Can excessive yawning be an indication of neurologic disease?

Ross Hauser, MD

We often see patients here at the Hauser Neck Center who routinely tell us that when they developed their primary condition, such as intracranial hypertension, dizziness, or other problems, they also developed an associated symptom of excessive yawning. Is this yawning a sign that the person is simply tired, fatigued, gasping for oxygen? Or, can excessive yawning be an indication of neurologic disease? The debate of the role of excessive yawning in patients is one that is decades old.

In 1986, Robert R. Provine of the Department of Psychology, University of Maryland, wrote in the journal Ethology (1), “Yawning may have the dubious distinction of being the least understood, common human behavior.”

Yawning is associated with various neurological diseases including intracranial hypertension, Excessive yawning may be characteristic of neurologic or brain disorders.

In a 2013 overview of research, or perhaps an overview as to why up until that time there was a lack of research and understanding into the yawning phenomena, doctors writing in the International Journal of Applied & Basic Medical Research (2) discussed that yawning may be a way for the body to cool down the brain. Let’s explore the significance.

This paper opens with a discussion of misunderstanding yawning’s significance. “Although yawning is a commonly witnessed human behavior, (yet) it has not been taught in much detail in medical schools because, until the date, no particular physiological significance has been associated with it.” The paper then goes on to state: that patients with clinical disorders such as multiple sclerosis, epilepsy, migraine, stress, anxiety, head trauma, and stroke experience excessive yawning as a symptom. The researchers cited earlier research that speculated that yawning becomes symptomatic because these conditions lead to an increase in the body core temperature, thereby resulting in abnormal thermoregulation, which the body then tries to correct transiently by way of yawning.

How is the brain trying to cool down? Why is it trying to cool down?

The brain is trying to cool down because it is overheating. When the brain overheats problems with cognitive function, brain fog, and neurological function may occur. The brain tries to cool down by getting new cooler blood (the blood outside the brain is cooler than the blood inside the brain) which pushes out the warmer venous blood is pushed out. In dealing with patients with cervical spine instability, we can see that the metabolic rate of the cells inside the heated brain is very high. (Please see my companion article Ross Hauser, MD Reviews Cervical Spine Instability and Potential Effects on Brain Physiology). In some patients, it can be speculated that if you have intracranial hypertension caused by compression of the jugular veins in the cervical spine, brain function can be impaired because warm blood is left stuck in the brain damage. This is when cervical instability patients may begin to develop excessive yawning.

An April 2023 paper in the journal Biomedicine & Pharmacotherapy (3) supports yawning as a vital function in brain temperature regulation. “Brain temperature determines not only an individual’s cognitive functionality but also the prognosis and mortality rates of many brain diseases. More specifically, brain temperature not only changes in response to different physiological events like yawning and stretching but also plays a significant pathophysiological role in a number of neurological and neuropsychiatric illnesses. ”

Yawning as an indication of neurologic disease?

In 2019, doctors pushed a case history of a 67-year-old woman in the journal Case Reports in Neurological Medicine. (4) This is a summary of this case and why it was so interesting to the doctors: “Pathological yawning is rarely observed in cerebral or spinal diseases. A 67-year-old woman was admitted with a seven-day progressive hemisyndrome (one side of the body is hypo or hyper-atrophied) with left-sided limb ataxia (no left-side coordination) and hypesthesia (loss of sensation or touch to the skin). The patient yawned with a high frequency, partially in salve-like episodes (her body was trying to fix something, like an overheated brain. She was yawning with greater frequency at these times.) MRI showed cervical myelitis (inflammation) over more than three vertebral segments up to the lower medulla and she was diagnosed with neuromyelitis optica spectrum disorder. Inflammation of the spinal cord at the cervical spine and optical nerve. Under treatment with methylprednisolone, followed by plasmapheresis and immunoadsorption (treatments to remove antibodies from the blood to bring down inflammation), clinical symptoms were regressive, and the frequency of yawning completely normalized.

Yawning in the clinical setting

In 2018, researchers in Brazil published these observations. (5) Not how many of these disorders can also be attributed to problems of cervical spine instability manifesting as neurological and digestive disorders.

“Other clinical conditions associated with yawning are functional digestive disorders (e.g., dyspepsia and irritable bowel syndrome), motion sickness, and hypoglycemia in diabetic patients under insulin therapy. In addition, vasovagal syncopal or presyncope episodes frequently present with yawning as well as malaise, dizziness, visual obscuration, nausea, pallor, and loss of consciousness. Excessive yawning has also been reported in patients with depression and can be caused by the many medications used in neurology, psychiatry, and internal medicine.”

Summary

If you have excessive yawning just know that can be a sign of serious neurologic disease it’s good to check for intracranial hypertension, if that’s found, then figure out the cause of the intracranial hypertension. I have an extensive article on Cervical Spine Instability, fluid build up and intracranial hypertension, that can help you understand this situation.

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References

1 Provine RR. Yawning as a stereotyped action pattern and releasing stimulus. Ethology. 1986 Jan 12;72(2):109-22. [Google Scholar]
2 Gupta S, Mittal S. Yawning and its physiological significance. International journal of applied and basic medical research. 2013 Jan;3(1):11. [Google Scholar]
3 Yulug B, Velioglu HA, Sayman D, Cankaya S, Hanoglu L. Brain temperature in healthy and diseased conditions: A review on the special implications of MRS for monitoring brain temperature. Biomedicine & Pharmacotherapy. 2023 Apr 1;160:114287. [Google Scholar]
4 Spahlinger V, Niessen A, Rauer S, Krämer S, Reinhard M. The Big Yawning: Pathological Yawning as a Symptom of Neuromyelitis Optica Spectrum Disorders. Case Reports in Neurological Medicine. 2019 Feb 24;2019. [Google Scholar]
5 Teive HA, Munhoz RP, Camargo CH, Walusinski O. Yawning in neurology: a review. Arquivos de Neuro-Psiquiatria. 2018;76:473-80. [Google Scholar]

 

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