Correspondence

Roller-Coaster Headache

N Engl J Med 1995; 332:1585June 8, 1995

Article

To the Editor:

We report a case of subdural hematoma caused by riding on a roller coaster.

A 64-year-old man presented to our neurology clinic with a 10-week history of headache. He was healthy, apart from hypertension controlled by triamterene (Dyazide) and hydrochlorothiazide. He had not previously had headaches. The headaches developed gradually after he began riding a roller coaster at an amusement park. The roller coaster, he reported, “swings people upside down as many as six times.” During the ride his head was enclosed within bars that kept him stable in a chair, and there was never direct trauma to his head. He rode the roller coaster on 11 different occasions until his headaches became so severe that he was unable to continue. Nevertheless, the headaches continued to worsen. They were worsened by shaking the head but not by coughing or sneezing, nor were they accompanied by nausea or vomiting. The headaches were located mainly over the left side of the head. They did not awaken him at night but tended to develop at about 10 a.m., after he had been up for about two hours. There were no other neurologic symptoms.

Examination disclosed an alert, cheerful man of normal body build whose neurologic examination, including testing of mental status, was normal. A computerized tomographic (CT) scan of the head showed a left-sided subdural hematoma, 8 mm in depth, with a mild midline shift. It was decided to treat the patient conservatively. However, a second CT scan two weeks later showed that the depth of the hematoma had increased to 10 mm (Figure 1Figure 1A CT Scan of the Head with Contrast Enhancement, Showing a Left-Sided Subdural Hematoma (Arrow) that Caused a Mild Shift of Midline Structures and Compression of the Adjacent Cerebral Hemisphere.). Thus, neurosurgery was performed, with successful evacuation of the hematoma. The patient had an excellent postoperative course.

This patient's subdural hematoma and resulting headaches occurred in association with riding a roller coaster. The swooping ride induces marked rotatory and other positional changes in a deformable brain that is moving within a relatively rigid skull, thus causing tensile and shearing stresses. Cortical veins, as they enter the more fixed portions of the dural sinuses, tear, thus causing subdural hematomas. Such an event is a recognized occurrence in the shaken-baby syndrome.1,2 Ommaya and Yarnell3 described a 62-year-old man who had a subdural hematoma and headache after a whiplash injury in which, as in our patient, there was no direct trauma to the head.

Patients in whom headaches develop for the first time in association with events that cause violent movement of the head, such as a ride on a roller coaster, even though there is no direct trauma to the skull, may have subdural hematoma. A CT or magnetic resonance imaging scan of the head should be performed on an emergency basis.

Y. Bo-Abbas, M.D.
C.F. Bolton, M.D.
Victoria Hospital, London, ON N6A 4G5, Canada

3 References

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   Thyen U, Tegtmeyer FK. Das Schütteltrauma des Säuglings -- eine besondere Form der Kindesmisshandlung. Monatsschr Kinderheilkd 1991;139:292-296
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   Ommaya AK, Yarnell P. Subdural haematoma after whiplash injury. Lancet 1969;2:237-239
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Citing Articles (8)

Citing Articles

1. 1

   Robert P. Olympia, Jodi Brady, Valerie Rupp, Cheryl Lansenderfer. (2011) Emergency Department Visits from a Local Amusement Park. The Journal of Emergency Medicine 41:1, 14-20
   CrossRef

2. 2

   Bryan J. Pfister, Larry Chickola, Douglas H. Smith. (2009) Head Motions While Riding Roller Coasters. The American Journal of Forensic Medicine and Pathology 30:4, 339-345
   CrossRef

3. 3

   Harald De Cauwer, Roel Van Giel, Luc Mortelmans, Luc van den Hauwe. (2009) An uncommon cause of headache after headbanging at a party. European Journal of Emergency Medicine 16:4, 212-213
   CrossRef

4. 4

   Kim A. Williams, Pelagia Kouloumberis, Herbert H. Engelhard. (2009) Subacute subdural hematoma in a 45-year-old woman with no significant past medical history after a roller coaster ride. The American Journal of Emergency Medicine 27:4, 517.e5-517.e6
   CrossRef

5. 5

   Juanita G. McBeath, Anil Nanda. (2000) Roller Coaster Migraine: An Underreported Injury?. Headache: The Journal of Head and Face Pain 40:9, 745-747
   CrossRef

6. 6

   WouterI. Schievink, MichaelJ. Ebersold, JohnL.D. Atkinson. (1996) Roller-coaster headache due to spinal cerebrospinal fluid leak. The Lancet 347:9012, 1409
   CrossRef

7. 7

   Randolph W. Evans. (1996) DIAGNOSTIC TESTING FOR THE EVALUATION OF HEADACHES. Neurologic Clinics 14:1, 1-26
   CrossRef

8. 8

   Valérie Biousse, Hugues Chabriat, Pierre Amarenco, Marie-Germaine Bousser. (1995) Roller-coaster-induced vertebral artery dissection. The Lancet 346:8977, 767
   CrossRef