Yawning is a physiological behavior, an
emotional stereotypy that indicates the
homeostatic process of the mechanisms
regulating rhythms such as sleeping-waking,
hunger-satiety or mating-relaxation,
generated by the diencephalon. As with all
physiological behaviors, its deregulation
reveals disorders. However, a property unique
to yawning, which is nevertheless
physiological, is its ability to trigger
certain disorders, and conversely, to cure
others !
Frustration due to an incomplete or
inharmonious development of a yawn is a
frequent complaint. Yawning is a stretching
of respiratory muscles and muscles of the
face, and is sometimes associated with a
generalized muscular stretching of the trunk
and limbs. The yawner perceives differences
in muscle tonus, a veritable and conscious
extraction of the progress of the phenomenon,
of its stimulus and its contextual valence,
through interoceptive pathways (projections
by the lateral spinothalamic tract onto the
insular cortex), leading to a hedonistic
perception. The dissatisfaction felt seems to
be linked to an unconscious inhibition of the
"letting go" that underlies a complete yawn.
Therapeutic interventions for anxiety states
or for insomnia, such as relaxation or
sophrology, do in fact use the control of
yawning as a means of relaxation or an
anti-stress aid, a veritable proprioceptive
rehabilitation of the body scheme (Craig,
2003; Craig, 2009).
André-Thomas, de Ajuriaguerra J.
Etude sémiologique du tonus
musculaire. Flammarion Ed. Paris 1949.
844p.
Adamantidis A, de Lecea L. Sleep and
metabolism: shared circuits, new connections.
Trends Endocrinol Metab.
2008;19(10):362-370.
Andy OJ, Jurko M. Diencephalic seizures.
Appl Neurophysiol. 1983;46(1-4):62-67.
Arai K, Kita K, Komiyama A et al.
Progressive dysautonomia in hemangioblastoma
in the region of the fourth ventricle. No To
Shinkei. 1986;38(2):195-200.
Avidan A. Dislocation of the
temporomandibular joint due to forceful
yawning during induction with propofol. J
Clin Anesth. 2002;14(2):159-160.
Bateman DE. Neurological assessment of
coma. JNNP. 2001;71(suppl I);113-117.
Bauer G, Gerstenbrand F, Hengl W.
Involuntary motor phenomena in the locked-in
syndrome. J Neurol. 1980;223(3):191-198.
Bauer G, Prugger M, Rumpl E. Stimulus
evoked oral automatismsin the locked-in
syndrome. Arch Neurol.
1982;39(7):435-436.
Beale MD. Murphree TM.Excessive yawning
and SSRI therapy. Int. J. Neuropsycho
pharmacol. 2000;3:275-276.
Beckmann H, Zimmer R. An ethological
interpretation of stereotypy induced by
environmental stimulus. Arch Psychiatr
Nervenkr. 1981;230(1):81-89.
Benoit, A. Caplier, A.
Hypovigilence analysis: open or closed eye or
mouth? Blinking or yawning frequency?
Advanced Video and Signal Based Surveillance.
AVSS 2005:207-212.
Bidat E, Sznajder M, Fermanian C, al. A
diagnostic questionnaire for the
hyperventilation syndrome in children. Rev
Mal Respir. 2008;25(7):829-838.
Billeth R, Jorgler E, Baumhackl U.
Bilateral anterior operculum syndrome.
Nervenarzt. 2000;71(8):651-654.
Blau JN. Migraine postdromes: symptoms
after attacks. Cephalalgia.
1991;11(5):229-231.
Blau JN, Engel HO. Premonitory and
prodromal symptoms in cluster headache.
Cephalalgia. 1998;18(2):91-93
Blin O, Masson G, Azulay JP, Fondarai J,
Serratrice G. Apomorphine-induced blinking
and yawning in healthy volunteers. Br J Clin
Pharmacol. 1990;30(5):769-773.
Blin O, Azulay JP, Masson G, Aubrespy G,
et al. Apomorphine-induced yawning in
migraine patients: enhanced responsiveness.
Clin Neuropharmacol. 1991;14(1):91-95.
