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Laughing Headache: A Novel Type of
Triggered Headache with Response
to Divalproex Sodium
Morris Levin, MD; Thomas N. Ward, MD
Posted: November 2003  
Headache 2003;43:801-803

Case History:   A 45-year old man with a history of intermittent, hemicranial, throbbing headaches for many years was seen in a regional headache treatment center complaining of severe lancinations of pain in posterior head regions following either weight lifting or laughing. In particular "hearty" laughter was a consistent precipitant, but no other form of exertion led to headache or pain of any type. Pain occurred rather acutely following the activity.

Approximately 10 months later the patient returned to the headache clinic complaining of recurrent bouts of 10 seconds’ duration of "excruciating", bilateral, posterior, head pain following even moderate laughter, regardless of head position.

Comments:   Laughing as a headache precipitant has been reported in the context of exertional headaches, but this case is unique in that other types of exertion were generally not triggers. Divalproex sodium was an effective prophylactic agent in the patient described. When prophylaxis was discontinued, laughter-induced headaches did not recur, suggesting that this may be a self-limited condition. When laughter-induced headache is identified, divalproex sodium may prove an effective treatment and may represent a viable treatment option in cough headache or other triggered headache syndromes.