What is Maxalt used for. How does Rizatriptan work to treat migraines. What are the potential side effects of Maxalt. How should Maxalt be taken for optimal migraine relief. What precautions should be considered when using Rizatriptan. How does Maxalt compare to other migraine medications. When should you seek medical attention while taking Maxalt.

Understanding Maxalt: A Powerful Migraine Treatment

Maxalt, also known by its generic name Rizatriptan, is a medication specifically designed to treat migraine headaches. It belongs to a class of drugs called triptans, which work by affecting serotonin levels in the brain. This medication is not intended for preventive use but rather for acute treatment when migraine symptoms occur.

How Does Maxalt Work?

Maxalt functions by narrowing blood vessels in the brain and affecting certain nerves. This dual action helps to alleviate the pain and associated symptoms of migraines, such as nausea, vomiting, and sensitivity to light and sound. By promptly addressing these symptoms, Maxalt enables individuals to return to their normal routines more quickly and may reduce the need for additional pain medications.

Proper Usage and Dosage Guidelines for Maxalt

Taking Maxalt correctly is crucial for its effectiveness and safety. Here are some key points to remember:

• Take Maxalt at the first sign of a migraine
• It can be taken with or without food, but may work faster on an empty stomach
• Dosage is based on individual factors such as medical condition, age, and response to treatment
• For children, the dosage is also determined by weight
• Always follow your doctor’s instructions and read the Patient Information Leaflet

Dosage Recommendations

For adults, the maximum recommended dose is 30 milligrams in a 24-hour period according to the US manufacturer. The Canadian manufacturer suggests a maximum of 20 milligrams for adults in the same timeframe. Children should not exceed 5 milligrams in a 24-hour period. It’s important to note that if symptoms persist or only partially improve, adults may take another dose at least 2 hours after the first, but children should not take more than one dose.

Potential Side Effects and Risks of Rizatriptan

While Maxalt is generally well-tolerated, it’s important to be aware of potential side effects. Common side effects may include:

• Flushing
• Tingling or numbness
• Tiredness or weakness
• Drowsiness or dizziness

More serious side effects, although rare, can occur. These may include:

1. Chest, jaw, or neck tightness or pain
2. Changes in blood pressure
3. Mental or mood changes
4. Signs of heart problems or stroke
5. Serotonin syndrome (in rare cases)

Is it necessary to monitor blood pressure while taking Maxalt? Yes, regular blood pressure checks are advisable, as Maxalt can potentially raise blood pressure in some individuals.

Precautions and Interactions with Rizatriptan

Before taking Maxalt, it’s crucial to inform your healthcare provider about all medications, supplements, and herbal products you’re using. This is because Rizatriptan can interact with other substances, particularly those that affect serotonin levels.

Risk Factors and Precautions

Individuals with a higher risk of heart problems may need additional screening before starting Maxalt. In some cases, doctors may administer the first dose in a clinical setting to monitor for serious side effects. It’s also important to be aware of the risk of medication overuse headache, which can occur if migraine medications are used too frequently.

Recognizing and Managing Serious Side Effects

While serious side effects are uncommon, it’s crucial to recognize their symptoms and seek immediate medical attention if they occur. These may include:

• Severe chest pain or pressure
• Shortness of breath
• Sudden severe headache
• Difficulty speaking or understanding speech
• Sudden vision changes
• Weakness on one side of the body

How quickly should you seek medical help if experiencing these symptoms? Immediate medical attention is crucial if any of these serious side effects occur while taking Maxalt.

Comparing Maxalt to Other Migraine Treatments

Maxalt is one of several triptans available for migraine treatment. While all triptans work similarly, individual responses can vary. Some key differences include:

• Onset of action
• Duration of effect
• Side effect profiles
• Available formulations (tablets, orally disintegrating tablets, nasal sprays)

Your healthcare provider can help determine which triptan is most suitable for your specific needs and medical history.

