A five-year-old boy living in the west of Ireland is being treated for headaches that occur when he laughs.
The boy first presented at the outpatient department at Mayo University Hospital “with a one-year history of headaches associated with laughter”.
In a new paper in the current July-August edition of the Irish Medical Journal (IMJ), the authors state they believe it is the first published paediatric case report of laughter as a precipitating factor for headaches.
They state that “laugh headaches” have been documented as a presenting feature for adults with a condition known as Chiari Malformation where part of the skull is misshapen or smaller than is typical, pressing on the brain and forcing it downward.
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In the case that was presented to medics at Mayo University Hospital, the authors of the paper state the five year old “experiences sudden-onset generalised headaches of variable severity, associated predominantly with laughing and once with shouting”.
‘Tightening sensation’
The medics state that the headaches “have not occurred with coughing, sneezing, straining or bending over”.
The report states that “the pain is described as a tightening sensation around his entire head which may be associated with pallor, nausea, gagging or generalised weakness”.
In the paper entitled “Chiari Malformation Presenting as Headaches Associated with Laughter”, the medics state that “his reaction to the pain is to grasp his head with both hands and sit or lie on the floor. The pain lasts for several seconds, then subsides with a return to good form afterwards.”
The report states that “these headaches have not interfered with schooling or hobbies including soccer and GAA. At the time of initial assessment, they were occurring daily”.
An MRI scan of the boy detected Chiari Malformation and a referral was made to a tertiary neurological centre for further management
The medics state that, at the time of review, the boy’s headaches “had reduced in frequency although were increasing in severity”. They state his parents are currently keeping a review of headache frequency and severity. “He will be followed up by the neurological team with serial MRI brain and whole spine and regular review of symptoms.”
The paper states that in conservatively managed Chiari Malformation patients, the natural history is improvement in headaches and nausea for many patients, with paediatric ones more likely to show improvement than adults.
The medics from Mayo University Hospital and Children’s Health Ireland at Temple Street in Dublin say that, in the light of the not-insignificant complication rate with neurosurgical interventions, it is reasonable to manage asymptomatic and mildly symptomatic Chiari Malformation patients conservatively with serial imaging – or tracking changes through brain scans – and reviewing symptoms.