Cough, exertional, and other miscellaneous headaches.
ABSTRACT We have discussed several miscellaneous headache disorders not associated with structural brain disease. The first group included those headaches provoked by "exertional" triggers in various forms. These include benign cough headache, BEH, and headache associated with sexual activity. The IHS diagnostic criteria were discussed. Benign exertional headache and cough headache were discussed together because of their substantial similarities. In general, BEH is characterized by severe, short-lived pain after coughing, sneezing, lifting a burden, sexual activity, or other similar brief effort. Structural disease of the brain or skull was the most important differential diagnosis for these disorders, with posterior fossa mass lesions being identified as the most common organic etiology. Magnetic resonance imaging with special attention to the posterior fossa and foramen magnum is the preferred method for evaluating these patients. Indomethacin is the treatment of choice. The headache associated with sexual activity is dull in the early phases of sexual excitement and becomes intense at orgasm. This headache is unpredictable in occurrence. Like BEH, the headache associated with sexual activity can be a manifestation of structural disease. Subarachnoid hemorrhage must be excluded, by CT scanning and CSF examination, in patients with the sexual headache. Benign headache associated with sexual activity has been successfully treated with indomethacin and beta-blockers. The second miscellaneous group of headache disorders includes those provoked by eating something cold or food additives, and by environmental stimuli. Idiopathic stabbing headache does not have a known trigger and appears frequently in migraineurs. Its occurrence may also herald the termination of an attack of cluster headache. Indomethacin treatment provides significant relief. Three headaches triggered by substances that are eaten were reviewed: ingestion of a cold stimulus, nitrate/nitrite-induced headache, and MSG-induced headache. For the most part, avoidance of these stimuli can prevent the associated headache. Lastly, we reviewed headache provoked by high altitude and hypoxia. The headache is part of the syndrome of AMS during its early or benign stage and the later malignant stage of HACE. The pain can be exacerbated by exercise. The best treatment is prevention via slow ascent and avoidance of respiratory depressants. Acetazolamide and dexamethasone have proved useful in preventing this syndrome.
- [Show abstract] [Hide abstract]
ABSTRACT: Activity-related headaches can be provoked by Valsalva maneuvers ("cough headache"), prolonged exercise ("exertional headache") and sexual excitation ("sexual headache"). These entities are a challenging diagnostic problem as can be primary or secondary and the etiologies for secondary cases differ depending on the headache type. In this paper we review the clinical clues which help us in the differential diagnosis of patients consulting due to activity-related headaches. Cough headache is the most common in terms of consultation. Primary cough headache should be suspected in patients older than 50 years, if pain does not predominate in the occipital area, if pain lasts seconds, when there are no other symptoms/signs and if indomethacin relieves the headache attacks. Almost half of cough headaches are secondary, usually to a Chiari type I malformation. Secondary cough headache should be suspected in young people, when pain is occipital and lasts longer than one minute, and especially if there are other symptoms/signs and if there is no response to indomethacin. Every patient with cough headache needs cranio-cervical MRI. Primary exercise/sexual headaches are more common than secondary, which should be suspected in women especially with one episode, when there are other symptoms/signs, in people older than 40 and if the headache lasts longer than 24 hours. These patients must have quickly a CT and then brain MRI with MRA or an angioCT to exclude space-occupying lesions or subarachnoid hemorrhage.Headache The Journal of Head and Face Pain 10/2014; · 2.94 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Zusammenfassung Die Dissektion einer hirnversorgenden Arterie ist die zweithäufigste Ursache von ischämischen Schlaganfällen bei Patienten unter 45 Jahren. Im vorliegenden Fall wird von einem Patienten berichtet, der postkoital stärkste holozephale Kopfschmerzen und ein diskretes Horner-Syndrom links entwickelte. Radiologisch konnte eine Dissektion der linken A. carotis interna gesichert werden. In der Notfallbehandlung von Patienten mit dem Leitsymptom Kopfschmerz muss zwischen symptomatischen, prinzipiell gefährlichen Kopfschmerzsyndromen und idiopathischen, in der Regel ungefährlichen Syndromen unterschieden werden. Die ernsthaften Ursachen von Kopfschmerzen wie Subarachnoidalblutung, Sinusthrombose und Dissektion einer hirnversorgenden Arterie sollten sicher erkannt werden. Klassische Leitsymptome einer Karotisdissektion sind: schmerzhaftes Horner-Syndrom, Karotidynie oder ein ziehender, oft pulsierender Nackenschmerz. Als beweisend für die Diagnose gilt die MRT mit Nachweis des intramuralen Wandhämatoms in T1- und T2-gewichteten axialen Bildern. Die empfohlene Therapie ist zurzeit die Behandlung mit unfraktioniertem Heparin, bis die PTT 2- bis 3-fach verlängert ist. Nachfolgend wird die orale Antikoagulation mit Phenprocoumon mit einer Ziel-INR von 2–3 zur Sekundärprophylaxe über 3 bis 24 Monate empfohlen.Intensivmedizin + Notfallmedizin 01/2011; 48(1):48-52.
Article: Cough, Exercise, and Sex Headaches.[Show abstract] [Hide abstract]
ABSTRACT: Cough, exercise, and sex headaches are underrecognized distinct but related syndromes, triggered by rapid rises in intra-abdominal pressure. All may occur as a manifestation of a possible underlying, symptomatic etiology, and additional diagnostics should typically be pursued to rule out serious causes. Cough headaches may be more common in certain subgroups or settings. Based on recent epidemiologic data, exercise-related headache may be more common than previously thought. There is no evidence that different pain types in sexual headaches are distinct from a pathophysiologic standpoint. Each of these headache syndromes is reported to be responsive to indomethacin.Neurologic Clinics 05/2014; 32(2):433-450. · 1.61 Impact Factor