PMC10327568_01
Brain magetic resonance imaging suggests normal structures. There are no midline structural abnormalities associated with circadian rhythms. (A) sagittal T1-weighted image, (B) axial T1-weighted image, (C) T2-weighted image, (D) fluid-attenuated inversion recovery, (E) diffusion-weighted imaging, and (F) apparent diffusion coefficient.
fneur-14-1179391-g001.jpg
PMC10327568_01_fneur-14-1179391-g001.jpg
fig1
Brain MRI did not reveal any midline structural abnormalities associated with circadian rhythms (Figure 1).
The sleep structure was approximately normal, with an increased proportion of N1 stage, a normal proportion of N2 stage, a decreased proportion of N3 stage, and a normal proportion of REM stage. Patient sat up with headache after the last REM sleep period at approximately 5:40 am (black arrow) without sleep apnea-hypopnea event observed. Meanwhile, the patient's oxygen saturation and blood pressure were normal. PLM, periodic limb movement; SpO2, saturation of pulse oxygen; SBP, systolic blood pressure; DBP, diastolic blood pressure; REM, rapid eye movement.
fneur-14-1179391-g002.jpg
PMC10327568_01_fneur-14-1179391-g002.jpg
fig2
To explore the possible causes of secondary headaches, such as sleep apnea, nocturnal hypertension, and awakening from sleep, we performed polysomnography and ambulatory blood pressure monitoring (Figure 2).