Exploding Head Syndrome (EHS)

What is exploding head syndrome (EHS)?

Exploding head syndrome (EHS) is a type of sleep disorder in which you hear a loud noise or explosive crashing sound in your head. The sound isn't real or heard by anyone else. The episode typically happens suddenly either when you're beginning to fall asleep or when you wake up during the night.

Along with the loud sound, EHS can occur along with flashes of light and muscle jerks (myoclonic jerks). Unlike its painful-sounding name, the episode is painless.

EHS is a parasomnia, which is an undesired event that happens while sleeping. It’s also called episodic cranial sensory shocks.

How common is exploding head syndrome (EHS) and who gets it?

Researchers don’t know how many people have had exploding head syndrome (EHS). It’s more common in females.

EHS can happen to persons of all ages. Some 16% of college students report EHS according to the results of one study.

How frequent are episodes of exploding head syndrome (EHS)?

How often an EHS episode occurs varies from person to person. Some people have several episodes in a single night. Others have episodes several nights in a row followed by weeks or months without episodes.

What factors can bring on an episode of exploding head syndrome?

In most cases, researchers don’t know what might trigger exploding head syndrome episodes. Some people report that feeling stressed or tired might have led to their episodes.

How long does an exploding head syndrome episode last?

An episode typically lasts less than a second.

Is exploding head syndrome dangerous?

Exploding head syndrome isn't dangerous and doesn’t harm your overall health.

What are the signs and symptoms of exploding head syndrome (EHS)?

Signs and symptoms of exploding head syndrome (EHS) include:

• Feeling frightened or anxious after the episode.
• Experiencing a sudden muscle jerk at the time of the episode.
• Having difficulty falling back to sleep.
• Waking up sweating, having a rapid heartbeat and/or trouble breathing.

You don’t experience physical pain with EHS.

How is an episode of exploding head syndrome described?

Most individuals who experience exploding head syndrome describe it as an explosion in their head or hearing sounds like gunshots, thunder or another very loud noise.

What causes exploding head syndrome?

Researchers don’t know the exact cause of exploding head syndrome. Most published medical reports on this topic are based only on a few patients.

However, there are some current theories about causes. These include:

• A brief increase in the activity of your brain’s sensory neurons.
• Damage or dysfunction in your inner ear structures.
• Abnormal attention processing in your brain during the sleep-wake transition.
• An aura that occurs before a migraine.
• Side effects from suddenly stopping selective serotonin reuptake inhibitors (used for treating depression) or benzodiazepines (used to treat anxiety).

How is exploding head syndrome diagnosed?

Your healthcare provider, usually a sleep disorder specialist, will ask you or your sleep partner about your episode(s). Criteria from the International Classification of Sleep Disorders help your provider make the diagnosis. These criteria are:

• You wake up suddenly to a loud noise or an explosion in your head.
• Your experience is intense and you feel frightened after the episode.
• You don’t experience any physical pain during or after the episode.

Your sleep specialist will also ask:

• If you saw any flashes of light during your episode (some people experience this).
• If you had any muscle twitches during the episode.

Your sleep specialist may want to order certain tests to rule out other conditions. These tests may include:

• Polysomnogram. This test measures brain and body activity during sleep. It records your brain waves, heart rate, eye movements and breathing while you sleep.
• Magnetic resonance imaging. This scan uses a large magnet, radio waves and a computer to produce detailed images of your brain and body.
• Electroencephalogram (EEG). This test records the electrical activity of your brain. It’s useful for detecting nocturnal (nighttime) epilepsy.

Your provider will also rule out other conditions by taking your full medical history and asking:

• If you or other family members have any other known sleep disorders, such as insomnia or sleep apnea.
• If you have a history of headaches or psychiatric disorders, such as post-traumatic stress disorder.

How is exploding head syndrome (EHS) treated?

Exploding head syndrome typically doesn’t need to be treated. Your provider will talk with you and reassure you that this condition isn't dangerous or a sign of any other serious condition.

The Food and Drug Administration hasn't approved any medications to treat exploding head syndrome specifically. However, if needed, your provider may choose to prescribe a medication used to treat other conditions. Medications that have been found helpful for EHS include the antiseizure medicine topiramate, the heart disease drug nifedipine, the antidepressant amitriptyline and a drug for obsessive-compulsive disorder, clomipramine.

How can I reduce the frequency of my exploding head syndrome episodes?

If you and your healthcare provider think certain factors might trigger an episode, work on those triggers. For example:

• If lack of sleep triggers an episode, try to get seven to nine hours of sleep a night and follow other good sleep habits.
• If stress triggers an episode, consider relaxation techniques such as yoga, deep breathing exercises or meditation. You can also try taking a warm bath before bedtime, spraying a calming fragrance in your bedroom or using other methods that work for you to relieve stress.
• If you have other existing sleep disorders, make sure your provider knows. Follow instructions for taking medications or using any device (such as the device for sleep apnea).
• If your anxiety over these episodes is overwhelming, talk with your provider. They may prescribe a short course of an anti-anxiety medication.

What can I expect if I have exploding head syndrome?

Your outlook is good. Exploding head syndrome isn't dangerous and isn't a sign of another serious health condition. With some reassurance from your health care provider, education about this condition and control of any triggers or other sleep problems, your episodes should completely disappear with time.

When should I see my healthcare provider?

If you have disrupted sleep or are anxious about these episodes, see your healthcare provider or a sleep specialist.

Be sure to tell your healthcare provider:

• All the medications you're taking.
• Any supplements, vitamins and herbal products you're taking.
• All recreational drugs you’re using and your alcohol use.

Your sleep specialist may have asked you to keep a sleep diary to keep track of your sleeping patterns and any episodes of EHS. Bring your journal with you to your appointment and share your findings with your provider.

A note from Cleveland Clinic

Waking up suddenly from sleep because you’ve heard a loud noise or an explosion in your head can certainly be frightening. You’re not alone if you think this is a symptom of a serious health condition, such as a brain tumor or stroke. However, rest assured that there's nothing to worry about if you do have exploding head syndrome. Your condition isn’t harmful and should completely go away with time.