The term "headbanging" does not sound particularly healthy, but can any medical harm really come from rocking out in time to the music at a concert using a "violently rhythmic movement of the head"? The case of a Motörhead fan published in The Lancet suggests it can.
The authors of the case study say it is the first reported example of chronic bleeding in the brain brought on by this type of rock music appreciation favored by heavy metal fans.
The 50-year-old man in question presented to the neurosurgical department of Hannover Medical School in Germany in January 2013, after 2 weeks of a worsening constant headache that affected his whole head.
Scan showing the patient's subdural hematoma.
Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
Apart from this, there was nothing remarkable about the medical history of the man - who wishes to remain anonymous - and he had not suffered any head trauma.
There was no substance misuse, and a neurological examination and laboratory studies came back normal. A cranial CT scan, however, showed the man had a chronic subdural hematoma on the right side of his brain.
This is the first reported case to suggest that headbanging can cause chronic subdural hematoma - that is, the type that develops over a number of days - although the authors did uncover three cases of subdural hematoma secondary to headbanging that were acute or sub-acute.
The clinicians knew that headbanging could also be associated with injuries such as carotid artery dissection (which starts with a tear in one of the arteries in the neck), whiplash, mediastinal emphysema, and odontoid neck fracture (a type of break in the second cervical vertebra).
The authors say the headbanging injury experienced by the Motörhead follower could be an underreported phenomenon.
"Even though there are only a few documented cases of subdural hematomas, the incidence may be higher because the symptoms of this type of brain injury are often clinically silent or cause only mild headache that resolves spontaneously," lead author Dr Ariyan Pirayesh Islamian explains.
Brisk forward and backward forces
As for an explanation of how exactly the bleed forms in the space between the skull and the surface of the brain, the authors say:
"We assume that headbanging, with its brisk forward and backward acceleration and deceleration forces, led to rupturing of bridging veins causing hemorrhage into the subdural space."
Headbanging can be defined as "violently rhythmic movement of the head" in time to music, typically of the metal genre.
While it is a serious condition, surgeons were able to resolve it for the Motörhead man. They made a burr hole in his skull through which to remove the blood clot that had developed. The space under the skull could then be drained for 6 days after the surgery, and his headache subsided. He was reported to be well on his last examination 2 months post-treatment.
The authors outline that headbanging was introduced in the early 1970s. "The number of avid aficionados is unknown." They cite that Motörhead were also "seminal in the creation of the speed metal sub-genre, where tempos greater than 200 beats per minute are aspired to."
"While such shows are enjoyable and stimulating for the audience, some fans might be endangered by indulging in excessive headbanging."
The authors offer a final (safe) nod to their patient's rock idols and a cautionary tale at the end of the article:
"This case serves as evidence in support of Motörhead's reputation as one of the most hardcore rock'n'roll acts on earth, if nothing else because of their contagious speed drive and the hazardous potential for headbanging fans to suffer brain injury."