Alternatives to Triptans

For individuals who cannot take triptans or find them ineffective, other migraine treatments may be considered, such as:

1. Ergotamines
2. Nonsteroidal anti-inflammatory drugs (NSAIDs)
3. Combination medications
4. Newer targeted therapies like CGRP antagonists

Long-term Considerations and Migraine Management

While Maxalt is effective for acute treatment, it’s important to consider long-term migraine management strategies. This may include:

• Identifying and avoiding migraine triggers
• Maintaining a consistent sleep schedule
• Managing stress through relaxation techniques or therapy
• Considering preventive medications if migraines are frequent
• Regular follow-ups with your healthcare provider

How often should you reassess your migraine treatment plan? It’s advisable to review your treatment plan with your healthcare provider at least annually or more frequently if your migraine patterns change.

Special Considerations for Different Patient Groups

The use of Maxalt may require special considerations for certain groups of patients:

Pediatric Use

Maxalt is approved for use in children 6 years and older, but dosing is weight-based and may differ from adult dosing. Close monitoring by a healthcare provider is essential.

Use in Older Adults

Older adults may be more sensitive to the side effects of Maxalt, particularly those related to blood pressure and heart function. Careful monitoring and potentially lower doses may be necessary.

Pregnancy and Breastfeeding

The safety of Maxalt during pregnancy and breastfeeding is not fully established. Women who are pregnant, planning to become pregnant, or breastfeeding should discuss the risks and benefits with their healthcare provider before using Maxalt.

Are there alternative migraine treatments that are considered safer during pregnancy? Some healthcare providers may recommend non-pharmacological approaches or safer medication options for pregnant women experiencing migraines.

Maximizing the Benefits of Maxalt in Your Migraine Treatment Plan

To get the most out of your Maxalt treatment, consider the following tips:

1. Keep a migraine diary to track frequency, severity, and potential triggers
2. Take Maxalt as soon as you recognize migraine symptoms for optimal effect
3. Be aware of the maximum daily and weekly doses to avoid medication overuse
4. Combine Maxalt with non-pharmacological strategies like rest and hydration
5. Communicate regularly with your healthcare provider about the effectiveness of your treatment

How can you determine if Maxalt is working effectively for you? Track the time it takes for your migraine symptoms to improve after taking Maxalt, as well as any side effects you experience. This information can help your healthcare provider adjust your treatment plan if needed.

Understanding the Limitations of Maxalt and When to Seek Additional Help

While Maxalt is an effective treatment for many migraine sufferers, it’s important to recognize its limitations:

• Maxalt does not prevent migraines or reduce their frequency
• It may not be effective for all types of headaches
• Some individuals may experience diminished effectiveness over time
• Overuse can lead to medication overuse headaches

When should you consult your healthcare provider about your Maxalt treatment? Contact your doctor if you find that Maxalt is not providing adequate relief, if you’re using it more frequently than recommended, or if you’re experiencing new or worsening side effects.

Emergency Situations

Certain symptoms warrant immediate medical attention, even if you’ve taken Maxalt. These include:

• The worst headache of your life
• A headache accompanied by fever, stiff neck, or rash
• A headache following a head injury
• A headache with neurological symptoms that don’t resolve

In these cases, seek emergency medical care promptly, as these could indicate more serious conditions requiring immediate assessment and treatment.

Maxalt Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Uses

Rizatriptan is used to treat migraines. It helps to relieve headache, pain, and other migraine symptoms (including nausea, vomiting, sensitivity to light/sound). Prompt treatment helps you return to your normal routine and may decrease your need for other pain medications. Rizatriptan belongs to a class of drugs known as triptans. It affects a certain natural substance (serotonin) that causes narrowing of blood vessels in the brain. It may also relieve pain by affecting certain nerves in the brain.Rizatriptan does not prevent future migraines or lessen how often you get migraine attacks.

