Hair Grooming Syncope

One of the great aspects of our jobs is that every day offers a new opportunity to learn.  One of my residents taught me something new my last shift in the Peds ED (thank you, Dr. Skefos!)… I honestly do not recall reading in any textbooks about “Hair-Grooming Syncope,” but apparently it exists and Dr. Skefos diagnosed it correctly.

Syncope

  • Certainly, syncope is a common complaint and we need to worry about the big, the bad, and the ugly first.
    • For the well-appearing, consider FingerStick Glucose, Hemoglobin, Pregnancy Test (maybe not for the boys), and an ECG.
    • For the ECG document presence or lack of:
      • Any conduction abnormalities (blocks, etc)
      • Any abnormal intervals… particularly Prolonged or Short QTc.
      • Delta Waves
      • Brugada Sign
      • Evidence of Hypertrophic Obstructive Cardiomyopathy
        • LVH
        • Very narrow “q” waves in the lateral leads.
        • Very narrow and deep T-wave inversion in the lateral leads.
      • Evidence of ischemia (goes without saying really).
    • For those that have normal ECGs and no other significant abnormalities, the majority are going to be classified has having neurocardiogenic syncope or vasovagal syncope.
      • In those cases the History and Physical are paramount.
      • So ask about the event preceding the pre-syncopal or syncopal event.  Did it include hair-grooming?

Hair Grooming Syncope

  • Several case reports of this exist and one retrospective study.
  • Occurs more commonly in teenage girls, but does occur in boys as well.
  • Actions of Hair-Braiding, Combing, Brushing, Blowing, and Curling can trigger the event.
  • Interestingly, the boys were noted to have it occur with Hair Cutting more.
  • Most were standing, but some were seated, or kneeling.
  • All had negative neurologic and cardiac evaluations (the retrospective study was performed in a cardiology clinic where all patients even got Echos).
  • Seizures have been known to follow the syncopal event, just like any syncopal event (likely due to the brief hypoperfusion leading to a reduction in inhibitors).
  • Mechanism is speculative (so let’s speculate):
    • Pain from hair pulling or scalp stimulation of trigeminal nerve or cervical roots precipitate the event.
    • Positioning of the head leads to compression of the carotid baroreceptors (however, this was not noted to be the case in one study).
    • Standing for prolonged time can lead to syncope (but again, some were seated).

 

Evens WN, Acherman R, Kip K, Restrepo H. Hair-Grooming Syncope in Children. Clinical Pediatrics Vol 48 (8); Oct 2009, pp. 834-836.

Lewis DW, Frank LM. Hair-Grooming Syncope Seizures. Pediatrics 1993; 91: 836-837.

Sean Fox

I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renown educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.

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4 Responses

  1. LSanders says:

    My 12 year old grandson was just diagnosed with this. It is the craziest thing to me. I had never heard of such.

  1. July 30, 2017

    […] basics of pediatric syncope and even touched on some interesting entities related to syncope (ex, Hair Grooming, Breath Holding Spell, Brugada, Prolonged qTC, Sinus Bradycardia, and Heat Related Illness). […]

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