Boeve BF, Wijdicks EF, Benarroch EE, et
al. Paroxysmal sympathetic storms
("diencephalic seizures") after severe
diffuse axonal head injury. Mayo Clin Proc.
1998;73(2):148-152.
Brown RP, Gerbarg PL. Sudarshan Kriya
Yogic Breating in the treatment of stress,
anxiety and depression. J Alternat Complement
Med. 2005;11(1):189-201.
Bullard DE. Diencephalic seizures:
responsiveness to bromocriptine and morphine.
Ann Neurol. 1987;21(6):609-611.
Cattaneo L, Cucurachi L, Chierici E, et
al. Pathological yawning as a presenting
symptom of brainstem ischaemia in two
patients. JNNP. 2006;77(1):98-100.
Cerbo R, Barbanti P, Buzzi MG, et al.
Dopamine hypersensitivity in migraine: role
of the apomorphine test. Clin Neuropharmacol.
1997;20(1):36-44.
Collins GT, Newman AH, Grundt P, et al.
Yawning and hypothermia in rats: effects of
dopamine D3 and D2 agonists and antagonists.
Psychopharmacology (Berl).
2007;193(2):159-170.
Colosimo C, Francesco E, Pontieri V, et
al. Yawning in Parkinson's disease.
Neurology. 1999;52(2):428.
Cooper SJ, Dourish CT. Neural basis of
drug induced yawning in neurobiology of
stereotyped behaviour. Clarendon Press.
Oxford Ed. 1990:91-116.
Craig AD. Interoception: the sense of the
physiological condition of the body. Curr
Opin Neurobiol. 2003;13(4):500-505.
Craig AD. How do you feel - now ? The
anterior insula and human awareness. Nature
Rev Neurosci. 2009;10(1):59-70.
Crosby L, Parsons LC. Clinical neurologic
assessment tool: development and testing of
an instrument to index neurologic status.
Heart Lung. 1989;18(2):121-129.
Cronin TG. Yawning : an early
manifestation of vasovagal reflex. Am J
Roentgenology. 1988;150:209.
d'Andréa C, Méliet JL,
Staikowski F. Peripheral facial palsy
secondary to middle-ear overpressure Presse
Med. 2008;37(4 Pt 2):643-647. (French).
De Las Cuevas C, Sanz EJ.
Duloxetine-induced excessive disturbing and
disabling yawning. J Clin Psychopharmacol.
2007;27(1):106-107.
Del Bene E, Poggioni M. Video assessment
of yawning induced by sublingual apomorphine
in migraine. Headache.
1994;34(9):536-538.
Dewey RB, Hutton JT, Lewitt PA, Factor
SA. A randomized, double-blind,
placebo-controlled trial of subcutaneously
injected apomorphine for parkinsonian of
state events. Arch Neurol.
2001;58(9):1385-1392.
de Wied D. Behavioral pharmacology of
neuropeptides related to melanocortins and
the neurohypophyseal hormones. Eur J
Pharmacol. 1999;375(1-3):1-11.
D'Mello DA, Vincent FM, Lerner MP.
Yawning as a complication of
electroconvulsive therapy and concurrent
neuroleptic withdrawal. J Nerv Ment Dis.
1988;176(3):188-189.
Evans EB. Yawning in pharyngeal
obstruction. Br Med J.
1978;1(6110):443-444.
Evans SM, Griffiths RR. Caffeine
withdrawal: a parametric analysis of caffeine
dosing conditions. J Pharmacol Exp Ther.
1999;289(1):285-294.
Feldman VB. Eagle's syndrom: a case of
symtomatic calcification of the stylhyoid
ligaments. J Can Chiropr Assoc
2003;47(1):21-27.
Forté MC. Le Bâillement.
Thèse pour le doctorat en
médecine. Bordeaux 1982 n°117.
Amicale Corporative des Etudiants en
Médecine de Bordeaux. 89p.
Freye E, Levy J. Acute abstinence
syndrome following abrupt cessation of
long-term use of tramadol: a case study. Eur
J Pain. 2000;4(3):307-311.
