CureusDec 25, 2025

Ketamine may help treat Exploding Head Syndrome

Psychedelic Science Weekly Brief ↗PubMed ↗DOI ↗

Abstract

A 75-year-old man with exploding head syndrome experienced a reduction in episodes after treatment with ketamine.

Episodes of exploding head syndrome included lightning-like sensations, thunder-like sounds, and sleep paralysis.
Initially, treatments like gabapentin and amitriptyline were ineffective over five years.
After one month of ketamine treatment, episodes decreased from 3-4 times weekly to once every two weeks.
By three months, episodes occurred monthly with less intensity, and by six months, symptoms largely resolved.
Ketamine may work by affecting NMDA receptors and promoting neuroplasticity and sleep regulation.
This case suggests ketamine could be a potential treatment for this difficult-to-treat condition.

Simplified

Exploding head syndrome (EHS) is a parasomnia characterized by the perception of loud noises originating from inside the head during sleep transitions, often accompanied by visual phenomena and fear. Treatment remains challenging due to unknown etiology and limited therapeutic options. We report a 75-year-old man with chronic exploding head syndrome experiencing lightning-like sensations, thunder-like sounds, sleep paralysis, and intense fear during sleep onset. Episodes occurred multiple times weekly for over five years. Initial treatments, including gabapentin, valproic acid, amitriptyline, and buspirone, proved ineffective. The patient was subsequently treated with sublingual ketamine, starting at 25 mg every third night and escalating to nightly dosing. After one month, episode frequency decreased from 3-4 times weekly to once every two weeks. By three months, episodes occurred monthly with reduced intensity. After six months, the patient experienced only occasional sleep paralysis with the complete resolution of exploding head syndrome and reported improved quality of life. Ketamine's mechanism likely involves N-methyl-D-aspartate (NMDA) receptor modulation, brain-derived neurotrophic factor release, and σ1 receptor agonism, promoting neuroplasticity and sleep regulation. This case represents a reported successful treatment of exploding head syndrome with ketamine, suggesting a potential therapeutic approach for this refractory parasomnia. Further studies are warranted to evaluate ketamine's efficacy in exploding head syndrome treatment.

Full Text

We can’t show the full text here under this license.

View Full Text ↗

Funding

Competing interests

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

PubMed

Featured in

Psychedelic ScienceIssue #17

Psilocybin therapy in meth addiction—attitude of “leaning into the obstacle” drives recovery

↗

Ketamine may help treat Exploding Head Syndrome

Abstract

Full Text

Funding

Competing interests

Featured in

You found one interesting study. We’ll send the next 7.

What Lands in Your Inbox Each Week:

Recent issues from the psychedelic science brief