Exploding Head Syndrome is a sensory parasomnia characterized by sudden loud noises or sense of explosions occurring at sleep onset or during sleep, followed by arousal and fear but no pain. It affects more women than men and typically begins around age 54. While the cause is unknown, theories include a delay in brain areas shutting off during sleep transition. Treatment involves reassurance as it is generally benign, but benzodiazepines, antidepressants, or other medications have helped reduce symptoms in some cases.

1. Exploding Head Syndrome
Ade Wijaya, MD – September 2021

2. Outline:
• Introduction
• Epidemiology
• Clinical presentation
• Pathophysiology
• Treatment
• Summary

3. Introduction
• First described by Silas Weir Mitchell, 1890
• Named by J.M.S. Pearce in 1988
• AASM: Sudden loud noise or sense of explosion
occurring at the wake-sleep transition or during
sleep, followed by immediate arousal often with
a sense of fright, and without significant pain
Pearce JMS. Exploding head syndrome. Lancet. 1988;332(8605): 270–1.
Mitchell SW. Some disorders of sleep. Am J Med Sci. 1890;100: 109–27
American Academy of Sleep Medicine. International classification of sleep disorders. 3rd ed. Darien: American Academy of Sleep Medicine; 2014. Diagnostic criteria for EHS.

4. Epidemiology
• Female: Male = 1.5 : 1
• Age of onset: 54
Frese A, Summ O, Evers S. Exploding head syndrome: six new cases and review of the literature. Cephalgia. 2014;34(10):823– 7. A review of all cases reported in the literature
through 2014

5. Clinical Presentation
• Sudden loud noise or sense of explosion
occurring at the wake-sleep transition or during
sleep, followed by immediate arousal often with
a sense of fright, and without significant pain
American Academy of Sleep Medicine. International classification of sleep disorders. 3rd ed. Darien: American Academy of Sleep Medicine; 2014. Diagnostic criteria for EHS.

6. Clinical Presentation
• Additional symptoms: tachycardia, brief muscle
jerks or twitches, and visual phenomena, often
described as a flash of light, momentary
respiratory arrest, sleep paralysis, sleep-related
orgasms, headache
Ceriani CE, Nahas SJ. Exploding head syndrome: a review. Current pain and headache reports. 2018 Oct;22(10):1-3.

7. Pathophysiology
• A sensory variant of a hypnic jerk
• A delay in areas of the reticular formation in
switching off during transition to sleep causes a
paroxysm of neuronal activity which may cause
myoclonus or the perception of a loud sound or
flash of light
• Many other theories
Green MW. The exploding head syndrome. Curr Pain Headache Rep. 2001;5:279–80.
Ceriani CE, Nahas SJ. Exploding head syndrome: a review. Current pain and headache reports. 2018 Oct;22(10):1-3.
Feketeova E, Buskova J, Skorvanek M, Mudra J, Gdovinova Z. Exploding head syndrome: a rare parasomnia or a dissociative episode? Sleep Med. 2014;15:728–30.
Salih F, Klingbiel R, Zschenderlein R, Grosse P. Acoustic sleep starts with sleep-onset insomnia related to a brainstem lesion. Neurol. 2008;70:1935

8. Treatment
• Usually benign, no treatment needed
• Reassurance
• Benzodiazepines, including clonazepam and
clobazam have been reportedly effective.
• The tricyclic antidepressants clomipramine and
amitriptyline have also been used successfully in
some cases
• Nifedipine, flunarizine, and topiramate have all
been effective in case reports
Ceriani CE, Nahas SJ. Exploding head syndrome: a review. Current pain and headache reports. 2018 Oct;22(10):1-3.

9. Summary
• A sensory parasomnia that typically occurs at the
wake-sleep transition
• Benign, but may cause significant distress
• Reassurance