What should you know about hair combing syncope?

Pain from pulling the hair, standing still, heat, fear or an awkward neck position may activate the body's fainting reflex. Warning symptoms can include nausea, sweating, warmth, blurred vision or ringing in the ears. The person usually becomes pale and briefly loses awareness, then starts recovering after lying down.

Fainting can also be associated with dehydration, low blood sugar or anaemia. A racing or irregular heartbeat raises a different concern, including a heart rhythm problem such as atrial fibrillation, so the circumstances and medical history matter.

Stop combing, help the person lie flat and raise the legs if there is no injury. Loosen tight clothing, keep the area cool and check that breathing is normal. Do not give food or drink until the person is fully alert. Once recovered, rise slowly, drink fluids if suitable and avoid combing alone until the cause has been reviewed. Record the trigger, warning symptoms and recovery time for the clinician.

Call emergency services if the person does not wake promptly, has trouble breathing, chest pain, a severe injury, seizure-like movements, or remains confused. Prompt medical review is also needed for fainting during exercise, fainting without warning, repeated episodes, a family history of sudden cardiac death, or palpitations. A first faint should be assessed even when combing appears to be the trigger.

Could this be a reflex faint or another cause? Do I need an ECG or blood tests? Should I change how I comb my hair? What warning symptoms mean I should seek emergency help?