Ran Y, Liu H, Zhang M, Dong Z, Yu S. Laugh-Induced Headache:
Clinical Features and Literature Review. Headache. 2017 Nov;57(10):1498-1506.
Abstract
Background. Laughing is a rare precipitating factor for
headaches, and the pathogenesis underlying laugh-induced headache (LH) remains
unclear.
Methods. Two cases of headache triggered predominantly by
laughing were presented in this article. We also reviewed the published English
literature regarding LH, summarized the clinical characteristics of LH, and
discussed the probable pathophysiological mechanisms.
Results. In the first patient, magnetic resonance imaging of
the brain revealed cerebellar tonsillar herniation through the foramen magnum.
In the second patient, we did not find any evidence of intracranial disease.
The literature review showed that LH is a mild to severe, non-pulsating
headache. In most cases, the duration of each attack was limited to a few
minutes. The headache usually bursts after laughing and reaches its peak almost
immediately. In some cases, the headache can only be induced by mirthful
laughing rather than by fake laughing.
Conclusion. LH can be categorized as primary LH and secondary
LH. Changes in the spatial structure in the posterior cranial fossa and
cerebrospinal fluid circulation may contribute to the development of secondary
LH. Primary LH, primary cough headache, and primary exercise headache may share
some common pathogenesis. And we speculate that the regions of the brain
associated with the expression of mirth might be associated with LH.
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From the article
A 32-year-old woman reported recurrent headaches following
outbursts of laughing over a period of 3 years. The pain was intense and
located in both parietal and occipital areas. Attacks lasted 10 seconds. There
was no associated nausea, vomiting, photophobia, or phonophobia. She had also
suffered similar headaches after bending but never after coughing, sneezing,
sexual activity, or exercise. She did not previously suffer from headaches and
did not have a family history of headache. The neurological examination was
negative. Magnetic resonance imaging (MRI) of her brain revealed cerebellar
tonsillar herniation through the foramen magnum, also known as Arnold-Chiari
malformation type 1 (CM-1);. She refused brain surgery or conventional headache
medication and managed symptoms by avoiding triggering factors…
A 19-year-old man was referred to our department because of
bursting with severe headache after playing basketball for 20 minutes. For over
half a year, he had experienced episodic mild headache triggered by laughing,
without any other triggers. The pain also reached its peak immediately and
resolved within 1 minute after resting or stopping laughing. The nonthrobbing
headache was felt in both occipital areas and was mild to intense without any
associated symptoms. He had no history of other headaches. The neurological
examination and brain MRI were normal. The patient declined any further
investigation, including magnetic resonance angiography (MRA) and magnetic
resonance venography. He was treated with indomethacin 25 mg twice a day for 1
month, after which he has no longer suffered any headache attack, even after
laughing or any other strenuous physical exercise for the following 3 years…
Giraud et al reported a case of severe headache provoked by
outbursts of laughing, and MRI discovered giant pacchionian granulations (GPGs)
in bilateral transverse sinuses and the superior sagittal sinus. The patient
suffered an intense, nonpulsating, whole-head headache lasting 4–5 minutes for
each attack. With the exception of the patient reported by Boga, none of the
other previous reports, including the first patient we reported above,
underwent brain surgery on CM-1 malformation or GPG…
The course of headache in a patient reported by Levin et
al[8] was divided into two stages. At first, the severe headache burst with
boisterous laughing and weight lifting. In the second stage, the patient
suffered recurrent bouts of excruciating headache of 10 seconds in duration,
triggered by moderate mirthful laugh. Interestingly, "fake" laughing
(the absence of a mirthful feeling) did not produce any pain. Nonsteroid anti-inflammatory
drugs were not able to prevent the patient's headaches. Nevertheless,
divalproex sodium had significant preventive effects…
With headache characteristics that differed from those of
other cases, each attack of Shatti's patient lasted for most of the day and had
accompanying symptoms, including kaleidoscopic visual disturbance, photophobia,
and nausea. After the patient was treated with nortriptyline, the frequency of
headache attacks decreased significantly.
LH was a mild to severe, nonpulsating headache. In most
cases, the duration of the headache attack was limited to a few minutes. The headache
attack usually bursts with laughing and reaches its peak immediately. In some
cases, with unremarkable MRI findings, headaches were mainly induced by
mirthful laughing, rather than by fake laughing, and had good responses to
acute or prophylactic drugs for primary headache…
All these types of headache [laugh headaches, primary cough
headache, primary exercise headache] begin immediately or within seconds after
being triggered, reach their peak immediately, and last for a few minutes.
Although most cases of PEH are pulsating, LH and PCH are both nonthrobbing.
Attacks predominantly affect bilateral and posterior areas of the head in patients
with PCH or primary LH. The primary
headache may have associated symptoms and responds well to indomethacin…
The pathogeny of LH has been reported to include CM-1, GPG,
thrombophlebitis, intracranial tumors, posterior arachnoid cysts, intracranial
hypotension, and unruptured posterior communicating artery aneurysm. All
types of etiologies have influence on the spatial structure of the posterior
cranial fossa and cerebrospinal fluid circulation…
In addition, the similarity of good responses in primary LH,
PCH, and PEH to indomethacin or prophylactic drugs for treating primary
headache compels us to consider that there may be more common pathologies
underlying these primary headaches…
In reports by Levin et al and Shatti et al, patients
suffered with headache mainly after mirthful laughing. This is not a unique
instance about headache in connection with emotional change. As Blau in 1995
and Evans in 1998 both reported, patients with migraine-like headaches that
were precipitated by crying were associated with sadness or emotional upset.
However, the headaches could not be triggered by crying from happiness or
cutting onions…
Therefore, we speculate that the regions of the brain
associated with the expression of mirth might be associated with LH. The exact pathophysiological connection
between emotional laughing and LH requires further study.
LH can be categorized as primary LH and secondary LH.
Neurological analysis and imaging examination are necessary to exclude
secondary cases in patients with similar symptoms. The first patient we
reported with CM-1 can be categorized as secondary LH, while the second patient
can be categorized as primary LH. We concluded that changes in spatial
structure in the posterior cranial fossa and cerebrospinal fluid circulation
may contribute to the development of secondary LH. For primary LH, there may be
some common pathologies underlying primary headaches, including primary LH,
PCH, and PEH. Considering that in some patients, primary LH is only triggered
by mirthful laugh, we speculate that the regions of the brain associated with
the expression of mirth might be associated with LH.
Courtesy of : https://www.medscape.com/viewarticle/889420_4
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