Chronic subdural hematomas occur mainly in older patients with a male to female ratio of 3: 1. The most common cause is a mild, but direct, head injury. Rare causes include severe sneezing or coughing, strain from heavy lifting, and whiplash injury. Medical problems such as hypertension, diabetes, anticoagulation therapy (e.g. coumadin), alcohol use, and seizures may also predispose patients to developing chronic subdural hematomas.

There have been several reported cases of headaches and chronic subdural hematoma formation in roller coaster enthusiasts. Subdural hemorrhage can occur from the tearing of bridging veins by tensile and shearing stresses caused by rotatory acceleration, and up-and-down/to-and-fro movements in giant roller coasters. This in turn can lead to chronic subdural hematomas through neomembrane formation. In one case, a 26-year old man developed bilateral subdural hematomas after riding a double-loop, corkscrew type of roller coaster. In another, a 73-year old man on coumadin developed a left-sided subdural hematoma and a parenchymal temporal hematoma five days after a roller coaster ride, with a fatal outcome despite surgery. In a third case, a 24-year old female without past medical problems developed a constant headache after riding three different roller coasters twice in one day. Although she was first diagnosed with tension headaches, the headaches were unrelieved, becoming worse in the evening. An MRI revealed bilateral subdural hematomas with neomembranes, requiring surgical evacuation with alleviation of her symptoms.

People who ride roller coasters and experience headaches, even if delayed, should consider the possibility of cervical problems like whiplash injury or subdural hematomas. Patients who are on blood thinners should stay off rides which cause an acceleration-deceleration injury. People who are older or who have weak neck/shoulder muscles are also more susceptible to violent whiplash movements. Subdural hematomas are treatable, but the timing is critical, because the affected brain tissue will die. Builders and designers of amusement parks and potential passengers should be aware of this risk.

For more information read:

Fukutake, M.D. et al. Roller Coaster Headache and Subdural Hematoma. Clinical/Scientific Notes: American Academy of Neurology. 2000: P. 264.

Davis, Jeanie Lerche. New Worries for Roller Coaster Riders: Giant Coasters May Cause Brain Injury. WebMD Medical News. 2000.

Lisa Palen Hu, M.D.