Brief Answer:
Exploding Head Syndrome WHILE AWAKE

Detailed Answer:
Good evening. My name is Dr. Saghafi and I'm a neurologist from XXXXXXX OH. You may not believe this but just yesterday I was brushing up on some of my long lost SLEEP DISORDER residency cases that I found interesting and then, tried finding updated information on them......THE EXPLODING HEAD SYNDROME was one of them and so I reviewed the case of a woman who I had seen during training who was about 65 years old who had the exact complaints as you did...except she was awoken from a sound sleep with what she perceived a loud "explosion"...at first she thought it was a real and got out of bed to check things outside fearing the worst of a neighbor's house or something.....she then, thought about it and came to the conclusion that she had heard something she'd never heard before but it was "in her head." There was no pain, no headache, no nausea, vomiting...nothing really. She went back to bed. Testing showed nothing at the hospital as we looked for everything from a burst aneurysm to some type of tumor and even thought she could've had some odd form of migraine....but there was no headache and no real pain....just a loud BANG that lasted for a brief time and went away. We concluded after some research that she had suffered from what was written in the literature as "The Exploding Head Syndrome" and came to learn that this had been described as far back as 1920...but it is rarely reported or studied because the symptoms are so fleeting, most of the time people never had any other events, and usually there is no residual symptom to speak of so it really doesn't interfere with anybody life, lifestyle, work, etc.

It is generally described in patients who are either fast asleep or just falling asleep in a twilight state. It is similar to the sudden jerks that occur in some people (myself for instance) as they are falling asleep....which are called hynagogic jerks....and do not represent anything more than the body's way of transitioning from an awake state to asleep.

The most recent information on this syndrome which I was just looking up last evening and thinking..."I'll never see another one of these!" HA!...And then, YOU pose the question!....Wow....states that the syndrome is much more common than once believed...that it does occur with some frequency in patients much younger than 50 and that many who experience this "auditory hallucination" also have experienced other sleep disorder events during their lifetime such as SLEEP PARALYSIS. This is where a person awakens and is fully awake but cannot move anything of their body nor can they speak....they are literally frozen as if their bodies were fast asleep while their minds were fully awake. Has this ever happened to you? Also, nightmares might be part of a patient's clinical picture

The sound of the explosion is described as an:

explosion, gunshot, door slamming, roar, waves crashing against rocks, loud voices, a ringing noise, the terrific bang on a tin tray, the sound of an electrical arcing (buzzing), or a thud.

Nobody knows how these come about or if they can be predicted by certain risk factors or predicted to return but we do know that in many patients who have experienced this phenomenon they had recently been withdrawn (nearly cold turkey'ed) from drugs such as Effexor, Prozac, Paxil, Zoloft, Ativan, Xanax, Valium, and Klonopin. Theories have come out as to what causes these very scary and unexpected nuisance symptoms. Some think that some middle ear component somehow jars around inside the head....almost like smacking a live microphone....you know when that happens how everyone reaches for the sky? Others think it could be some type of movement or stimulation of the Eustachian tube that equalizes pressure between the middle ear and the throat...and others have suggested that these are possible epileptic episodes but none of these conjectures have ever been proven.

Some people can be treated with medication to calm things down but this is only considered necessary in people with chronic repetitious events who develop almost an anxiety laden fear of going to sleep and develop insomnia because they are so afraid of hearing the sound. In first timers such as yourself....it is enough to recognize what it is and to simply relax and not be afraid of sleeping, or driving, or going out...and if it were to happen again, you would know that this is known to be a BENIGN PROCESS....in other words, no need to do any more MRI's, Lumbar punctures, CT scans, blood work or anything since it's already been done.

And by the way, I'm glad you're 75 and in good health....do you work to stay that way? Exercise? Good eating habits? Good family connections and activities? Do you work? These are all important things to keep doing no matter how old one gets. My mom started marathon running at age 55...She is now 81 and continues to run about 10 miles weekly outdoors and at least 60 min. on a treadmill 2x per week so I applaud your efforts since you and my mom are in a league by yourselves if you're being good to yourself and watching things.

There's nothing that I've found in the literature which would indicate that you should curtail any of your normal routine activities because of this....so get behind that wheel young lady...and give 'er the gas! LOL.....Although repeat episodes are rare...as I said, without knowing more about the actual risk factors of the entity (which nobody really does) we'll just have to see what happens. The good news is you've HEARD this thing once....a repeat should not bother you quite as much....it certainly could be a bother...especially if you were giving a speech in a public place....folks might think it odd that you're hitting the deck for cover! LOL.....but in all honesty....my research has shown that the vast majority of patients should lose no productivity or time from normal activities and most never report a repeat episode.....

If anything changes down the road...lemme know...

If this answer satisfactorily addresses your question then, I'd appreciate the favor of a HIGH STAR RATING with some written feedback.

Also, CLOSING THE QUERY on your end (if there are no further comments) will be most helpful and appreciated so that this question can be transacted and archived for further reference by colleagues as necessary.

Please keep me informed as to the outcome of your situation by writing me at: bit.ly/drdariushsaghafi

All the best.

The query has required a total of 74 minutes of physician specific time to read, research, and compile a return envoy to the patient.

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Brief Answer:
That's right about the detail of FEELING THE EXPLOSION INSTEAD OF HEARING

Detailed Answer:
Thanks for clarifying the detail of suddenly FEELING the explosion as opposed to HEARING it. I did not forget about the kaleidoscope of cars but have been thinking about how to bring that odd symptom into line with everything else.

Believe the overall answer doesn't change whether you HEAR or FEEL the explosion. It is still the case that such strange and aberrant sensations of altered consciousness vs. altered perceptual shift in your sensory systems will still fall in the category of either a BENIGN parasomnia (sleep disorder) or possibly even complex partial seizure.

The explanation of the cars suddenly fractionating so to speak likely has to do with the perceptual consequence and shift of awareness from the explosion you FELT to be an immediate electrical ripple wave (which was instantaneous) having gone from your thalamus to the occipital lobes. This sudden disjointed signal that triggered your visual pattern to become fragmented and actually fairly dysfunctional until occurred as a consequence of the tactile or sensory disturbance of the feeling of an explosion. The connection is likely through the thalamic connections to all parts of brain when sensory input of interest or significance is recognized by the brain. What happened electrically in your brain is similar in a way to what one might experience if their TV set suddenly crashed to the ground without warning. Assuming it doesn't shatter in a million pieces then, could the jolt be strong enough to mess up the screen so that the picture suddenly looks funny, fragmented, odd? I believe the answer is YES. Also, other things about the TV may be off such as volumen, colors, contrast, maybe the built in DVD player will start to do funny things? So think of your brain as a TV set that just got dropped! LOL...crude by useful....

I still believe that you are not necessarily at risk while driving of anything serious happening a 2nd time. A sleep study should be asked for in terms of trying to ferret some of these things out.

And so I still believe that in essence we are talking about the same syndrome or constellaion of symptoms as what we understand Exploding Head Syndrome in that the episodes are part of a larger sleep disorders paradigm which will need to evaluated at some point.

If this answer satisfactorily addresses your question then, I'd appreciate the favor of a HIGH STAR RATING with some written feedback.

Also, CLOSING THE QUERY on your end (if there are no further comments) will be most helpful and appreciated so that this question can be transacted and archived for further reference by colleagues as necessary.

Please keep me informed as to the outcome of your situation by writing me at: bit.ly/drdariushsaghafi

All the best.

The query has required a total of 174 minutes of physician specific time to read, research, and compile a return envoy to the patient.

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