To describe three patients with recurrent severe paroxysmal
headache precipitated by yawning.
Pain elicited by yawning is a well-recognized clinical phenomenon in patients with cranial
neuralgia,
temporomandibular joint dysfunction syndrome and
Eagle syndrome. Clinical history, neurological and
oral examinations, brain magnetic resonance imaging (MRI), cranial nerve electrophysiological testing and skull X-rays are reported. In all the patients
pain was induced by yawning; in the third patient
pain was also triggered by
eructation. None had history of
migraine. Facial gestures and forceful opening of the mouth did not reproduce the
pain. The first patient had retroauricular
pain,
simvastatin-induced
myopathy and subclinical axonal
peripheral neuropathy; the second patient had a post-viral benign sensory neuropathy; and the third had retroauricular and
facial pain and no underlying neurological illness. Cranial nerve testing and MRI of the brain were normal except for a coincidentally found
pituitary adenoma on the first patient.
Headache or
cranial pain with yawning may occur in patients with no apparent cause (primary yawning
headache). It is a chronic, benign condition that requires no specific treatment but needs to be distinguished from secondary yawning
headache, of greater clinical relevance.