A 27-Year-Old Woman With Constant Headache Too Tired to Party

Heidi Moawad, MD


August 08, 2022

Sleepiness and the associated symptoms of narcolepsy may interfere with a patient's ability to socialize or participate in hobbies or other leisure activities. This can contribute to a sense of isolation and/or depression. In addition, a number of medical comorbidities, including hypertension, thyroid disease, peripheral neuropathy, and diabetes, are associated with narcolepsy.[3]

The diagnosis of narcolepsy type 2 is based on clinical criteria as well as a nighttime polysomnogram and a daytime MSLT. The nighttime polysomnogram may be normal or can show shortened sleep latency, and the daytime MSLT typically shows shortened sleep latency.[4]

Lifestyle factors may influence the symptoms of narcolepsy. According to the National Institutes of Health, regular exercise is recommended for patients who are diagnosed with this condition.[5] However, little research has been done to show the effects of exercise on the disease or on its symptoms.

One small study suggested that maximal oxygen uptake was lower among participants who had narcolepsy compared with controls. The researchers concluded that "cardiopulmonary fitness in narcolepsy is inversely related to the degree of sleepiness and cataplexy episode frequency."[6] But it is not clear whether exercise could have an impact on the symptoms or whether the condition affects oxygen uptake. This patient's consistent participation in athletics may have played a role in alleviating her symptoms, if her exercise improved her baseline oxygen uptake. This may have delayed her seeking medical attention.

The incidence of obesity and dyslipidemia is higher than normal among patients with narcolepsy.[7] Although this patient has been paying attention to her diet in a manner that is likely to prevent these effects, it would be helpful for her to have a discussion with her physician about her specific dietary habits to ensure that she is not excessively eliminating nutrients or calories.

Patients with symptoms similar to those in this case should begin medical treatment. The standard first-line treatment for narcolepsy type 2 is modafinil. Other options include stimulants and sodium oxybate. This patient has not been treated for her symptoms before; thus, it makes sense to start with a first-line treatment and to follow up with her to assess her response to the medication. Several different comorbidities are associated with narcolepsy. It may be beneficial for some patients to start with treatment of only narcolepsy, whereas other patients may need to begin therapy for narcolepsy symptoms and other associated conditions at the same time.


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