Le bâillement, du réflexe à la pathologie
Le bâillement : de l'éthologie à la médecine clinique
Le bâillement : phylogenèse, éthologie, nosogénie
 Le bâillement : un comportement universel
La parakinésie brachiale oscitante
Yawning: its cycle, its role
Warum gähnen wir ?
 
Fetal yawning assessed by 3D and 4D sonography
Le bâillement foetal
Le bâillement, du réflexe à la pathologie
Le bâillement : de l'éthologie à la médecine clinique
Le bâillement : phylogenèse, éthologie, nosogénie
 Le bâillement : un comportement universel
La parakinésie brachiale oscitante
Yawning: its cycle, its role
Warum gähnen wir ?
 
Fetal yawning assessed by 3D and 4D sonography
Le bâillement foetal
http://www.baillement.com

mystery of yawning 

 

 

 

 

mise à jour du
15 octobre 2017
Headache
2017
Migraine and Yawning
Bülent Güven, Hayat Güven, Selim Selçuk Comoglu
Ankara, Turkey

Chat-logomini

 Yawning and migraine
 
Abstract
Yawning is considered to be a symptom that reflects dopaminergic activity, although its pathophysiological mechanism is not yet fully understood. Interestingly, repetitive yawning is seen in some patients during migraine attacks. The aim of this cross-sectional study is to investigate the frequency of yawning during migraine attacks and its association with different characteristics of migraine.
 
Patients with migraine with or without aura were evaluated using questionnaires and diaries to determine the characteristics of headache and accompanying symptoms. Repetitive yawning in the premonitory phase and/or during headache were determined.
 
Three hundred and thirty-nine patients were included in the study. One hundred and fifty-four patients reported repetitive yawning (45.4%) during migraine attacks. Repetitive yawning was reported in the 11.2% of the patients in the premonitory phase, 24.2% during headaches, and 10% both in the premonitory phase and during headaches. Migraine with aura (46.8 vs 31.9%; P5.005), accompanying nausea (89.6 vs 75.1%; P5.001), vomiting (48.7 vs 37.8%; P5.044), osmophobia (66.7 vs 52.3%; P5.024), and cutaneous allodynia (58.2 vs 46%; P5.032) were more common in patients with yawning than without. Other dopaminergic-hypothalamic premonitory symptoms (41.6 vs 26.5%; P5.003), especially sleepiness (17.5 vs 5.9%; P5.001), irritability/anxiety (21.4% vs 11.4%; P5.019), nausea/vomiting (10.4 vs 4.3%; P5.03), and changes in appetite (18.2 vs 9.7%; P5.024), were also more frequent in patients with yawning than without. After being adjusted for all other relevant covariates, the odds of repetitive yawning were increased by the presence of nausea (OR 2.88; 95% CI 1.453-5.726; P5.002) and migraine with aura (OR 1.66; 95% CI 1.035-2.671; P5.036).
 
These results demonstrated that yawning is a common self-reported symptom leading or accompanying migraine attacks and is associated with aura, nausea and/or vomiting, osmophobia, and cutaneous allodynia in patients with migraine. Although yawning is a rather frequently seen behavior, it is a unique and reliable symptom in patients with migraine that may offer an opportunity for early treatment of migraine attacks.
 
 
Résumé
Le bâillement est considéré comme un symptôme qui reflète l'activité dopaminergique, bien que son mécanisme physiopathologique ne soit pas encore entièrement compris. Fait intéressant, des bâillements répétitifs sont observés chez certains patients lors d'attaques de migraine. Le but de cette étude transversale est d'étudier la fréquence des bâillements lors des crises de migraine et son association avec différentes caractéristiques de la migraine.
 
Les patients atteints de migraine avec ou sans aura ont été évalués à l'aide de questionnaires et d'auto-observations afin de déterminer les caractéristiques du mal de tête et des symptômes qui l'accompagnent. Les bâillements répétitifs à la phase prémonitoire et / ou pendant le mal de tête ont été analysés.
 
Trois cent trente-neuf patients ont été inclus dans l'étude. Cent cinquante-quatre patients ont signalé des bâillements répétitifs (45,4%) lors d'attaques de migraine. Des bâillements répétés ont été rapportés chez 11,2% des patients en phase prémonitoire, 24,2% lors des maux de tête et 10% à la fois dans la phase prémonitoire et pendant les maux de tête.
 
La migraine avec aura (46,8 vs 31,9%, P5.005), c'est à dire accompagnée de nausées (89,6 vs 75,1%, P5.001), de vomissements (48,7 vs 37,8%, P5,044), d'osmophobie (66,7 vs 52,3%, et l'allodynie cutanée (58,2 vs 46%, P5.032) était plus fréquente chez les patients ayant des bâillements que chez ceux sans. Autres symptômes prémonitoires dopaminergiques et hypothalamiques (41,6 vs 26,5%, P5.003), en particulier la somnolence (17,5 vs 5,9%; P5.001); l'irritabilité / l'anxiété (21,4% vs 11,4%; P5,019); les nausées / vomissements vs 4,3%, P5,03), et les changements d'appétit (18,2 vs 9,7%; P5.024) étaient également plus fréquents chez les patients avec bâillements que sans.
 
