Successful Treatment of Exploding Head Syndrome With Ketamine.
Cureus November 23, 2025 Luiza Haruyunyan, Mitchell Liester, Bertrand Liang
A 75-year-old man with chronic exploding head syndrome—loud internal noises, lightning-like sensations, and sleep paralysis for over five years—failed multiple standard medications. Sublingual ketamine, starting at 25 mg every third night and increasing to nightly, reduced episodes from 3-4 times weekly to once every two weeks after one month, monthly by three months, and resolved completely by six months, with only occasional sleep paralysis remaining. The treatment improved quality of life. Ketamine may work through NMDA receptor modulation and neuroplasticity. This case suggests a potential new approach for this difficult-to-treat sleep disorder.