Exploding head syndrome

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Exploding head syndrome
Classification and external resources
Specialty Sleep medicine

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 up.[1][2][3] These noises have a sudden onset, are typically brief in duration, and are often jarring for the sufferer.[4]

Exploding head syndrome is classified as a parasomnia and a sleep-related dissociative disorder by the 2005 International Classification of Sleep Disorders[5] and is an unusual type of auditory hallucination in that it occurs in people who are not fully awake.[6] Neither the cause nor the mechanism of exploding head syndrome is known.[6] As of 2015 there had not been sufficient studies conducted to make conclusive statements about prevalence nor who tends to suffer EHS.[7] It was once thought that EHS was rare (occurring primarily in females, those over 50 years old, and those suffering from sleep paralysis) but a 2015 study indicated that it affects more younger people than thought, with one in five interviewed college students experiencing EHS at least once. Statistics from the study did not show that EHS was more frequent in females, but instead found that more than one-third of those who had EHS also experienced isolated sleep paralysis. Furthermore, the study found that some subjects experienced exploding head syndrome to such a degree that it significantly impacted their lives.[8]

Case reports of EHS have been published since at least 1876, which Silas Weir Mitchell described as "sensory discharges" in a patient.[7] The phrase "exploding head syndrome" was coined in a 1920 report by the Welsh physician and psychiatrist Robert Armstrong-Jones.[7] A detailed description of the syndrome was given by British neurologist John M. S. Pearce in 1989.[9]


Individuals with exploding head syndrome hear or experience loud imagined noises as they are falling asleep or waking up. In his article, "Clinical features of the exploding head syndrome," J. M. Pearce asked individuals with exploding head syndrome to describe what noises they commonly heard during an episode. Examples included a loud bang, explosion, shot gun, thunderclap, loud metallic noise, firecrackers, and "noise as if head will burst open". Because the sound seems to occur abruptly and with apparently great force, patients may be so alarmed that they may initially and inaccurately describe the noise as pain. In fact, in a clinical study, some patients reported the sound as an "enormous roar, so loud it could kill me". However, upon closer questioning in several studies, there is no pain associated with the syndrome. In some cases, some subjects reported that the sound was mild.[10]

In addition to noise, some people report fear, distress, confusion, myoclonic jerks, tachycardia, sweating, tinnitus, simultaneously seeing flashes of light, and the sensation that felt as if they had stopped breathing and had to make a deliberate effort to breathe again.[2][10][11][12]

The pattern of these auditory hallucinations is variable. Some patients 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 lifetime. Some patients reported having up to seven EHS attacks throughout the night.[10]


Though the causes of EHS are not known, there are currently a few theories to explain its causes:

  • Experts[who?] believe that EHS occurs due to the brain having problems when shutting down areas of the brain in preparation of sleep. Usually, different parts of the brain (such as auditory, motor, and visual neurons) shut off in different stages. With EHS, the auditory neurons may instead be activated all at once instead of shutting down properly, causing the abrupt, and often jarring, auditory hallucination. It is also postulated that with EHS, there is a delay in selected areas of the reticular formation.[13]
  • Minor seizures affecting the temporal lobe[3]
  • Sudden shifts in middle ear components[3]
  • Sensory variant of a hypnic jerk or sleep start
  • Stress and anxiety[14]
  • Variable and broken sleep, associated with a decline in delta sleep[10]
  • Prior repetitive auditory trauma whereupon the victim's brain begins to anticipate the sound


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, methylphenidate.[1] Studies suggest that education and reassurance can reduce the frequency of EHS episodes.[2]


  1. ^ a b Sharpless, Brian A. (December 2014). "Exploding head syndrome". Sleep Medicine Reviews. 18 (6): 489–493. doi:10.1016/j.smrv.2014.03.001. 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:10.1177/0333102414536059. PMID 24907167. 
  3. ^ a b c "Exploding Head Syndrome - American Sleep Association". www.sleepassociation.org. Retrieved 2015-11-28. 
  4. ^ Sharpless, Brian (December 2014). "Exploding head syndrome". Sleep Medicine Reviews. 
  5. ^ Thorpy, Michael J. (2012-10-01). "Classification of Sleep Disorders". Neurotherapeutics. 9 (4): 687–701. doi:10.1007/s13311-012-0145-6. ISSN 1933-7213. PMC 3480567Freely accessible. PMID 22976557. 
  6. ^ a b Blom JD (2015). "Auditory hallucinations". Handb Clin Neurol. 129: 433–55. doi:10.1016/B978-0-444-62630-1.00024-X. PMID 25726283. 
  7. ^ a b c Sharpless BA (2015). "Exploding head syndrome is common in college students". J Sleep Res. 24: 447–9. doi:10.1111/jsr.12292. PMID 25773787. 
  8. ^ Sorensen, Eric (March 30, 2015). "'Exploding head syndrome' affects more young than thought". Washington State University. Archived from the original on 19 September 2015. 
  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. 
  10. ^ a b c d Pearce, J.M. (July 1989). "Clinical features of the exploding head syndrome". Journal of Neurology, Neurosurgery, and Psychiatry. 52: 907–10. doi:10.1136/jnnp.52.7.907. PMC 1031943Freely accessible. PMID 2769286. 
  11. ^ Blom, Jan Dirk (2009-12-08). A Dictionary of Hallucinations. Springer Science & Business Media. ISBN 9781441912237. 
  12. ^ 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. 
  13. ^ Bever, Lindsey (2015-04-02). "That loud bang that startles you awake: It may be 'exploding head syndrome'". The Washington Post. ISSN 0190-8286. Retrieved 2015-11-28. 
  14. ^ Feketeova, Eva Feketeova (June 2014). "Exploding head syndrome – a rare parasomnia or a dissociative episode?". Sleep Medicine. 

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