Après ajustement pour toutes les autres covariables pertinentes, les risques de bâillements répétitifs ont été augmentés en cas de nausées (OR 2,88, IC 95% 1,453-5,726, P5,002) et de migraine avec aura (OR 1,66; IC 95% 1,035-2,671 ; P5.036).
 
Ces résultats montrent que le bâillement est un symptôme commun auto-déclaré débutant ou accompagnant les crises de migraine et est associé à une aura, des nausées et / ou des vomissements, une osmophobie et une allodynie cutanée chez des patients souffrant de migraine. Bien que le bâillement soit un comportement fréquemment observé, il s'agit d'un symptôme unique et fiable chez les patients souffrant de migraine qui peut offrir une opportunité de traitement précoce des crises de migraine.
 

The variety of symptoms developed during migraine attacks indicates that different parts of the brain are affected directly or indirectly. The symptoms that start from the premonitory phase, accompany headaches during attack, and extend to the postdromal phase reflect a wide range of neural system dysfunction. In addition, findings such as hypersensitivity to visual, auditory, and olfactory stimuli seen in migraine patients during the interictal period may be included in this scope.
 
Prevalence of premonitory symptoms of migraine patients varies between 7% and 88%, depending on the study population and design. The most common symptoms in the premonitory phase indicate the possible influence of the hypothalamus, brainstem, cortex, and the limbic system.
 
Yawning is a phylogenetically old, stereotypic behavior seen in most mammals ranging from rodents to humans.The role of yawning in human physiology is not yet fully understood. There are numerous descriptions and explanations of yawning: some state that it increases wakefulness and aims to make a person more alert when they feel sleepy; some state that it is a thermoregulatory mechanism, which may be triggered by an increase in heat of the brain and provide compensatory cooling when the other options fail; and some state that it has a respiratory function to regulate oxygen and carbon dioxide levels in the blood.
 
However, yawning is considered to have a significant role in providing social and empathetic communication. Although the physiological role of yawning has not been fully elucidated yet, studies conducted over the past 50 years have provided a better understanding of the neuropharmacological regulation of yawning. Many neurotransmitters and neuropeptides, especially dopamine and oxytocin as well as acetylcholine, glutamate, serotonin, gammaaminobutyric acid, opioids, adrenergic, nitric oxide, gonadal hormones, and orexin were found to be responsible for the modulation of yawning.
 
Paraventricular nucleus of hypothalamus plays a key role in the occurrence of yawning. The stimulation of dopamine D2 receptors of the nucleus activates oxytocinergic neurons projected to the pons (reticular formation, locus coeruleus), hippocampus, insula, and orbitofrontal cortex. Oxytocin stimulates cholinergic transmission in the hippocampus, and acetylcholine ultimately causes yawning through muscarinic receptors of the effectors.
 
Excessive yawning is seen in several neurological disorders such as vasovagal syncope, migraine, intracranial hypertension, epilepsy, pituitary tumors, and stroke. Iatrogenic yawning may develop due to the use of dopaminergic medication and serotonin reuptake inhibitors.
 
In this study, we aimed to determine the frequency of yawning accompanying migraine attacks and to investigate the relationship between yawning and the clinical features of migraine.
 
DISCUSSION
In this study, repetitive yawning was reported in 45% of patients during migraine attacks. Most of the studies investigating the frequency of premonitory symptoms in migraine attacks reported the frequency of yawning between 34 and 40%;4-6 however, some studies reported lower frequencies. Yawning was evaluated as a premonitory symptom in most of the previous studies. The frequency of accompanying symptoms in the premonitory, ictal, and postdromal phases of migraine attack was investigated in only one study, and was reported that yawning during headaches is seen to a similar extent as in the premonitory phase, and 27.8% of the patients reported yawning in the premonitory phase, 25.4% during headache, and 13.9% in the postdromal phase.3 In our study, repetitive yawning was not only reported in the premonitory phase but also even more frequently during headache, and it was reported both in the premonitory phase and during headache in some of the patients. These findings can be explained since the activation of dopaminergic-hypothalamic mechanisms causing yawning in migraine attack exists during both the premonitory phase and during headache. In addition, there is a similarity between yawning and symptoms such as nausea, vomiting, and photosensitivity and phonosensitivity, since these symptoms can be seen both in the premonitory phase and during headache.
 
