Exploding head syndrome: clinical features, theories about etiology, and prevention strategies in a large international sample

Exploding head syndrome (EHS) is a benign sensory parasomnia characterized by the perception of loud noises or a sense of explosion in the head. Few studies have assessed clinical features and little is known about demographic differences or prevention strategies. A cross-sectional study of 3286 individuals with and 2954 without lifetime EHS episodes was conducted via online questionnaires. Those with EHS had shorter sleep durations, longer sleep onset latencies, poorer sleep quality, and less sleep efficiency, but effect sizes for these differences were small. Females were slightly more likely than males to endorse EHS. 44.4% of individuals with EHS experienced significant fear during episodes, but fewer reported clinically significant distress (25.0%) or interference (10.1%) as a result of EHS. Most sufferers believed it to be a brain-based phenomenon, but a small minority endorsed anomalous causes. Five prevention strategies with >50% reported effectiveness were identified. EHS was assessed in the largest sample to date. Though associated with clinical impacts, no empirically supported interventions yet exist. The five prevention strategies may prove useful for treatment development. •EHS is associated with marginally poorer/shorter sleep.•EHS is often associated with clinically significant fear during episodes.•EHS can be associated with clinically significant distress and/or impairment.•Five EHS prevention strategies may be useful for behavioral interventions.