BACKGROUND: Exploding head syndrome (EHS) is characterized by attacks of a 
sudden noise or explosive feeling experienced in the head occurring during the 
transition from wake to sleep or from sleep to wake.
METHODS: We present six new cases extending the clinical experience with the 
syndrome. We also reviewed all available cases from the scientific literature 
and evaluated the typical features of EHS.
RESULTS: The female to male ratio is 1.5 to 1. The median age at onset is 54. In 
average, one attack per day to one attack per week occurs. Some patients suffer 
from several attacks per night. In about half of all patients, a chronic time 
course can be observed but episodic or sporadic occurrence is also common. The 
most frequent accompanying symptoms beside the noise are fear and flashes of 
light. Polysomnographic studies do not reveal any specific sleep pattern 
associated with EHS. Tricyclic antidepressants are helpful in some patients. 
However, most patients do not need treatment because of the benign nature of the 
syndrome.
CONCLUSION: EHS is a well-defined disease entity with a benign nature.