Repetitive yawning is important as a symptom because it can be evaluated more objectively by the patients with migraine when compared with other frequently seen symptoms in the population, such as fatigue or depressive mood state. It was reported that yawning can predict the onset of headache in 84% of cases and was suggested to be one of the most predictive premonitory symptoms.3 We observed that the patients were responding without any doubt when we asked them if they had yawning before or during headache compared to other symptoms.
 
The hypothalamus plays an important role in the human circadian rhythm and in the maintenance of homeostasis. Since brains with migraines are highly sensitive to changes in homeostasis, it is possible that the hypothalamic neurons are the source of dopamine-mediated premonitory symptoms, such as yawning.1,2 In a study carried out using H15 2 O-PET in patients with nitroglycerintriggered migraine attacks, activations in the posterolateral hypothalamus, midbrain tegmental area, periaqueductal gray, dorsal pons, and various cortical areas including occipital, temporal, and prefrontal cortex were observed in the premonitory phase of headache.8 Considering the known pain modulatory effects of these areas, it was suggested that the early activation of these areas before headache may represent an abnormal response, resulting in increased pain.
 
In this study, migraine with aura was found to be more frequent in patients with repetitive yawning than without. Migraine aura is known to develop as a result of cortical spreading depression. However, the specific event initiating the cortical spreading depression is unknown. The threshold for initiation of cortical spreading depression is probably lower in patients with migraine with aura compared to healthy individuals and might be associated with hyperexcitability of the brain. The timing of aura relative to premonitory symptoms of migraine raises the question about its role in initiating headache. Factors initiating aura and premonitory symptoms of migraine attack may be common and explain the relation between aura and yawning in our study. It was suggested that ongoing neurophysiologic abnormalities during the pain-free interval may lead to both premonitory symptoms and create the conditions for ignition of cortical spreading depression.
 
Reciprocal anatomic connections between the hypothalamus and spinal trigeminal nucleus have been demonstrated. Findings demonstrating the activation of hypothalamic areas during migraine indicated its role in pain modulation and contribution to the development of central sensitization in trigeminovascular neurons. It was supported by a study demonstrating that the paraventricular hypothalamic nucleus neurons directly control both spontaneous and induced activities of spinal trigeminovascular neurons in rats. These findings may explain the association between yawning and allodynia, which reflects central sensitization in our study.
 
In this study, nausea and vomiting were found to be more frequent both in the premonitory phase and during headache in patients with repetitive yawning during migraine attacks. This relationship may be interpreted to suggest that nausea and vomiting also reflect increased dopaminergic activity, as in yawning. Although functional connections between trigeminal neurons and nucleus tractus solitarius may explain the presence of nausea along with headache, nausea&emdash;which is also seen as a premonitory symptom&emdash;is thought to be a centrally developed symptom in migraine. The results of a study using H15 2 O PET in the premonitory phase of a migraine attack triggered by nitroglycerin showed that nausea may develop independently of pain and trigeminal activation. In addition, connections between paraventricular nucleus of hypothalamus and nucleus tractus solitarius and area postrema demonstrate the role of the hypothalamus in development of nausea and vomiting. In our study, osmophobia, which reflects dopaminergic neurotransmission, was also found to be more frequent in patients with repetitive yawning than without. This study showed that the number of patients with other dopaminergic-hypothalamic premonitory symptoms is higher in patients with repetitive yawning than without. Sleepiness was found to be more frequent in patients with yawning, and it may be associated with the role of the hypothalamus in the sleep-wake cycle. However, the physiological function of yawning to increase alertness is also thought to contribute to the association of these two symptoms.
 
This study has some limitations. First, estimating the frequency of repetitive yawning or other symptoms was based on self-reported data obtained from the patients. As data were obtained from selfreported questionnaires or diaries, underestimation might have occurred due to not recalling the premonitory and associated yawning. Overestimation might have occurred due to having affirmative responses when study participants were asked if they had any repetitive yawning associated with headache. We cannot discount the possibility that there might still be incorrect or inadequate responses in the questionnaires or diaries, although of the patients were excluded from the study due to the fact that they had failed to complete the questionnaires or had unreliable responses. Furthermore, some patients might have had difficulties in distinguishing the time of yawning prior to an accompanying headache. Second, our study did not assess the prophylactic medications for migraine. It is known that antidepressant drugs may induce yawning, but both groups of patients with or without yawning had used these drugs similarly (21.4 vs 23.8%). Finally, we used multiple logistic regression analysis to determine the variables which may have an effect on yawning, but no adjustment for multiple comparisons was done in this study.
 
CONCLUSIONS
 
This study demonstrated that yawning is a common symptom that leads to or accompanies migraine headache and indicated an association between yawning and aura, nausea and/or vomiting, osmophobia, and cutaneous allodynia in patients with migraine. Yawning is a unique and objective symptom that may offer an opportunity for early treatment of migraine attacks.