How to use Maxalt

Read the Patient Information Leaflet if available from your pharmacist before you start taking rizatriptan and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take this medication by mouth as directed by your doctor, at the first sign of a migraine. It may be taken with or without food, but may work faster when it is taken on an empty stomach. The dosage is based on your medical condition, age, response to treatment, and other drugs you may be taking. For children, the dosage is also based on weight. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

If there is no improvement in your symptoms, do not take more doses of this medication before talking to your doctor. If your symptoms are only partly relieved, or if your headache comes back, adults may take another dose at least 2 hours after the first dose. Children should not take more than one dose, or 5 milligrams in a 24-hour period. For adults, the US manufacturer recommends a maximum dose of 30 milligrams in a 24-hour period. The Canadian manufacturer recommends a maximum dose of 20 milligrams (for adults) in a 24-hour period.

If you have a higher risk for heart problems (see Precautions), your doctor may perform a heart exam before you start taking rizatriptan. He/she may also direct you to take your first dose of this medication in the office/clinic to monitor for serious side effects (such as chest pain). Talk to your doctor for details.

If you are using drugs for migraine attacks on 10 or more days each month, the drugs may actually make your headaches worse (medication overuse headache). Do not use medications more often or for longer than directed. Tell your doctor if you need to use this medication more often, or if the medication is not working as well, or if your headaches get worse.

Side Effects

Flushing, feelings of tingling/numbness/prickling/heat, tiredness, weakness, drowsiness, or dizziness may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.

Tell your doctor right away if you have any serious side effects, including: blue fingers/toes/nails, cold hands/feet, hearing changes, mental/mood changes.

Rizatriptan can commonly cause chest/jaw/neck tightness, pain, or pressure that is usually not serious. However, these side effects are like symptoms of a heart attack, which may include chest/jaw/left arm pain, shortness of breath, or unusual sweating. Get medical help right away if these or other serious side effects occur, including: fast/irregular heartbeat, fainting, severe stomach/abdominal pain, bloody diarrhea, signs of a stroke (such as weakness on one side of the body, trouble speaking, sudden vision changes, confusion).

This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US – Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Precautions

Before using rizatriptan, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: blood circulation problems (for example, in your legs, arms/hands, or stomach), certain types of headaches (hemiplegic or basilar migraine), heart problems (such as chest pain, irregular heartbeat, previous heart attack), liver disease, seizure, stroke or “mini-stroke” (transient ischemic attack).

Certain conditions can increase your risk for heart problems. Tell your doctor if you have any of these conditions, including: high blood pressure, high cholesterol, diabetes, family history of heart disease, overweight, smoker, postmenopausal (women), age more than 40 years (men).

This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

The risk of heart disease, liver disease, and high blood pressure increases with age. Older adults may be more sensitive to the side effects of this drug, especially increased blood pressure and heart problems.

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.

Interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Do not take any MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before treatment with this medication. Ask your doctor when to start or stop taking this medication.

The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/”ecstasy,” St. John’s wort, certain antidepressants (including SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.

If you also take any ergotamine medication (such as dihydroergotamine) or other “triptan” drugs (such as sumatriptan, zolmitriptan), you will need to separate your rizatriptan dose at least 24 hours apart from your dose of these other medications to lessen the chance of serious side effects.

Does Maxalt interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

Do not share this medication with others.

Certain foods, beverages, or food additives (such as red wine, cheese, chocolate, monosodium glutamate) as well as lifestyle patterns such as irregular eating/sleeping habits or stress may bring on a migraine headache. Avoiding these “triggers” may help lessen migraine attacks. Consult your doctor for more details.

Lab and/or medical tests (such as blood pressure) may be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.

Not applicable. (See How to Use section.

Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Images

Maxalt 10 mg tablet

Color: pale pinkShape: oblongImprint: MAXALT MRK 267

This medicine is a pale pink, oblong, tablet imprinted with “MAXALT” and “MRK 267”.

