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.
- 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
- 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.