Yawning

Exploring the neurobiology of the premonitory phase of migraine preclinically - a role for hypothalamic kappa opioid receptors?

Background

The migraine premonitory phase is characterized in part by increased thirst, urination and yawning. Imaging studies show that the hypothalamus is activated in the premonitory phase. Stress is a well know migraine initiation factor which was demonstrated to engage dynorphin/kappa opioid receptors (KOR) signaling in several brain regions, including the hypothalamus. This study proposes the exploration of the possible link between hypothalamic KOR and migraine premonitory symptoms in rodent models.

Methods

Rats were treated systemically with the KOR agonist U-69,593 followed by yawning and urination monitoring. Apomorphine, a dopamine D1/2 agonist, was used as a positive control for yawning behaviors. Urination and water consumption following systemic administration of U-69,593 was also assessed. To examine if KOR activation specifically in the hypothalamus can promote premonitory symptoms, AAV8-hSyn-DIO-hM4Di (Gi-DREADD)-mCherry viral vector was microinjected into the right arcuate nucleus (ARC) of female and male KOR^CRE or KOR^WT mice. Four weeks after the injection, clozapine N-oxide (CNO) was administered systemically followed by the assessment of urination, water consumption and tactile sensory response.

Results

Systemic administration of U-69,593 increased urination but did not produce yawning in rats. Systemic KOR agonist also increased urination in mice as well as water consumption. Cell specific Gi-DREADD activation (i.e., inhibition through Gi-coupled signaling) of KOR^CRE neurons in the ARC also increased water consumption and the total volume of urine in mice but did not affect tactile sensory responses.

Conclusion

Our studies in rodents identified the KOR in a hypothalamic region as a mechanism that promotes behaviors consistent with clinically-observed premonitory symptoms of migraine, including increased thirst and urination but not yawning. Importantly, these behaviors occurred in the absence of pain responses, consistent with the emergence of the premonitory phase before the headache phase. Early intervention for preventive treatment even before the headache phase may be achievable by targeting the hypothalamic KOR.

Supplementary Information

The online version contains supplementary material available at 10.1186/s10194-022-01497-7.

Occurrences of yawn and swallow are temporally related

Yawning is a stereotyped motor behavior characterized by deep inhalation and associated dilation of the respiratory tract, pronounced jaw opening, and facial grimacing. The frequency of spontaneous yawning varies over the diurnal cycle, peaking after waking and before sleep. Yawning can also be elicited by seeing or hearing another yawn, or by thinking about yawning, a phenomenon known as "contagious yawning". Yawning is mediated by a distributed network of brainstem and supratentorial brain regions, the components of which are shared with other airway behaviors including respiration, swallowing, and mastication. Nevertheless, the possibility of behavioral coordination between yawning and other brainstem-mediated functions has not been examined. Here we show, with a double-blind methodology, a greater-than-fivefold increase in rest (saliva) swallowing rate during the 10-s period immediately following contagious yawning elicited in 14 adult humans through the viewing of videotaped yawn stimuli. Sixty-five percent of yawns were followed by a swallow within 10 s and swallows accounted for 26 % of all behaviors produced during this post-yawn period. This novel finding of a tight temporal coupling between yawning and swallowing provides preliminary evidence that yawning and swallowing are physiologically related, thus extending current models of upper airway physiology and neurophysiology. Moreover, our finding suggests the possibility that yawning plays a role in eliciting rest swallowing, a view not considered in previous theories of yawning. As such, the present demonstration of a temporal association between yawning and swallowing motivates a re-examination of the longstanding question, "Why do we yawn?".

Pathological yawning in a patient with anxiety and chronic disease anaemia

Yawning, frequent in daily life, is accepted as a complex arousal reflex. Excessive yawning may be due to neurological, psychiatric, infectious, gastrointestinal or metabolic diseases. This reflex has also been associated with different selective serotonin reuptake inhibitors. We report a female patient, with excessive yawning, who was on selective serotonin reuptake inhibitor treatment with the diagnosis of generalised anxiety disorder. She was then found to have endometrial carcinoma. Her complaints of palpitation, shortness of breath and loss of energy might be explained by a psychiatric disease and/or anaemia. Previous anaemic periods and partial response of her psychiatric symptoms during last 3 years alerted us to think about an organic cause. Investigations for chronic disease anaemia resulted in diagnosis of endometrial carcinoma. This case is a good example showing misdiagnosis caused by medical stigmatisation.

Does yawning increase arousal through mechanical stimulation of the carotid body?

Yawning is a stereotyped event that occurs in humans and animals from fish to mammals, but neither its mechanisms nor its functions are entirely known. Its widespread nature suggests that it has important physiological functions. It is associated with stretching of muscles in a large area, but the function of this stretching is understood far from completely. It has been proposed that yawning increases arousal and that it is an arousal defense reflex, whose aim is to reverse brain hypoxia. Whilst yawning has been speculated to have an important role in reversing hypoxia, there is a structure in the neck that is known to be intimately involved in the regulation of oxygen homeostasis, namely the carotid body. It senses acute changes in oxygen levels. In spite of this, a connection has never been proposed either between the carotid body and arousal, or between yawning and the carotid body. We propose that yawning stimulates mechanically the carotid body (and possibly other structures in the neck). We further propose that this stimulation gives rise to increased arousal, alertness and wakefulness and that one important physiological function of yawning is increase of arousal through this stimulation. We also propose that mechanical effects on the shunt system of the carotid body may be involved in this stimulation. Our hypothesis is supported by several facts. For example, yawning causes movements and compressions that may affect the carotid body that is situated strategically at the bifurcation of the common carotid artery. Thus, yawning may stimulate the carotid body. The carotid body is highly vascular and compressions may affect its shunt system and blood flow and for example give rise to release of hormones or other substances. Also several facts related to situations where people yawn or do not yawn support our hypothesis and are discussed. Further support comes from facts related to somnogenic substances, hormones and transmitters, and from facts related to the interconnection of homeostatic mechanisms, sleep, arousal and ventilation.