Maxalt 10 mg tablet

Color: pale pinkShape: oblongImprint: MAXALT MRK 267

This medicine is a pale pink, oblong, tablet imprinted with “MAXALT” and “MRK 267”.

Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.

CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.

Maxalt Dosage Guide – Drugs.com

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Generic name: rizatriptan benzoate 10mg
Dosage forms: tablet, oral, tablet, orally disintegrating
Drug class: Antimigraine agents

Medically reviewed by Drugs.com. Last updated on Jun 1, 2022.

​Although rizatriptan benzoate 5 mg tablets and orally disintegrating tablets are available in the marketplace, MAXALT Tablets and MAXALT-MLT Orally Disintegrating Tablets are no longer marketed in the 5 mg strength.

Dosing Information in Adults

The recommended starting dose of rizatriptan benzoate is either 5 mg or 10 mg for the acute treatment of migraines in adults. The 10-mg dose may provide a greater effect than the 5-mg dose, but may have a greater risk of adverse reactions [see Clinical Studies (14.1)].

Redosing in Adults

Although the effectiveness of a second dose or subsequent doses has not been established in placebo-controlled trials, if the migraine headache returns, a second dose may be administered 2 hours after the first dose. The maximum daily dose should not exceed 30 mg in any 24-hour period. The safety of treating, on average, more than four headaches in a 30-day period has not been established.

Dosing Information in Pediatric Patients (Age 6 to 17 Years)

Dosing in pediatric patients is based on the patient’s body weight. The recommended dose of rizatriptan benzoate is 5 mg in patients weighing less than 40 kg (88 lb), and 10 mg in patients weighing 40 kg (88 lb) or more.

The efficacy and safety of treatment with more than one dose of rizatriptan benzoate within 24 hours in pediatric patients 6 to 17 years of age have not been established.

Administration of MAXALT-MLT Orally Disintegrating Tablets

For MAXALT-MLT Orally Disintegrating Tablets, administration with liquid is not necessary. Orally disintegrating tablets are packaged in a blister within an outer aluminum pouch and patients should not remove the blister from the outer pouch until just prior to dosing. The blister pack should then be peeled open with dry hands and the orally disintegrating tablet placed on the tongue, where it will dissolve and be swallowed with the saliva.

Dosage Adjustment for Patients on Propranolol

Adult Patients

In adult patients taking propranolol, only the 5-mg dose of rizatriptan benzoate is recommended, up to a maximum of 3 doses in any 24-hour period (15 mg) [see Drug Interactions (7.1) and Clinical Pharmacology (12.3)].

Pediatric Patients

For pediatric patients weighing 40 kg (88 lb) or more, taking propranolol, only a single 5-mg dose of rizatriptan benzoate is recommended (maximum dose of 5 mg in a 24-hour period). Rizatriptan benzoate should not be prescribed to propranolol-treated pediatric patients who weigh less than 40 kg (88 lb) [see Drug Interactions (7.1) and Clinical Pharmacology (12.3)].

Frequently asked questions

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Headache – causes, examination and treatment | Symptoms

Cluster headache
Signs: Severe, piercing pain that affects one part of the head and is concentrated in the periocular region, usually lasts from 30 minutes to 1 hour, often occurs at the same time of day, occurs in clusters and is separated by intervals with a complete absence of headache, usually not aggravated by exposure to light, sounds or smells and is not accompanied by vomiting. Inability to lie down and restlessness. On the part of the manifestation of pain: runny nose, lacrimation, drooping eyelid (Bernard-Horner syndrome) and sometimes swelling under the eye.

Migraine headache
Signs: Moderate to severe headache, usually throbbing, unilateral and bilateral, lasting from several hours to several days, may be caused by lack of sleep, head trauma, hunger, or consumption of certain wines and foods, may be aggravated by physical activity and relieved after sleep, often accompanied by nausea, vomiting, and sensitivity to loud noises, bright lights, and/or smells, including possible mood changes, loss of appetite, and nausea, sometimes preceded by temporary disturbances in sensation, balance, muscle coordination, speech, or vision (seeing flashes or blind spots ).

