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The curious exploding head syndrome: a case report


Exploding head syndrome is a benign parasomnia, more common in women over 50 years old, whose etiology and pathophysiology are still uncertain. It is characterized by a sensation of explosion in the head or sudden noise and occurs in the transition between sleep and waking states. There is a feeling of fear and anguish, but no associated pain. There is no description of disease-specific polysomnographic alterations. The prevalence is difficult to determine due to literature based on few cases.


To report the case of a patient with exploding head syndrome who later also presented symptoms compatible with REM sleep behavior disorder.


We present the case of a 76-year-old female patient with hypertension and hypothyroidism, seen in our ambulatory sleep clinic in 2021 with chronic insomnia that started about five years prior. In the last three years she presented four events described as head explosion during wake-sleep transition with visual hallucination (green light flashes). She denies experiencing associated pain, but was afraid that something serious could be happening. There was improvement in her condition with amitriptyline 50mg. After 18months, the patient started taking paroxetine 20mg due to a depressive condition and began to present daily hypnagogic hallucinations and vivid dream enactment, with her memory preserved when awake. Six months later she discontinued the use of paroxetine, maintaining only amitriptyline and there was complete remission of her condition. She underwent polysomnography with a result of REM sleep without atonia, but also without abnormal motor behaviors or vocalizations during the night of the exam.


Patient was diagnosed with exploding head syndrome and REM sleep parasomnia according to the International Classification of Sleep Disorders 3rd edition (ICSD-3) criteria.


Exploding head syndrome, despite being a benign disease, can be a reason for great anguish and consequently worsening sleep stability. In the majority of cases, behavioral orientation and education about the benign evolution are sufficient, but in some cases, treatment with medication is necessary and may involve the use of antidepressants. In these cases it is very important to pay attention to potential adverse side effects. The surprising association with a REM sleep without atonia must have clinical follow-up due to the potential emergence of REM sleep behavior disorder and neurodegenerative diseases.


exploding head syndrome, parasomnia, sleep disorder


Relato de Caso


Thaina Rocha Braga Machado, João Victor Valinho de Moraes, Flavia Zuccolotto dos Reis Requena, Gracielly Porte de Oliveira, Camila Munaro Monteiro, Alexandre Pinto de Azevedo, Hugo Gustavo Vega Alcivar, Rosa Hasan, Eddy Alberto Betancourt Flores, Andrea Cecilia Toscanini