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 M. 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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11 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.

  2. Wheatifer says:

    My granddaughter, 9 years old, was just diagnosed. How odd!

  3. Tawnya says:

    One of my twins was just diagnosed with this. I was blown away I would never think that there would be a diagnosis on this. I have so many questions.

  4. Adaryn Arthur says:

    My 11 year old daughter just had what appeared to be vasovagal syncope today, and after returning from the ER, and wanting to do some research, I found this page. She was on her knees in the bathroom while I was trying to hot-roll her pony tail when the incident occurred. My question is this: immediately before passing out, she said her stomach and head hurt. Have there been reports that in the case of hair grooming syncope the patient reported stomach and/or head pain?

  5. Jayla says:

    Thia just haopened to me tis morning with my 7 year old. She also complained of stomach pain right before

  6. Anna says:

    My daughter is 6 and has this as well. She has had syncopical episodes twice while I was braiding/brushing her hair all while standing. We haven’t had any other episodes since we have started making sure she is seating before starting. Before she passes out it is always that her stomach hurts and she thinks she is going to vomit.

  7. Joan says:

    This just happened to my 9 yr old granddaughter while having her her brushed, she totally fainted, we also thought the doctor at the hospital was joking when he ssid it was hairbrush syncope.

  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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