Exploding head syndrome (EHS) is a rare benign sleep-wake transition disorder of unknown aetiology and was first described in 1920 as a “snapping of the brain” [1]. EHS attacks are characterized by sudden loud banging noises “bomb-like explosions” or “shotgun” and in 10–20% of patients are accompanied by the sensation of “flashing lights”. These attacks are not painful but are unpleasant and sometimes even terrifying to the patients, often raising concerns that an acute subarachnoid haemorrhage may have occurred. EHS attacks occur in relaxed wakefulness or at the transition from wakefulness to sleep and can vary in frequency [2]. Video-documentation of EHS attacks is to our best knowledge not available to the medical community so far.
We present the unusual case of a 54-year-old male with a three-year history of sudden “attacks of an exploding head”, who consistently reported on an exacerbation of his chronic migraine with each EHS attack. Attacks occurred every two hours in the daytime and about two times at night. On video polysomnography (PSG) and multiple sleep latency test (MSLT), EHS attacks evolved at the transition from wakefulness to sleep (non-rapid eye movement [NREM] sleep stage 1, NREM1) and from NREM2 with an impressing characteristic (see Fig. 1 and video). Abrupt movement artefacts but no epileptic discharges were recorded during these attacks.
Fig. 1. 54-year-old patient holding his head six seconds after waking up from NREM2 sleep (during MSLT) due to an EHS attack.
Together with a recent report of migraine aura presenting as EHS [3] our case suggests that EHS may represent more than a “snapping of the brain” and might sometimes be a rare visual and/or acoustic migraine aura.
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