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Exploding head syndrome

exploding head syndrome, exploding head syndrome mayo clinic
Exploding head syndrome EHS is a benign condition in which a person hears loud imagined noises such as a bomb exploding, a gunshot, or a cymbal crash or experiences an explosive feeling when falling asleep or waking up123 These noises have a sudden onset, are typically brief in duration, and are often jarring for the person1 Neither the cause nor the mechanism is known4


  • 1 Classification
  • 2 Symptoms
  • 3 Causes
  • 4 Treatment
  • 5 Epidemiology
  • 6 History
  • 7 Research
  • 8 References
  • 9 Further reading


Exploding head syndrome is classified as a parasomnia and a sleep-related dissociative disorder by the 2005 International Classification of Sleep Disorders and is an unusual type of auditory hallucination in that it occurs in people who are not fully awake5


Individuals with exploding head syndrome hear or experience loud imagined noises as they are falling asleep or waking up, have a strong, often frightened emotional reaction to the sound, and do not report significant pain; around 10% of people also experience visual disturbances like perceiving visual static, lightning, flashes of light Some people may also experience heat, strange feelings in their torso, or a feeling of electrical tinglings that ascends to the head before the auditory hallucinations occur1 With the heightened arousal, people experience distress, confusion, myoclonic jerks, tachycardia, sweating, and the sensation that felt as if they had stopped breathing and had to make a deliberate effort to breathe again267

The pattern of the auditory hallucinations is variable Some people report having a total of two or four attacks followed by a prolonged or total remission, having attacks over the course of a few weeks or months before the attacks spontaneously disappear, or the attacks may even recur irregularly every few days, weeks, or months for much of a lifetime1


The causes of EHS are not known4


As of 2014, no clinical trials had been conducted to determine what treatments are safe and effective; a few case reports had been published describing treatment of small numbers of people two to twelve per report with clomipramine, flunarizine, nifedipine, topiramate, carbamazepine, methylphenidate1 Studies suggest that education and reassurance can reduce the frequency of EHS episodes2


There have not been sufficient studies conducted to make conclusive statements about prevalence nor who tends to suffer EHS1


Case reports of EHS have been published since at least 1876, which Silas Weir Mitchell described as "sensory discharges" in a patient8 The phrase "exploding head syndrome" was coined in a 1920 report by the Welsh physician and psychiatrist Robert Armstrong-Jones8 A detailed description of the syndrome was given by British neurologist John M S Pearce in 19899


The cause of EHS is unknown and has been the subject of hypothesis-generation and research The most prevalent theory on the cause of EHS is dysfunction of the reticular formation in the brainstem responsible for transition between waking and sleeping1

Other theories into causes of EHS include:

  • Minor seizures affecting the temporal lobe1
  • Ear dysfunctions, including sudden shifts in middle ear components or the Eustachian tube, or a rupture of the membranous labyrinth or labyrinthine fistula1
  • Stress and anxiety3
  • Variable and broken sleep, associated with a decline in delta sleep3
  • Antidepressant discontinuation syndrome1
  • Temporary calcium channel dysfunction1


  1. ^ a b c d e f g h i j k Sharpless, Brian A December 2014 "Exploding head syndrome" Sleep Medicine Reviews 18 6: 489–493 doi:101016/jsmrv201403001 PMID 24703829 
  2. ^ a b c Frese, A; Summ, O; Evers, S 6 June 2014 "Exploding head syndrome: Six new cases and review of the literature" Cephalalgia 34 10: 823–827 doi:101177/0333102414536059 PMID 24907167 
  3. ^ a b c "Exploding Head Syndrome - American Sleep Association" wwwsleepassociationorg Retrieved 2015-11-28 
  4. ^ a b Blom JD 2015 "Auditory hallucinations" Handb Clin Neurol 129: 433–55 doi:101016/B978-0-444-62630-100024-X PMID 25726283 
  5. ^ Thorpy, Michael J 2012-10-01 "Classification of Sleep Disorders" Neurotherapeutics 9 4: 687–701 doi:101007/s13311-012-0145-6 ISSN 1933-7213 PMC 3480567  PMID 22976557 
  6. ^ Blom, Jan Dirk 2009-12-08 A Dictionary of Hallucinations Springer Science & Business Media ISBN 9781441912237 
  7. ^ Larner, Andrew J; Coles, Alasdair J; Scolding, Neil J; Barker, Roger A 2011-01-19 A-Z of Neurological Practice: A Guide to Clinical Neurology Springer Science & Business Media ISBN 9781848829947 
  8. ^ a b Sharpless BA 2015 "Exploding head syndrome is common in college students" J Sleep Res 24: 447–9 doi:101111/jsr12292 PMID 25773787 
  9. ^ Thorpy MJ, Plazzi G 2010 The Parasomnias and Other Sleep-Related Movement Disorders Cambridge University Press p 231 ISBN 0-521-11157-9 Retrieved 2011-03-18 

Further readingedit

  • Møller, Aage R; Langguth, Berthold; DeRidder, Dirk; Kleinjung, Tobias 2010-11-16 Textbook of Tinnitus Springer Science & Business Media ISBN 9781607611455 

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