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Research Christmas 2008: Music

Head and neck injury risks in heavy metal: head bangers stuck between rock and a hard bass

BMJ 2008; 337 doi: (Published 18 December 2008) Cite this as: BMJ 2008;337:a2825

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Head bangers may provide important clues to understanding shaken baby syndrome

Patton and McIntosh (1) describe the potential for mild traumatic
brain injury and neck injury amongst head bangers, but only cite three
documented injuries: a stroke, a traumatic aneurysm of the cervical
vertebral artery and a subdural haematoma. With no overall prevalence
data for head banging, it is impossible to determine an incidence of
intracranial trauma, but regardless of incidence, interesting parallels
emerge with respect to shaken baby syndrome. The incidence of the latter
is estimated to be 21 per 100,000 babies under 1 year, with a case
fatality rate of 27% and significant morbidity amongst survivors (2).
Both conditions are presumed to involve a violent shaking of the head
resulting in substantial angular acceleration. In shaken babies, this is
presumed to be an involuntary forwards-backwards motion, sometimes
suddenly interrupted by contact with a solid surface (shaken-impact
syndrome) and caused by a carer shaking the baby (3). In head bangers
Patton and McIntosh describe different styles, including up-down,
circular, full body and side-to-side; contact of the head with a stage is

So wherein the differences? One presumes that head bangers retain
some control of the degree of head movement, though in the heat of a heavy
metal concert this may be debatable. The age of the head bangers, their
relative head to body weight and the strength of their neck muscles may
all protect against intracranial damage; factors that are presumed to
contribute to the vulnerability of infants to shaking.

These similarities and differences are worthy of further study.
Drawing on postulated theories in relation to shaken baby syndrome, one
could hypothesize that head bangers are at risk of subdural haemorrhages
due to shearing of the bridging veins during rapid angular acceleration
and deceleration; one could further hypothesize that this risk is
mitigated by the factors described above, particularly if the forces
involved were shown to be less than those described in biomechanical
models of shaken baby syndrome. Both hypotheses are amenable to testing:
first by undertaking brain scans (and ophthalmoscopy, looking for evidence
of retinal haemorrhages) of head bangers after a concert; and second by
movement analysis of a head banger’s head and neck during the concert
itself. Such experiments would be ethical, relatively easy to conduct,
and could potentially provide much needed insight into the tragedy of
infants with subdural haemorrhage.

1. Patton D, McIntosh A. Head and neck injury risks in heavy metal:
head bangers stuck between rock and a hard bass. BMJ 2008;337:a2825.

2. Jayawant S, Rawlinson A, Gibbon F, Price J, Schulte J, Sharples P, et
al. Subdural haemorrhages in infants: population based study. BMJ

3. Cobley C, Sanders T. Non-accidental head injury in young children :
medical, legal and social responses. London: Jessica Kingsley, 2007.

Competing interests:
Dr Sidebotham acts as both a professional and expert witness in child protection cases

Competing interests: No competing interests

29 December 2008
Peter D Sidebotham
Senior Lecturer in Child Health
Warwick Medical School, University of Warwick, Coventry CV4 7AL