Focus on therapy of the Chapter IV headaches provoked by exertional factors: primary cough headache, primary exertional headache and primary headache associated with sexual activity

Allena, Marta; Rossi, Paolo; Tassorelli, Cristina; Ferrante, Enrico; Lisotto, Carlo; Nappi, Giuseppe

doi:10.1007/s10194-010-0261-9

Cited by 27 publications

(30 citation statements)

References 43 publications

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“…PCH is a sudden-onset headache that usually lasts from 1 second to 30 minutes, tends to be bilateral and posterior, is brought on by and occurring only in association with coughing, straining and/or Valsalva maneuver, and it responds to indomethacin [4,5,9-14]. A craniocervical MRI study is mandatory to rule out posterior fossa lesions [5,9]; in fact cough headache can be symptomatic in about 40% of cases and the large majority of them are due to CM1 [4,5,9-11], as in case 2 of the present study.…”

Section: Discussionmentioning

confidence: 99%

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Short lasting activity-related headaches with sudden onset in children: a case-based reasoning on classification and diagnosis

et al. 2013

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BackgroundShort lasting headaches related to activity or cough are rare, particularly in childhood, and can be difficult to diagnose, especially in young children who are not able to describe their symptoms. In the literature there are few data on this topic in adults and the paediatric cases reported are even more rare.FindingsWe present the clinical history of a 7-year-old child and a 3-year-old child both diagnosed as having activity-related headaches, characterized by sudden onset of short lasting (few seconds) attacks, that were triggered by cough or exercise. There were no accompanying symptoms and the neurological examination was normal in both cases. Brain magnetic resonance imaging showed, in the first case, a cerebellar pilocytic astrocytoma and, in the second case, a Chiari 1 malformation. Both cases received an early diagnosis, were surgically treated and had a good prognosis at follow-up.ConclusionsWhen headache has a recent onset, it presents suddenly, and it is triggered by strain, even with normal neurological examination, neuroimaging is mandatory in order to exclude secondary headaches, especially in children.

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Section: Discussionmentioning

confidence: 99%

“…Among 72 cases with activity-related headaches, primary exertional headache (age: 24±11, 10-48) began significantly earlier than PCH and secondary exertional headache [5]. On first occurrence of this headache type, it is mandatory to exclude subarachnoid haemorrhage and arterial dissection [6-8,12,14]. …”

Section: Discussionmentioning

confidence: 99%

Short lasting activity-related headaches with sudden onset in children: a case-based reasoning on classification and diagnosis

et al. 2013

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“…It is commonly believed that the head pain in PCH is also caused by an increase in intracranial CSF pressure with exertion, as with secondary cough headache [5,6]. Lumbar puncture is reported to relieve PCH in some cases, consistent with this hypothesis [24].…”

Section: Discussionmentioning

confidence: 83%

“…There is inevitably some degree of overlap between primary exertional headache and cough headache in terms of provocative activities. A recent review provides an excellent summary of these conditions and their treatment [5]. …”

Section: Introductionmentioning

confidence: 99%

Modified Valsalva test differentiates primary from secondary cough headache

Lane

Davies

2013

J Headache Pain

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BackgroundThe current definition of cough headache includes provocation of the symptom by Valsalva manoeuvre, and it is generally believed that all cough headache results from a sudden increase in intracranial pressure. We sought to question that presumption and to determine whether the Valsalva test might distinguish primary from secondary cough headache.MethodsWe examined 16 consecutive cough headache patients using a modified Valsalva test (exhalation into the connecting tube of a standard anaeroid sphygmomanometer to 60 mm Hg for 10 seconds). A positive response was recorded if the manoeuvre provoked headache. All patients subsequently underwent brain MRI.ResultsNone of the patients had neurological signs. Eleven had positive modified Valsalva tests. Ten were found subsequently to have posterior fossa pathologies (secondary cough headache: 8 Chiari Type 1 malformations, 2 posterior fossa meningiomas). The cough headache was relieved following surgery in all cases. One patient with a positive Valsalva test had an apparently normal brain MRI but measurements of hindbrain and posterior fossa dimensions were consistent with ‘posterior fossa crowdedness’. The remaining 5 patients had negative (4 patients) or equivocal (1 patient) Valsalva tests and normal MRI scans (primary cough headache).ConclusionsThese findings suggest that secondary cough headache results from a transient increase in intracranial CSF pressure during exertion in the presence of obstruction to normal cerebrospinal fluid dynamics. The modified Valsalva test can also determine whether tonsillar herniation found on brain MRI is symptomatic. Primary cough headache appears to be caused by a different mechanism, possibly through congestion of the orbital venous plexus in the presence of jugular venous incompetence and a reduced threshold for trigeminal sensory activation.

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“…Modifications to the exercise regimen, including proper warm-up, adequate rest, nutrition and hydration, can also help 4. Other options include non-steroidal anti-inflammatory drugs (particularly indometacin, 25–150 mg, used up to an hour before predicted exertion) or traditional migraine prophylactic agents such as propranolol (40–200 mg/day), which can be taken regularly or before the physical activity in question 5. Altitude can exacerbate effort headaches and migraines (with a particularly high prevalence during the 1968 Mexico Olympic Games6), as can dehydration, hypoglycaemia, alcohol and caffeine.…”

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confidence: 99%

Weightlifter's headache

Simpson

2016

Pract Neurol

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Focus on therapy of the Chapter IV headaches provoked by exertional factors: primary cough headache, primary exertional headache and primary headache associated with sexual activity

Cited by 27 publications

References 43 publications

Short lasting activity-related headaches with sudden onset in children: a case-based reasoning on classification and diagnosis

Short lasting activity-related headaches with sudden onset in children: a case-based reasoning on classification and diagnosis

Modified Valsalva test differentiates primary from secondary cough headache

Weightlifter's headache

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