Yawning despite trismus in a patient with locked-in syndrome caused by a thrombosed megadolichobasilar artery

We report a 62-year-old woman with a locked-in syndrome with bilateral masticatory spasms and persistent trismus, who was still able to yawn. A vascular malformation of the basilar artery-megadolichobasilar artery (fusiform aneurysm, vertebrobasilar dolichoectasia) was determined to be the underlying cause of this rare combination of symptoms. A thrombus in the megadolichobasilaris as well as an almost total pontine infarction were demonstrated on CT- and MRI-scans. Thus, trismus may be associated with locked-in syndrome due to megadolichobasilar artery thrombus, although yawning is still possible.

Acute or chronic effects of cannabinoids on spontaneous or pharmacologically induced yawning in rats

Yawning is a reflex or event that is not fully understood. It is controlled by many neurotransmitters and neuropeptides and can be induced pharmacologically by cholinergic or dopaminergic agonists. Amongst their many actions, cannabinoids acting on cannabinoid (CB(1) or CB(2)) receptors can alter cholinergic and/or dopaminergic activity. This study examined the effects of Delta(8)-tetrahydrocannabinol (Delta(8)-THC) administered acutely (2.5 mg/kg intraperitoneally [ip], 15 min before test) or chronically (5 mg/kg for 30 days followed by 24 h or 7 days of discontinuation) on yawning induced by pilocarpine, a cholinergic agonist (0, 1, 2, 4 or 8 mg/kg ip), or apomorphine, a dopaminergic agonist (0, 20, 40 or 80 microg/kg subcutaneously [sc]). Acute effects of different doses of Delta(9)-tetrahydrocannabinol (Delta(9)-THC: 0, 0.5, 1.25 or 2.5 mg/kg ip) on yawning induced by pilocarpine (2 mg/kg ip) or apomorphine (40 microg/kg sc) were also investigated. Both pilocarpine and apomorphine produced yawning in a dose-related manner. Acute administration of Delta(8)-THC and Delta(9)-THC significantly reduced yawning induced by both pilocarpine and apomorphine. Chronic administration of Delta(8)-THC did not change yawning induced by either agonist 24 h or 7 days after discontinuation of Delta(8)-THC. However, a high frequency of spontaneous yawning was observed 7 days after Delta(8)-THC discontinuation. These results suggest that cannabinoid agonists inhibited yawning induced by cholinergic or dopaminergic agonists. In addition, the increased frequency of spontaneous yawning following cessation of chronic administration of a cannabinoid agonist may be of importance as a withdrawal sign for these drugs.

Yawning

YAWNING IS A COMMON PHYSIOLOGICAL EVENT THAT CAN BE DIVIDED INTO THREE DISTINCT PHASES: a long inspiratory phase, a brief acme and a rapid expiration. The aim of yawning is not yet well defined. However this semi-voluntary event increases vigilance and aims to alert when drowsiness occurs. Yawning probably has an important role for social communication as well. Yawning can be responsible for pain, luxation or even transient ischaemic attack. Abnormal yawning is present in various pathologies: migraine, Parkinson's disease, tumours, psychiatric diseases, infections or iatrogenic pathologies. The neuro-pharmacology of yawning is complex and knowledge of its mechanisms is incomplete. While under the control of several neurotransmitters, yawning is largely affected by dopamine. Dopamine may activate oxytocin production in the paraventricular nucleus of the hypothalamus. Oxytocin may then activate cholinergic transmission in the hippocampus and, finally, acetylcholine might induce yawning via the muscarinic receptors of the effectors. This is an over-simplification; many other molecules can modulate yawning, such as nitric oxide, glutamate, GABA, serotonin, ACTH, MSH, sexual hormones and opium derivate peptides. Dopamine involvement in yawning could have practical applications in the study of new drugs or the exploration of neurological diseases such as migraine or psychosis. 2001 Harcourt Publishers Ltd

Sphenoidal sinus mucocoele and yawning after radiation treatment for nasopharyngeal carcinoma

The long term complications of radiotherapy in treating patients with nasopharyngeal carcinoma (NPC) are well recognized. Among these, neurological and endocrinological complications are usually considered to be more clinically important. On the other hand, postirradiation sinusitis is often neglected or overlooked because symptoms are usually non-specific or not clinically disturbing. This leads to the under-reporting of this complication. We report the case history of a patient with NPC who developed recurrent and debilitating bouts of yawning attacks 13 years after radiotherapy. The attacks were thought to be due to the compression of the hypothalamus by a large mucocoele in the sphenoidal sinus, which was successfully managed by surgical drainage.

Inhibition of muscle sympathetic nerve activity during yawning

Yawning is a complex event that depends largely on the autonomic nervous system. Microneurographic techniques were used to study the mechanism involved in yawning. A series of spontaneous yawns displayed by a healthy 39-year-old male offered us the opportunity to study the muscle sympathetic nerve activity (MSNA) during this phenomenon. It was found that 2 s of yawning inhibited the MSNA recorded at the right peroneal nerve in the lateral knee area, while 3 s of slow expiration succeeding a yawn provoked an MSNA discharge. Blood pressure decreased with each slow expiration by 5-6 mmHg, and increased again with the renewed MSNA discharge. We conclude that yawning is associated with a sympathetic suppression that favours a parasympathetic dominance, as indicated by the MSNA and the decrease in blood pressure. The slow expiration following a yawn is associated with a sympathetic activation marked by an MSNA discharge and an increase in blood pressure.