Freye E, Levy J. Constitutive opioid
receptor activation: a prerequisite mechanism
involved in acute opioid withdrawal. Addict
Biol. 2005;10(2):131-137.
Furukawa T. Yawning behavior for
preclinical drug evaluation. Meth Find Exp
Clin Phamaco. 1996;18(2):141-155.
Gallezzo
SR . Examining the connection between
yawning and depression. 2006.
Ghika J, Vingerhoets F, Bogousslavsky J.
Dissociated preservation of
automatic-voluntary jaw movements in a
patient with biopercular and unilateral
pontine infarcts. Eur Neurol.
2003;50(3):185-188.
Gilles de la Tourette G, Huet E, Guinon
G. Contribution à l'étude des
bâillements hystériques.
Nouvelle Iconographie de la
Salpêtrière. Paris. Lecrosnier
& Babé. 1890;3:97-119.
Giroud M, Sautreaux JL, Thierry A, et al.
Diencephalic epilepsy with congenital
suprasellar arachnoid cyst in an infant.
Childs Nerv Syst. 1988;4(4):252-254.
Goh KY, Conway EJ, Da Rosso RC, et al.
Sympathetic storms in a child with a midbrain
glioma: a variant of diencephalic seizures.
Pediatr Neurol. 1999;21(4):742-744.
Goldberg RL. Sustained yawning as a side
effect of imipramine. Int J Psychiatry Med.
1983-84;13(4)277-280.
Goldie L, Green JM. Yawning and epilepsy.
J Psychosomatic Res. 1961;5:263-268.
Goren J, Friedman J. Yawning : an aura
for an L-Dopa induced "of" in Parkinson's
disease. Neurology. 1998;50(3):823.
Gowers WR. Epilepsy and other chronic
convulsive diseases:their causes, symptoms
& treatment. New York, Willam Wood and
Co. 1885. 255p.
Gowing L, Ali R, White J. Buprenorphine
for the management of opioid withdrawal.
Cochrane Database Syst Rev.
2004;(4):CD002025.
Graybiel A, Knepton J. Sopite syndrome: a
sometimes sole manifestation of motion
sickness. Aviat Space Environ Med.
1976;47(8):873-882.
Greco M, Baenninger R. On the context of
yawning: when, where and why?
The Psychological Recod.
1993;43:175-183.
(http://baillement.com/recherche/questionnaire.html)
Grönqvist J, Häggman-Henrikson
B, Eriksson PO. Impaired jaw function and
eating difficulties in whiplash-associated
disorders. Swed Dent J.
2008;32(4):171-177.
Grover M, Drossman DA.
Psychopharmacologic and behavioral treatments
for functional gastrointestinal disorders.
Gastrointest Endosc Clin N Am.
2009;19(1):151-170.
Gschwend J. Yawning in a case with
transsecting glioma of the pons. Fortschritte
Neurol Psychiat und ihrer Grenzgebiete.
1977;45(12):652-655.
Gugle MM. Etiology, pathogenesis and
treatment of habitual dislocations of the
T.M. Joints . Indian J Dent Res.
2002;13(2):88-94.
Gutierrez-Alvarez AM. Do your patients
suffer from excessive yawning? Acta Psychiat
Scandinavica. 2007;115(1):80-81.
Harada KI. Paroxetine-induced excessive
yawning. Psychiat Clin Neurosci.
2006;60:260.
Helöe B, Helöe LA. Frequency
and distribution of myofascial
pain-dysfunction syndrome in a population of
25-year-olds. Community Dent Oral Epidemiol.
1979;7(6):357-360.
Jackson JH. Selected Writings of John
Hughlings Jackson. Edited by James Taylor On
Epilepsy and Epileptiform Convulsions.
London, 1931.
Jacome DE. Compulsive yawning as migraine
premonitary symptom. Cephalalgia.
2001;21(5):623-625.
Jacome DE. Primary yawning headache.
Cephalalgia. 2001;21(6)697-699.
Jacome DE. Extracephalic yawning pain.
