Cacophony

Exploding head syndrome is a condition that causes the sufferer to occasionally experience a tremendously loud noise as originating from within his or her own head, usually described as the sound of an explosion, roar, waves crashing against rocks, loud voices or screams or a ringing noise.

This noise usually occurs within an hour or two of falling asleep, but is not the result of a dream and can happen while awake as well. Perceived as extremely loud, the sound is usually not accompanied by pain. 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. It is not thought to be dangerous, although it is sometimes distressing to experience.

The cause of the exploding head syndrome 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. Attacks can be one-time events, or can recur.

The mechanism 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.

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 familiarisation with the subsequent fear or panic element such that they no longer consciously experience it.

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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