate an individual participant’s experience with a wellness strategy for self-reported poor sleep quality. Participants (N=60) will be sent a Fitbit device and 3 smart pill bottles, with one containing 3 mg of melatonin, one containing 0.5 mg of melatonin, and the final bottle containing placebo pills. Participants will be asked several questions a day, sent via text message, about their sleep quality as well as their stress, fatigue, concentration, confidence, mood, and pain levels, to demonstrate relevant secondary impacts of sleep quality. Participants will also have access to several videos explaining the protocol. The study will take place over 14 weeks. The first two weeks will be a baseline period, where no supplement is assigned, but data are collected, including self-report of sleep quality and duration and accelerometer-derived sleep and activity data. After successful completion of the baseline period, participants will be randomized to six 2-week intervention blocks of a 3 mg dose melatonin, a 0.5 mg dose melatonin, and a placebo. At the end of the 14 weeks, a report containing the individual’s observed data will be prepared for each participant and electronically sent to them along with a satisfaction survey (electronic, or phone/video call if they are non-responders).

After the 14-week trial, participants will receive a summary of their observed data in a personalized report. Creating this type of report will help to assess the feasibility of using an N-of-1 trial design through user-acceptability of sleep quality and wellness-related data visualizations, and the ability to choose a preferred intervention (if any) based on the data. Participants will be asked to complete the System Usability Scale, a satisfaction survey (electronic or phone/video call if they are non-responders), and participate in a virtual interview (such as over Microsoft Teams or a phone call) to inform feasibility and acceptability of protocol requirements, study materials, and personalized reports.

Title: Validation of Circadian Biomarkers in Patients With Sleep Disorders

Stage: Recruiting

Contact: Mia Friedman

Brigham and Women’s Hospital

Boston, MA 

Current methods for assessing circadian timing require sampling over hours (or even as long as a day) while the patient is in controlled conditions. The investigators aim to develop a method that can estimate individual circadian time with a single blood sample taken at any time of the day or night. To do this, the investigators will use two state-of-the-art methods, a plasma proteomics-based method to identify a panel of rhythmic proteins (extending our preliminary data), and a whole blood-derived monocyte-based method using a panel of 15 transcripts (to validate and extend a recent study).

Investigators will test both methods in a series of patients with circadian rhythm sleep disorders. The investigators will validate separately the proteomics-based biomarker and the monocyte-based transcript biomarker, and also explore whether combining them can improve the accuracy of our timing estimates. In all cases, circadian phase estimates from the biomarker panels will be compared with those derived from plasma or saliva melatonin (the current “gold-standard” circadian phase marker).

Title: Targeted Intervention for Insufficient Sleep Among Typically-Developing Adolescents (TAPAS)

Stage: Recruiting

Principal investigator: Jessica C. Levenson, PhD

University of Pittsburgh

Pittsburgh, PA 

Dr. Levenson’s research proposal aims to test the acceptability, feasibility, and preliminary outcomes of a sleep promotion program delivered to 13-15-year-olds who report insufficient sleep. Dr. Levenson will examine the feasibility and acceptability of the program through a randomized pilot trial (n=40) that uses a two-period, wait-list control design. Then, Dr. Levenson will test whether the program is associated with changes in sleep, motivation, and four outcome domains: academic functioning, attention, risk behavior, and affect. Such a broadly relevant program has the potential for enormous public health impact by improving sleep and facilitating healthy development across a range of domains among typically-developing adolescents who are highly vulnerable to adverse consequences.