Laughing headache

Abstract

Headache is one of the most common problems that bring patients to the neurology clinic. Several precipitants can trigger headaches such as laughing, coughing, straining, sneezing, stooping, or sexual activity. 1 Here we described an atypical presentation of headache onset after laughter in one patient. Case reportA 50-year-old man visited the Comprehensive Headache Clinic at Bangkok Hospital Medical Center with the chief complaint of headaches occurring when he was laughing.

Laugh Headache, Not a Joke! A Case Report

“…Cases of a pathological laugh as in gelastic seizure, Angelman syndrome, or hypothalamic hamartoma, are well known [8]. Even laugh as a precipitant for cough headaches could also be seen [6]. In our case, no trigger points tenderness rules out spasmodic pain, and an MRI scan ruled out any bony deformity like platy basileus, atlantoaxial subluxation, disc bulge, or any other congenital anomaly.…”

“…Very few cases of laugh-induced headache are reported so far [6,7], although, in clinical practice, the numbers might be more in specialized headache centers. Cases of a pathological laugh as in gelastic seizure, Angelman syndrome, or hypothalamic hamartoma, are well known [8].…”

“…The associated signs symptoms of syringomyelia and syringobulbia with the above malformation could be present and should not be missed. Occasionally, tonsillar herniation or the dens of cervical vertebrae C1 could compress and may precipitate medullary signs [6].…”

“…Even isolated giant pacchionian arachnoid granulation presenting as severe laugh headaches are mentioned in literature [9]. This could ignite another plausible explanation related to craniospinal pressure dissociation [6] and the concept of dural elasticity and compliance, which needs to be explored if the symptoms persist and repeat scans shows no pathology. A rise of intracranial pressure due to vigorous laugh could press the tonsils or distal cerebellar portion to herniate down transiently, causing symptoms [6] but maybe back to normal position once the laugh ceases.…”