Tension headache
Signs: Usually mild to moderate headache that feels like a band of pressure on the head and begins in the front of the head or around the eyes, affects the entire head, lasts from 30 minutes to several days, may worsen at the end of the day, does not worsen with physical exertion, under the influence of light, sounds or smells, is not accompanied by nausea, vomiting or other symptoms.

Altitude sickness
Signs: Dizziness, loss of appetite, nausea and vomiting, fatigue, weakness, irritability, or trouble sleeping. People who have recently climbed to high altitudes (including those who have been in an airplane for 6 hours or longer).

Brain tumor, abscess or other neoplasm in the brain
Signs: Mild to severe headache that may get progressively worse, usually comes on more frequently and eventually becomes permanent with no signs of relief, may cause blurred vision with a sudden change in body position, may be accompanied by clumsiness, weakness, disorientation, nausea, vomiting, seizures, or blurred vision.

Carbon monoxide exposure
Signs: Possible unawareness of exposure as carbon monoxide is colorless and odorless.

Dental infection (upper teeth)
Signs: Pain, which is usually felt in the facial region and is mainly one-sided, aggravated by chewing, toothache.

Encephalitis (brain infection)
Signs: Headaches with variable characteristics. Often accompanied by fever, increased drowsiness, confusion, agitation, weakness and/or poor coordination. Convulsive seizures and coma.

Giant cell (temporal) arteritis
Signs: Unilateral throbbing pain in the temporal part of the head. Pain when combing hair or while chewing. Sometimes enlarged arteries in the temples (temporal arteries) and aching and dull pain, especially in the shoulders, hips, and pelvis. Vision may be impaired or lost, and is more common in people over the age of 55.

Glaucoma (angle-closure glaucoma)
Signs: Moderate to severe pain that occurs in the front of the head or in the ocular or supraocular region. Redness of the eyes, iridescent circles around light sources, nausea, vomiting, and loss of vision.

Head injury (post-concussion syndrome)
Signs: Headache begins immediately or shortly after a head injury (with or without loss of consciousness). Sometimes memory lapses, personality changes, or both.

Idiopathic intracranial hypertension (increased intracranial pressure)
Signs: Headaches that occur daily or almost daily with fluctuating intensity, affecting both sides of the head, sometimes double vision or blurred vision, nausea, or ringing in the ears in rhythm with the beats of the pulse (throbbing tinnitus).

Cerebral hemorrhage
Signs: Mild or severe pain that starts suddenly, occurs on one or both sides of the head, is often accompanied by nausea and sometimes vomiting. Possible severe drowsiness, clumsiness, weakness, difficulty speaking and understanding speech, loss of vision, loss of sensation or disorientation, occasionally seizures or coma.

Headache associated with low blood pressure (due to removal or leakage of cerebrospinal fluid)
Signs: Intense headaches, often accompanied by neck stiffness and nausea. Pain that gets worse when the person is sitting or standing and gets better when the person lies down. It usually occurs after a spinal tap (lumbar puncture) is performed.

Medicine overuse headache
Signs: Chronic and often daily headaches. Often with migraine or tension headaches

Meningitis
Signs: Severe, persistent headache. fever, stiff neck, in connection with which it is painful to lower the chin to the chest, sometimes it is impossible. Malaise, drowsiness, nausea or vomiting.

Sinusitis
Signs: Pain, which is sometimes felt in the face, front of the head, or like a toothache, may start suddenly and last for days or hours, or start gradually and become persistent. Runny nose, sometimes with pus or blood, malaise, cough at night, and often fever.

