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  • Updated 07.05.2022
  • Released 10.11.2014
  • Expires For CME 07.05.2025

Pathologic yawning

Introduction

Overview

Pathologic yawning can be a manifestation of stroke, seizures, hysteria, and disorders involving muscles responsible for the act of yawning. Several neurotransmitters and neurohormones are involved in the regulation of yawning. Several areas in the brain are implicated in yawning, but no definite yawning center has been identified. Propranolol can reduce the severity of yawning.

Key points

• Pathological spontaneous yawning has been reported with migraine, cerebral infarction, brain tumors, epilepsy, demyelinating disorders, and psychogenic disorders.

• Susceptibility to contagious yawning is reduced in patients with disorders that affect the ability for social interaction, such as autism spectrum disorders, psychopathy, and schizophrenia.

• Painful yawning disorders include primary yawning headache, primary stabbing headache with buccal triggers, secondary yawning pain resulting from cranial neuralgia (particularly with trigeminal neuralgia and glossopharyngeal neuralgia) or Eagle syndrome.

• Painful yawning may also occur with disorders of the musculoskeletal structures involved in yawning, as with temporomandibular joint pain, head and neck cancers, and postsurgical pain.

• Several drugs have been reported to induce repeated or forceful yawning, including antidepressants (particularly serotonin reuptake inhibitors), opioids, dopaminergic agents (especially the D2 dopamine agonist apomorphine), benzodiazepines, and some induction agents for intubation.

• Yawning involves a distributed neural network of the cerebrum, basal ganglia, cerebellum, brainstem, and upper cervical spinal cord.

• Yawning likely has a multifactorial purpose that includes increased vigilance, arousal when drowsiness occurs, social communication, and possibly facilitation of respiration and thermoregulatory modulation.

• The neuropharmacology of yawning is complex and involves several neurotransmitters, hormones, and modulators.

Historical note and terminology

Hippocrates listed yawning as one of the useful “natures,” and several others in the 16th and 17th centuries advanced theories from the release of tainted humor to the awakening of animal spirits. The metaphors that developed from these theories endured until the 19th century when Charcot used it as a patient diagnosis during his lectures, and Darwin mentioned yawning in connection with emotional behavior (135).

French neurologist Henri Meige (1866-1940) noted yawning-like movements in a form of focal dystonia, characterized by involuntary oromandibular dystonia and blepharospasm (Meige syndrome, or blepharospasm-oromandibular dystonia syndrome) (105). British neurologist C David Marsden (1938-1998), on the suggestion of British neurologist Reginald Edward Kelley (1917-1990), suggested the name "Bruegel syndrome," believing that Flemish painter Pieter Brueghel the Elder (c1525-1530/1569) had "clearly recognised the syndrome" in the small oval painting "Yawning Man" (99; 47).

"Yawning Man" by Flemish painter by Pieter Brueghel the Younger (1564-1638)

Painting previously attributed to Brueghel's father. Royal Museums of Fine Arts of Belgium, Brussels, Belgium. (Public domain.)

However, more recent scholarship suggests that the painting was by his eldest son, Pieter Brueghel the Younger (1564-1638) and that it depicts a rural man yawning with an uncovered mouth, something then considered rude (150). Other versions have also appeared.

"A Peasant Yawning," after Bruegel

Anonymous 17th-century Flemish engraving previously attributed to Lucas Vorsterman (1595–1675). Harris Brisbane Dick Fund, 1953. Metropolitan Museum of Art, New York. (Public domain.)

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