Exploding Head Syndrome

exploding head by keith haring

Exploding head syndrome is a parasomnia condition (sleep disorder) that causes the sufferer occasionally to experience a tremendously loud noise as originating from within his or her own head, usually described as the sound of an explosion, roar, gunshot, loud voices or screams, a ringing noise, or the sound of electrical arcing (buzzing). This noise usually occurs within an hour or two of falling asleep, but is not necessarily the result of a dream and can happen while awake as well. While the sound is perceived as extremely loud, it is usually not accompanied by pain. In some cases an instant flash of what is perceived as video ‘static’ is reported.

Attacks appear to change in number over time, with several attacks occurring in a space of days or weeks followed by months of remission. Sufferers often feel a sense of fear and anxiety after an attack, accompanied by elevated heart rate. Attacks are also often accompanied by perceived flashes of light (when perceived on their own, known as a ‘visual sleep start’) or difficulty in breathing. The condition is also known as ‘auditory sleep starts.’ It is not thought to be dangerous, although it is sometimes distressing to experience. Sufferers may experience an inability to vocalize any sound, or mild forms of sleep paralysis during an attack.

The cause of the exploding head syndrome (EHS) is not known, though some physicians have reported a correlation with stress or extreme fatigue. The condition may develop at any time during life and women suffer from it slightly more often than men. It is more common over the age of fifty, although it has been reported as young as age 10. Attacks can be one-time events, or can recur increasingly or decreasingly over time, and sometimes with no incidents over long periods of time.

The mechanism of EHS is also not known, though possibilities have been suggested; one is that it may be the result of a sudden movement of a middle ear component or of the eustachian tube, another is that it may be the result of a form of minor seizure in the temporal lobe where the nerve cells for hearing are located. Electroencephalograms recorded during actual attacks show unusual activity only in some sufferers, and have ruled out epileptic seizures as a cause. But an attack must happen during an episode. If results are normal during the test, only then can epilepsy be completely ruled out.

SSRI withdrawals have also been known to cause similar phenomena (i.e. brain zaps).

These loud noises are a common feature of out-of-body experiences. In surveys, many respondents indicate perception of them during the onset of such experiences.

The exploding head syndrome was first described in 1920 by the Welsh physician and psychiatrist Robert Armstrong-Jones. He characterized this condition as an exploding sensation in the head. Patients were awakened from their sleep by this event and the sensation persisted for several seconds. A detailed description of the syndrome was given by British neurologist John M. S. Pearce in 1989.

This syndrome can also cause the sufferer to feel an extreme rush or adrenaline kick going through his or her head, sometimes multiple times. In most cases, it occurs when they are in a state between asleep and awake. Some sufferers report familiarization with the subsequent fear or panic element such that they no longer consciously experience it. In some cases repeated attacks lead to the sufferer gaining a fear of sleeping or resting, as this is the most common time for attacks to take place, and this can lead to the development of sleeping disorders such as insomnia. In some cases it is isolated on the left side of the head, and seems to come from the inner ear region.

Symptoms may be resolved spontaneously over time. It may be helpful to reassure the patient that this symptom is harmless. Clomipramine has been used in three patients, who experienced immediate relief from this condition.

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