Subarachnoid hemorrhage (bleeding between the inner and middle layer of tissue covering the brain)
Symptoms: Severe, persistent pain that starts suddenly and reaches its maximum intensity within a few seconds is often described as the worst headache ever experienced. There may be a brief loss of consciousness at the onset of the headache, and there may be drowsiness, confusion, difficulty waking up, or coma. Stiff neck, nausea, vomiting, dizziness and back pain.

Subdural hematoma (accumulation of blood between the outer and middle layer of tissue covering the brain)
Signs: Headaches with variable characteristics. Drowsiness, confusion, forgetfulness, and/or weakness or paralysis on one side of the body may occur.

Diseases of the temporomandibular joint
Signs: Pain when chewing solid foods. Sometimes pain in the jaw or nearby area or in the neck, sometimes clicking or cracking when opening the mouth, blocking the position of the jaw, or difficulty opening the mouth wide.

Hypnic headache. What is Hypnic Headache?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Hypnic headache is a distinct form of primary chronic cephalalgia that occurs during sleep in patients aged 50 and older. A distinctive feature of the disease is the absence of similar attacks in the waking state. This variant of cephalalgia is diagnosed taking into account clinical features after the exclusion of organic brain damage using instrumental studies (Echo-EG, MRI, ultrasound). The main pharmaceuticals used in the treatment of hypnic headache are lithium salts, sleeping pills, caffeine, indomethacin, melatonin.

ICD-10

R51 Headache

• Causes of HGB
• Symptoms of HGB
• Complications
• Diagnostics
• HGB treatment
• Prognosis and prevention
• Prices for treatment

General

Headache (cephalgia) is one of the most common complaints among patients of various age categories. At a young age, primary cephalalgias (tension headache, migraine) predominate, in the elderly, secondary pains are more often observed due to various intracranial pathologies (tumors, cerebrovascular diseases, arachnoiditis, etc.). The only variant of primary cephalalgia that occurs exclusively in the older age group is hypnic headache (HGB). The peak incidence occurs at the age of 50-60 years, women get sick more often than men. The prevalence of pathology is at the level of 1.1%. Due to the peculiarities of its occurrence in the literature on neurology and among patients, hypnic cephalgia has received the synonymous name “alarm clock” headache.

Hypnic headache

Causes of HGB

The provoking etiofactors are unknown. Most researchers suggest that the disease is based on a specific disorder in the regulation of circadian rhythms. Cephalgic paroxysms occur during sleep accompanied by rapid movements of the eyeballs (REM sleep phase). Since the regulation of the alternation of sleep-wake cycles is carried out by the suprachiasmatic hypothalamic nucleus, its dysfunction is considered the pathogenetic basis of hypnic seizures. A likely explanation is the change in the relationship of the suprachiasmatic nucleus with the noceptive structures of the brain responsible for pain sensations.

Symptoms of HGB

Hypnic cephalgia develops paroxysmal at night. The patient wakes up with a headache, cannot fall asleep until the attack ends. In 10% of cases, patients note that paroxysms can also occur during daytime sleep. The pain is usually dull and moderate. Complaints of intense pain syndrome are presented by 20% of patients. The hypnic form of cephalgia is diffuse in nature, in 60% of cases it covers both halves of the head. Sometimes migraine-like symptoms are observed: nausea, increased susceptibility to light and sounds, but phono- and photophobia do not reach significant severity.

The minimum duration of cephalgic paroxysm is 15 minutes, the maximum is 3 hours. On average, a headache lasts 0.5-1 hour. The number of attacks varies from 1 episode per week to 6 during the night, the hypnic attack begins 2-6 hours after falling asleep. After its completion, patients are able to fall asleep again. HGB has a long chronic course. Appearing once, paroxysms accompany the patient until the end of life.

Complications

Hypnic cephalgia is a relatively benign pathology that is not accompanied by serious complications. Frequent hypnotic attacks that occur several times a night negatively affect the patient’s quality of life. This course of HGB can lead to sleep deprivation. Shortened to 4-5 hours of sleep adversely affects the ability to work, provokes problems with concentration, daytime sleepiness, increased emotional lability, irritability, memory impairment for current events. Sleep deprivation increases the risk of developing diabetes, obesity, stomach ulcers, and fibromyalgia.