Cephalalgia. 2004;24(5):411-413.
Jurko MF, Andy OJ. Post-lesion yawning
and thalamotomy site. Appl Neurophysiol.
1975;38:(1):73-79.
Klécha A, Hafian H, Devauchelle B
et al. A Report of Post-Traumatic Eagle's
Syndrome. Int J Oral Maxillofac Surg.
2008;37(10):970-972.
Klein DF. False suffocation alarms,
spontaneous panics, and related conditions,
an integrative hypothesis. Arch Gen
Psychiatry. 1993;50(4):306-317.
Kolls BJ, Stacy M. Apomorphine: A Rapid
Rescue Agent for the Management of Motor
Fluctuations in Advanced Parkinson Disease.
Clinical Neuropharmacology.
2006;29(5):292-301.
Krasnianski M, Gaul C, Neudecker S, et
al. Yawning despite trismus in a patient with
locked-in syndrome caused by a thrombosed
megadolichobasilar artery. Clin Neurol
Neurosurg. 2003;106(1):44-46.
Lafleur J, Reiher J. Pseudo-absences. EEG
Clin neurophysiol. 1977;43:279-280.
Lagares A, Gomez P, Perez-Nunez A, et al.
Short-lasting unilateral neuralgiform
headache with conjonctival injection and
tearing syndrome. Neurosurgery.
2005;56(2):E413.
Lal S. Apomorphine in the evaluation of
dopaminergic function in man. Progr
Neuro-psychopharmacol Biol Psych.
1988;12(2-3):117-164.
Lal S, Tesfaye Y, Thavundayil JX. et al.
Effect of time-of-day on yawning response to
apomorphine in normal subjects.
Neuropsychobiology. 2000;44(4):178-180.
Lane JD, Phillips-Bute BG. Caffeine
deprivation affects vigilance performance and
mood. Physiol Behav. 1998;65(1):171-175.
Laskiewicz A. Yawning with regard to the
respiratory organs and the ear. Acta Oto
laryngologica (Stockholm).
1953;43(2-3):267-270.
Laurent-Vannier A, Fadda G, Laigle P, et
al. Syndrome de Foix Chavany Marie d'origine
traumtaique. Rev Neurol.
1999;155(5):387-390.
Lepp FH. Remarques sur la signification
physiologique du bâillement. Bull Group
Int Rech Sci Stomtol Odontol.
1982;25:251-290.
Lewitt PA, Ondo WG, Van Lunen B, et al.
Open-Label Study Assessment of Safety and
Adverse Effects of Subcutaneous Apomorphine
Injections in Treating "Off" Episodes in
Advanced Parkinson Disease. Clin
Neuropharmacol. 2009. In press.
Louwerse E. Forced yawning as a
pseudobulbar sign in amyotrophic lateral
sclerosis. J Neurosci Res. 1998;sup:392.
Lum LM, Connolly MB, Farrell K, et al.
Hyperventilation-induced high-amplitude
rhythmic slowing with altered awareness: a
video-EEG comparison with absence seizures.
Epilepsia. 2002;43(11):1372-1378.
Manish M, Veenu S. Persistent vegetative
state. Neurology. 2007;68(19):1635.
Marcus N. Yawning : analytic and
therapeutic considerations. Int J Child
Psychotherapy. 1973;2(4):406-418.
McCorkell SJ. Fractures of the styloid
process and stylohyoid ligament: an uncommon
injury. J Trauma.
1985;25(10):1010-1012.
McGinnis JM Jr. Fracture of an ossified
stylohyoid bone. Arch Otolaryngol.
1981;107(7):460.
McLean JD, Forsythe RG, Kapkin IA.
Unusual side effects of clomipramine
associated with yawning. Can J Psychiatry.
1983;28(7):569-570.
Marcos MM, Velicia MR, Aguirre JJ.
Primary stabbing headache with buccal
triggers. Eur Neurol. 2005;53(2):91-92.
Marsden CD Blepharospasm-oromandibular
dystonia syndrom. JNNP.
1976;39(12):1204-1209.
