Headaches known to arise primarily from dilation of pain-sensitive intracranial vessels (i.e., histamine headache, hypoglycemic headache, and the headaches of fever, systemic infection, “hangover,” post-lumbar puncture, and the early postconcussive state) or inflammation of pain-sensitive intracranial arteries and veins and their adjacent structures (the headache of meningitis) are particularly sensitive to head jolting. The threshold of jolt headache during these states may be depressed 2.0 to 3.0 g or more. Patients with intracranial masses (i.e., subdural hematoma or brain tumor) usually have a depressed threshold of jolt headache. The location of the headache induced by jolting may indicate the site of the lesion. The threshold of jolt headache may be lowered during a migraine headache.

Headaches not arising from involvement of intracranial structures of the head (i.e., tension-type headache, some migraine headaches, and the headache induced by the injection of hypertonic saline into the temporal muscle) are not significantly intensified by head jolting, and the threshold to jolt headache is not lowered.

Sleep
Migraine usually does not disrupt sleep. Brain tumor, sinus disease, and tension-type headache usually do not interfere with sleep. Complaints of long periods of sleep loss because of headache may be due to coexistent anxiety or depression. The headache of meningitis usually interrupts sleep. Migraine may also occur after periods of excessively prolonged or very deep sleep.

Cluster headache often occurs during rapid-eye-movement (REM) sleep.

Editors: Silberstein, Stephen D.; Lipton, Richard B.; Dalessio, Donald J.