Diagnostics

Since hypnic headache is a rare pathology, many practicing neurologists and therapists are not sufficiently informed about the criteria for its diagnosis. A characteristic feature of older patients is the presence of a burdened premorbid background (arterial hypertension, coronary heart disease, chronic gastrointestinal pathology). As a result, hypnic paroxysms are attributed to nocturnal attacks of hypertension, manifestations of abuse headache, symptoms of impaired venous outflow from the cranial cavity (venous DEP).

Diagnosis of HGB allows a thorough study of clinical symptoms, the exclusion of any intracranial organic pathology that can provoke such cephalalgia. Diagnostic criteria were developed in 2003. According to the International Classification of Headaches, there are four signs of the hypnotic form of the disease. There is a dull headache that occurs only during sleep, leading to awakening. Cephalgic attacks are characterized by at least two of the following signs: they debut at the age of over 50 years, appear more than 15 times within a month, and last more than 15 minutes. Headache is not accompanied by autonomic symptoms. There are no other causes of cephalgic paroxysms.

In order to confirm the latter criterion, instrumental examinations are carried out to identify sleep disorders, organic cerebral pathology. According to indications, consultations of a cardiologist, vertebrologist, somnologist are appointed. The list of required examinations includes:

• Echoencephalography. With the help of a special ECHO-EG, intracranial pressure is measured. Research is necessary to exclude intracranial hypertension.
• Assessment of cerebral circulation. It is carried out using ultrasound of the vessels of the head and neck, duplex scanning. In many patients, due to age, various hemodynamic abnormalities are recorded. In the absence of headache during the waking period, their presence does not exclude the diagnosis of HGB.
• Polysomnography. Performed in conjunction with the consultation of a somnologist. Polysomnography makes it possible to exclude various somnological disorders: sleep apnea syndrome, nocturnal seizures, parasomnias.
• Tomography. MRI of the brain visualizes morphological changes in cerebral tissues. Allows you to diagnose brain tumors, cysts, inflammatory foci, to detect the area of ​​a stroke, lacunar infarcts.

Differential diagnosis of HGB is carried out with nocturnal paroxysms of migraine, cluster headache, venous form of discirculatory encephalopathy. Migraine is characterized by the presence of daytime attacks along with nighttime ones. Beam cephalgia is distinguished by the vegetative coloring of paroxysms, high intensity of pain, psychomotor agitation of the patient. Venous DEP occurs with a predominance of night and morning cephalgic paroxysms. The test with a tilt of the head helps to carry out differential diagnosis.

HGB treatment

A single method for the treatment of hypnic cephalgia has not been developed. Clinical studies of the effectiveness of pharmaceuticals used in the treatment of HGB have not been conducted. The main means used in therapy are:

• Lithium preparations (lithium carbonate). They act on the noceptive system, increase the night production of melatonin. Appointed for the night.
• Hypnotics (zopiclone). The positive effect of drugs is associated with a regulatory effect on the structure of sleep, an increase in the awakening threshold. Atypical benzodiazepines (clonazepam) have a similar effect.
• Other pharmaceuticals. The literature describes successful attempts at treatment with indomethacin, verapamil, gabapentin, prednisolone. The effectiveness of taking caffeine and melatonin preparations before bedtime has been noted.

Prognosis and prevention

The hypnic form of headache is characterized by a benign chronic course. Therapeutic measures can reduce the likelihood of another nocturnal paroxysm, but do not lead to recovery. After manifestation, the disease continues throughout the life of the patient. Preventive measures have not been developed, since the etiofactors provoking the disease are unknown.

You can share your medical history, what helped you in the treatment of hypnic headache.

Sources

1. Differential diagnosis of hypnic headache.