Medrano V, Selles-Galiana MF,
Fernandez-Izquierdo S, et al. Yawning and
temporal lobe epilepsy. Rev Neurol (Spain).
2005;41(1):63-64.
Meige H, Feindel G. Les tics et leur
traitement. Paris. Masson. 1902. 633p.
Minagar A, Sheremata W. Glossopharyngeal
neuralgia and multiple sclerosis. Neurology.
2000; 54(6):1368-1370.
Mogilnicka E, Klimek V. Drugs affecting
dopamine neurons and yawning behavior.
Pharmacol Biochem Behav.
1977;7(4):303-305.
Muchnik S, Finkielman S, Semeniuk G, de
Aguirre MI. Yawning and temporal lobe
epilepsy. Medicina (B Aires).
2003;63(2):137-139.
Mupparapu M, Robinson MD. The mineralized
and elongated styloid process: a review of
current diagnostic criteria and evaluation
strategies. Gen Dent. 2005;53(1):54-59.
Myrhaug H. Luxation of the mandible in
yawning. Tidsskr Nor Laegeforen.
1961;81:362-365. (Norwegian).
Nardi AE, Freire RC, Zin WA. Panic
disorder and control of breathing. Respir
Physiol Neurobiol. 2009. in press.
Nassif NJ, Talic YF. Classic symptoms in
temporomandibular disorder patients: a
comparative study. Cranio.
2001;19(1):33-34.
Ndiokwelu E. Bilateral dislocation of the
mandible. 2 cases in a nuclear family.
Odontostomatol Trop. 2005;28(112):27-30.
Oh JY, Kim JE, Park KD et al. A case of
familial inverse Marcus Gunn phenomenon.
JNNP. 2003;74(2):277-282.
Ostrea EM Jr, Chavez CJ, Strauss ME. A
study of factors that influence the severity
of neonatal narcotic withdrawal. Addict Dis.
1975;2(1-2):187-199.
Pae CU, Kim JJ, Lee CU, Lee SJ, et al.
Injured temporomandibular joint associated
with fluoxetine-monotherapy-induced repeated
yawning. Gen Hosp Psychiatry.
2003;25(3):217-218.
Penfields W, Jasper H. Epilepsy and the
functionnal anatomy of the human brain.
Little, Brown & Comp. Boston. 1954.
896p.
Philippot P, Chapelle G, Blairy S.
Respiratory feedback in the generation of
emotion. Cognition Emotion.
2002;16(5):605-627.
Phillips-Bute BG, Lane JD. Caffeine
withdrawal symptoms following brief caffeine
deprivation Physiol Behav.
1997;63(1):35-39.
Postert T, Pöhlau D, Meves S, et al.
Pathological yawning as a symptom of multiple
sclerosis. J Neurol.
1996;243(3):300-301.
Quessard A, Barrière P, Levy F, et
al. Delayed diagnosis of a postanaesthesia
temporomandibular joint dislocation. Ann Fr
Anesth Reanim. 2008;27(10):846-849.
Quintela E, Castillo J, Munoz P, et al.
Premonitory and resolution symptoms in
migraine: a prospective study in 100
unselected patients.Cephalalgia.
2006;26(9):1051-1060.
Riley DE. Paroxysmal kinesigenic dystonia
associated with a medullary lesion. Mov
Disord. 1996;11(6):738-740.
Robe LB, Gromisch DS, Iosub S. Symptoms
of neonatal ethanol withdrawal. Curr Alcohol.
1981;8:485-493.
Sandyk R. Excessive yawning and
progressive supranuclear palsy. Int J
Neurosci. 1987;34(1-2):123-124.
Saper CB. The central autonomic Nervous
System: conscious visceral perception and
autonomic pattern generation. Annu Rev
Neurosci. 2002;25:433-469.
Sato F, Aoki H, Nakamura K, T, et al.
Suppressive effects of chronic
hyperprolactinemia on penile erection and
yawning following administration of
apomorphine to pituitary-transplanted rats. J
Androl. 1997;18(1):21-25.
Sato-Suzuki I, Kita I, Seki Y, et al.
