0841 Case Report: Can LSD be Associated with Chronic Exploding Head Syndrome?

Abstract

Abstract Introduction Exploding head syndrome is a rare phenomenon characterized by a loud imagined noise at sleep onset. Less commonly, it is associated with a simultaneous stab of pain in the forehead. It may result in recurring arousals and anxiety regarding the events. The underlying pathophysiology remains unknown. Report of Cases: A 27 year old male with no past medical history presented to the sleep medicine clinic with a 2-year history of sleep-onset pain between his eyes, like “a flash of lightning,” associated with moderate to severe pain. He experiences “brain zaps” or “a jolt of electricity between his eyes every night.” He would yell and jolt out of bed due to this sensation. These episodes occur approximately 60 to 90 minutes after sleep onset almost every night, jolting him from sleep and lasting approximately 1 minute. He also has difficulty seeing in the dark and also eye twitching. He experiences palpitations, diaphoresis, and a sense of fear often with these episodes. He denies any neurological deficits or muscle jerks. He is not on any daily medications. He does not regularly use any sleep aids but has tried melatonin 3 mg in the past. Evaluation by ophthalmology has ruled out ophthalmologic and neuro ophthalmic causes. He does report use of illicit substances including lysergic acid diethylamide (LSD), marijuana, methylenedioxymethamphetamine (MDMA), and cocaine. He did not experience any unpleasant effects after his first use of LSD, however within minutes of his second ingestion, he felt a sharp pain on his nasal bridge and forehead 10/10 in intensity. He states that since then, this pain has recurred almost every night. He does not have a family history of any neurologic disorders or migraines. The current plan for workup includes an in lab polysomnography with seizure montage and, if negative, a trial of a tricyclic antidepressant is planned. Conclusion This case illustrates the potential issues after LSD use causing severe dopaminergic and serotonin surge with drug use and the value of a complete history. Awareness of a possible correlation is clinically useful and may serve as a caution in the use of recreational drugs. Support (If Any)