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Headbanging could damage your (Motör)head

Friday 4 July 2014

“German doctors are highlighting the dangers of headbanging after a 50-year-old man developed bleeding in the brain following a Motörhead concert,” BBC News reports.

The news is based on a case report in The Lancet about a man who developed a subdural haematoma.

subdural haematoma occurs when a blood vessel in the space between the skull and the brain splits apart. This is a serious condition that can be fatal, so early recognition and diagnosis is essential.

This is only one in a very small number of documented cases of brain blood clots that have been associated with headbanging. However, the incident serves as an important caution that the vigorous activity of headbanging may not always be as harmless as supposed. 

What is the story?

This was a case report. A case report usually consists of a particularly unusual set of circumstances.

The case was reported by doctors from Hannover Medical School in Germany and published in the peer-reviewed medical journal The Lancet.

They report on a 50-year-old man who presented to their neurosurgery department in January 2013, complaining of a constant and worsening headache for two weeks. He had no history of head injury, but did report headbanging at a Motörhead concert four weeks earlier. He had no other past health problems of note, and clinical examination and blood tests were normal. However, a CT scan of his brain it showed a chronic subdural haematoma on the right side of his brain.

What is a subdural haematoma?

Both the media, and to a large extent The Lancet, adopt a somewhat whimsical reporting of the case, which is understandable given the unusual circumstances. However, a subdural haematoma is no laughing matter.

The brain and spinal cord are covered by protective membranes called meninges, which are made up of three layers: an inner layer (pia mater – closest to the brain), middle (arachnoid mater) and outer layer (dura mater – closest to the skull). A subdural haematoma therefore means that there is a blood clot underneath (sub) the dura mater. This means that the bleeding has happened between the middle and outer layers of the meninges.

Usually subdural haematoma occurs as a result of head injury or trauma. For example, there have been cases reported in the media where people have developed a subdural bleed after falling and hitting their head while skiing. The Formula One racing driver Michael Schumacher was reported to have developed a subdural haematoma as a result of skiing accident in December 2013, that kept him in a coma for six months.

The actress Natasha Richardson died of a subdural haematoma, the symptoms of which only become apparent several hours after she had a skiing injury.

When the bleed develops, the collection of clotting blood takes up space and puts pressure on the underlying brain, causing symptoms such as headache, nausea and vomiting, and possibly drowsiness, confusion, or loss of consciousness.

The speed at which the blood collection develops and at which symptoms develop, can vary from very quickly – with symptoms in the first minutes or hours after the trauma – to more chronic, as with the case of this man. In chronic haematoma, symptoms develop more slowly, several weeks after the initial trauma.

The outlook following subdural haematoma is also variable, depending on how big the blood collection is and the extent of damage to the underlying brain, and in some cases it can be fatal. Therefore, it is most important that subdural haematoma is suspected and diagnosed as soon as possible, so that treatment can be given.

In some cases of small haematoma, the person may just be observed to see if the clot reabsorbs by itself, but sometimes surgery is needed to remove the clot and relieve the pressure on the brain.

What happened in this case?

The German man with a chronic subdural haematoma received surgical treatment to remove the blood clot.

This involved making small “burr holes” in the skull to drain the collection of blood. Two months after surgery he was symptom-free and a repeat CT scan showed complete resolution of the haematoma.

Why is headbanging a risk?

As said, subdural haematoma usually results from direct trauma to the brain. However, in this single case it developed as a result of headbanging. Headbanging involves the fast backwards and forwards movement of the head in rhythm to music, usually heavy metal. As the study authors say, this movement involves acceleration and deceleration forces that can risk tearing blood vessels. 

The authors’ review of the wider literature identified three previous cases of subdural haematoma as a result of headbanging – one of which led to a sudden death.

They also identified various reports of other adverse outcomes associated with headbanging, including isolated cases of fracture of one of the neck bones and tearing of the carotid artery in the neck.

Therefore, though these serious adverse effects may be very rare, the number of headbangers worldwide is unknown, and therefore it is not possible to attach risk figures. However, these cases serve as a warning to headbangers of these very real potential risks, however small they may be.

At the risk of appearing to be nannying killjoys, we ought to point out that some of the potential perils of going to a gig or festival include:

For more information on festival health visit our festival guide.

Analysis by Bazian
Edited by NHS Website