Irish boy who gets headaches every time he laughs in daily pain

A five-year-old boy is being treated in Ireland for headaches that occur when he laughs.

The child first showed up at the Mayo University Hospital’s outpatient clinic “with a year history of headaches related with laughter.”

In a new paper in the current July-August edition of the Irish Medical Journal (IMJ), the authors say that they believe that it is the first ever 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.

In the case that was presented to medics at Mayo University Hospital, the authors of the new paper state that the five-year-old “experiences sudden onset generalised headaches of variable severity, associated predominantly with laughing and once with shouting”.

The medics say the headaches “have not occurred with coughing, sneezing, straining or bending over”.

The report also says “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 say “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

At the time of review the boy’s headaches “had reduced in frequency although were increasing in severity”, according to the report.

The medics say “his parents are currently keeping a review of headache frequency, severity and precipitants.

The boy will be followed up by the Neurological team with serial MRI brain and whole spine and regular review of symptoms”.

According to the paper, in conservatively managed Chiari malformation patients, the natural history is improvement in headaches and nausea for many patients with paediatric patients 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 natural history of Chiari malformation and not insignificant complication rate with neurosurgical interventions, it is reasonable to manage asymptomatic and mildly symptomatic Chiari malformation patients conservatively with serial imaging and review of symptoms.

News source: RTE

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