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Case report
Acoustic neuroma presenting as a hypnic headache
  1. Bryan Ceronie1,2,
  2. Frederick Green3 and
  3. Oliver Charles Cockerell4
  1. 1Cardiology, West Middlesex University Hospital, Isleworth, London, UK
  2. 2Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
  3. 3Ear, Nose and Throat Surgery, Barts Health NHS Trust, London, UK
  4. 4Neurology, The London Clinic, London, UK
  1. Correspondence to Dr Bryan Ceronie; bryan.ceronie{at}gmail.com

Abstract

Hypnic headache (HH) is a rare, primary headache syndrome that invariably occurs during sleep and wakes the patient. Acoustic neuroma (AN) is a benign tumour that uncommonly presents with isolated headache. Here, we describe a patient with AN that presented with an HH-like syndrome. A 40-year-old woman presented with 4 months of generalised, throbbing, nocturnal headaches that woke her from sleep. Neurological examination was unremarkable. Retrospectively, she reported a 4-year history of mild, bilateral tinnitus. Neuroimaging demonstrated a large, left-sided AN in the cerebellopontine angle without obstructive hydrocephalus. Gamma knife radiosurgery controlled tumour growth. One year after radiosurgery, she became nocturnal headache-free. AN has not previously been described as presenting with an HH-like syndrome. There are four previous reports of an HH-like syndrome secondary to intracranial masses. In all cases, patients became headache-free following surgery. This advocates for neuroimaging to exclude structural causes.

  • NEURology
  • headache (including migraines)
  • neurootology
  • neurosurgery
  • otolaryngology / ENT

https://doi.org/10.1136/bcr-2020-235830

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    Footnotes

    • Contributors OCC cared for the patient in clinic, conceived the idea of publishing the case report and obtained consent from the patient to publish the report. BC wrote the anonymised case presentation from the medical notes and selected the images for publication. BC and FG performed the literature review, wrote the discussion, drafted the final version and formatted the template for submission to BMJ Case Reports.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.