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.
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ABSTRACT: Rare primary headache syndromes Primary headaches include common forms such as migraine, tension-type headache, and the less frequent cluster headache. Besides, several uncommon primary headaches were included in the section on 'Cluster headache and other trigeminal autonomic neuralgias' (section 3) and 'Other primary headaches' (section 4) in the second edition of the International Classification of Headache Disorders (ICHD-II, 2004). Since the prevalences of these uncommon headaches are quite low, datas related to clinical features, physiopathology and management are still controversial. While paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) are listed in the third section, hemicrania continua (HC) with not prominent autonomical signs are classified in the fourth section in the ICHD-II classification. The fourth section also includes other rare primary headache syndromes. In this review, some of the uncommon primary types of headache will be discussed. Even though these headaches are reported seldomly, the prevalences are possibly higher than known. It is of importance to recognize these uncommon disorders, since their management differs from common primary headaches.
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ABSTRACT: Benign cough headache (BCH) presents as an intermittent, usually bilateral, severe bursting or explosive pain brought on by coughing. Some of the known conditions which can mimic the pain experienced in BCH are subarachnoid hemorrhage, increased intracranial pressure, intracranial tumors, and even toothache. Careful evaluation must be carried out in order to differentiate between these conditions. A case of BCH which presented as a toothache is reported. The evaluation for exertional headaches, and for headaches brought on by coughing, is discussed.Headache The Journal of Head and Face Pain 06/1993; 33(5):240-3. DOI:10.1111/j.1526-4610.1993.hed3305240.x · 3.19 Impact Factor
Article: Uncommon headaches[Show abstract] [Hide abstract]
ABSTRACT: Headaches associated with exercise, cough, and sexual activity may present a diagnostic challenge in the emergency room or primary care provider’s office. The majority of these patients have no underlying intra-cranial pathologic condition and have a good prognosis. However, new onset of these types of headache, with or without accompanying neurologic deficit, is an indication to exclude life-threatening conditions such as subarachnoid bleeding with neuroimaging and CSF examination. Since the pathophysiology is poorly understood, derstood, treatment choices are limited. Further research is needed to elucidate the pathophysiologic mechanisms of these uncommon headaches and to assess the cost — effectiveness of various diagnostic and follow-up strategies.Journal of General Internal Medicine 06/1993; 8(6):333-341. DOI:10.1007/BF02600150 · 3.42 Impact Factor