Cortical arousal induced by microinjection of
orexins into the paraventricular nucleus of
the rat. Behav Brain Res.
2002;128(2):169-177.
Shilkret H. Psychogenic sneezing and
yawning. Psychosom Med.
1949;11(2):127-128.
Schoonman GG, Evers DJ, Terwindt GM, et
al.The prevalence of premonitory symptoms in
migraine: a questionnaire study in 461
patients. Cephalalgia.
2006;26(10):1209-1213.
Sicard JA et Paraff A. Fou rire syncopal
et bâillements au cours de
l'encéphalite
épidémique. Bull Mém Soc
Méd Hôp Paris. 1921;45:232.
Skelton A, Fried R. Headphone neuralgia.
N Engl J Med. 1995;333(26):1786-1787.
Sommet A, Desplas M, Lapeyre-Mestre M,
Montastruc JL. Drug-induced yawning: a review
of the French pharmacovigilance database.
Drug Saf. 2007;30(4):327-331.
Symonds CP. Discussion on faints and
fits. Proc Royal Soc. Med.
1950;43(7):507-518.
Tassinari CA, Gardella E, Meletti S et
al. The neuro-ethological interpretation of
motor behaviours in
'nocturnal-hyperkinetic-frontalseizures':
emergence of 'innate' motor behaviours and
role of cental pattern generators. In Frontal
Seizures and Epilepsies in Children.
Beaumanoir A, Andermann F, Chauvel P et al.
Montrouge. J. Libbey Eurotext.
2003;43-48.
Tesfaye Y, Lal S. Hazard of yawning.
CMAJ. 1990;142(1):15.
Tjakkes GH, Rijnvis DJ, Timmenga NM,
Stegenga B. A patient with glossopharyngeal
neuralgia: a (un)known trap. Ned Tijdschr
Tandheelkd. 2008;115(5):263-265.
(Dutch).
Urba-Holmgren R, Holmgren B, Rodriguez R,
et al. Serotoninergic modulation of yawning.
Pharmacol Biochem Behav.
1979;11:371-372.
Ugboko VI, Oginni FO, Ajike SO, et al. A
survey of temporomandibular joint
dislocation: aetiology, demographics, risk
factors and management in 96 Nigerian cases.
Int J Oral Maxillofac Surg.
2005;34(5):499-502.
Unnikrishnan KP, Sinha PK, Rao S.
Mandibular dislocation from yawning during
induction of anesthesia. Can J Anaesth.
2006;53(11):1164-1165.
von Economo C. Encephalitis Lethargica,
its sequellae and treatment. Oxford Univ
Press. London. 1931. 200p.
Walusinski O. Yawning and stroke.
Editorial Commentaries. JNNP.
2007;78(11):1166.
Wicks P. Excessive yawning is common in
the bulbar-onset form of ALS. Acta Psychiatr
Scand. 2007;116(1):76.
Williams DR. The yawning reflex: an upper
motor neuron sign in amyotrophic lateral
sclerosis. Neurology.
2000;55(10):1592-1593.
Winther B, Gwaltney JM Jr, Phillips CD,
et al. Radiopaque contrast dye in nasopharynx
reaches the middle ear during swallowing
and/or yawning. Acta Otolaryngol.
2005;125(6):625-628.
Wong KY, Ngan KC, Sin VC et al.
Sphenoidal sinus mucocoele and yawning after
radiation treatment for nasopharyngeal
carcinoma. Clinical Oncol.
1997;9(6):415-417.
Yankovsky AE, Andermann F, Dubeau F.
Post-ictal forceful yawning in a patient with
nondominant hemisphere epilepsy. Epileptic
Disord. 2006;8(1):65-69.
Yap AU, Chua EK, Hoe JK. Clinical TMD,
pain-related disability and psychological
status of TMD patients. J Oral Rehabil.
2002;29(4):374-80.
Zafar H, Nordh E, Eriksson PO. Temporal
coordination between mandibular and head-neck
movements during jaw opening-closing tasks in
man. Arch Oral Biol. 2000;45(8):675-682.
