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J Headache Pain. 2008 October; 9(5): 259–266.
Published online 2008 August 28. doi:  10.1007/s10194-008-0063-5
PMCID: PMC3452197

Headaches precipitated by cough, prolonged exercise or sexual activity: a prospective etiological and clinical study

Abstract

Headaches provoked by cough, prolonged physical exercise and sexual activity have not been studied prospectively, clinically and neuroradiologically. Our aim was to delimitate characteristics, etiology, response to treatment and neuroradiological diagnostic protocol of those patients who consult to a general Neurological Department because of provoked headache. Those patients who consulted due to provoked headaches between 1996 and 2006 were interviewed in depth and followed-up for at least 1 year. Neuroradiological protocol included cranio-cervical MRI for all patients with cough headache and dynamic cerebrospinal functional MRI in secondary cough headache cases. In patients with headache provoked by prolonged physical exercise or/and sexual activity cranial neuroimaging (CT and/or MRI) was performed and, in case of suspicion of subarachnoid bleeding, angioMRI and/or lumbar tap were carried out. A total of 6,412 patients consulted due to headache during the 10 years of the study. The number of patients who had consulted due to any of these headaches is 97 (1.5% of all headaches). Diagnostic distribution was as follows: 68 patients (70.1%) consulted due to cough headache, 11 (11.3%) due to exertional headache and 18 (18.6%) due to sexual headache. A total of 28 patients (41.2%) out of 68 were diagnosed of primary cough headache, while the remaining 40 (58.8%) had secondary cough headache, always due to structural lesions in the posterior fossa, which in most cases was a Chiari type I malformation. In seven patients, cough headache was precipitated by treatment with angiotensin-converting enzyme inhibitors. As compared to the primary variety, secondary cough headache began earlier (average 40 vs. 60 years old), was located posteriorly, lasted longer (5 years vs. 11 months), was associated with posterior fossa symptoms/signs and did not respond to indomethacin. All those patients showed difficulties in the cerebrospinal fluid circulation in the foramen magnum region in the dynamic MRI study and preoperative plateau waves, which disappeared after posterior fossa reconstruction. The mean age at onset for primary headaches provoked by physical exercise and sexual activity began at the same age (40 years old), shared clinical characteristics (bilateral, pulsating) and responded to beta-blockers. Contrary to cough headache, secondary cases are rare and the most frequent etiology was subarachnoid bleeding. In conclusion, these conditions account for a low proportion of headache consultations. These data show the total separation between cough headache versus headache due to physical exercise and sexual activity, confirm that these two latter headaches are clinical variants of the same entity and illustrate the clinical differences between the primary and secondary provoked headaches.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
1. Tinel J. La céphalée a l’effort. Syndrome de distension douloureuse des veines intracraniennes. Médecine (Paris) 1932;13:113–118.
2. Symonds C. Cough headache. Brain. 1956;79:557–568. doi: 10.1093/brain/79.4.557. [PubMed] [Cross Ref]
3. Rooke ED. Benign exertional headache. Med Clin North Am. 1968;52:801–808. [PubMed]
4. Sands GH, Newman L, Lipton R. Cough, exertional and other miscellaneous headaches. Med Clin North Am. 1991;75:733–747. [PubMed]
5. Headache Classification Committee of the International Headache Society Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia. 1988;8(Suppl 7):19–28.
6. Lance JW. Solved and unsolved headache problems. Headache. 1991;31:439–445. doi: 10.1111/j.1526-4610.1991.hed3107439.x. [PubMed] [Cross Ref]
7. Silbert PL, Edis RH, Stewart-Wynne EG, et al. Benign vascular sexual headache and exertional headache: interrelationships and long term prognosis. J Neurol Neurosurg Psychiatry. 1991;54:417–421. doi: 10.1136/jnnp.54.5.417. [PMC free article] [PubMed] [Cross Ref]
8. Pascual J, Iglesias F, Oterino A, Vázquez-Barquero A, Berciano J. Cough, exertional, and sexual headaches. An analysis of 72 benign and symptomatic cases. Neurology. 1996;46:1520–1524. [PubMed]
9. Headache Classification Committee of the International Headache Society (2004) The international classification of headache disorders, 2nd edn. Cephalalgia 24(Suppl 1):1–160.
10. Rasmussen BK, Olesen J. Symptomatic and nonsymptomatic headaches in a general population. Neurology. 1992;42:1225–1231. [PubMed]
11. Sjaastad O, Pettersen H, Bakketeig LS. The Vaga study; epidemiology of headache I: the presence of ultrashort paroxysms. Cephalalgia. 2001;21:207–215. doi: 10.1046/j.1468-2982.2001.00189.x. [PubMed] [Cross Ref]
12. Mathew NT. Indomethacin responsive headache syndromes. Headache. 1981;21:147–150. doi: 10.1111/j.1526-4610.1981.hed2104147.x. [PubMed] [Cross Ref]
13. Diamond S. Prolonged benign exertional headache: its clinical characteristics and response to indomethacin. Headache. 1982;22:96–98. doi: 10.1111/j.1526-4610.1982.hed2203096.x. [PubMed] [Cross Ref]
14. Williams B. Cerebrospinal fluid changes in response to coughing. Brain. 1976;99:331–346. doi: 10.1093/brain/99.2.331. [PubMed] [Cross Ref]
15. Williams B. Cough headache due to craniocerebrospinal pressure dissociation. Arch Neurol. 1980;37:226–230. [PubMed]
16. Sansur CA, Heiss JD, DeVroom LH, Eskioglu E, Ennis R, Oldfield EH. Pathophysiology of headache associated with cough in patients with Chiari malformation. J Neurosurg. 2003;98:453–458. [PubMed]
17. Pujol A, Roig C, Capdevila A, et al. Motion of the cerebellar tonsils in Chiari type I malformation studied by cine-phase contrast MRI. Neurology. 1995;45:1746–1753. [PubMed]
18. Pascual J, Oterino A, Berciano J. Headache in type I Chiari malformation. Neurology. 1992;42:1519–1521. [PubMed]
19. Wang SJ, Fuh JL, Lu SR. Benign cough headache is responsive to acetazolamide. Neurology. 2000;55:149–150. [PubMed]
20. Raskin NH. Short-lived head pains. Neurol Clin. 1997;15:143–152. doi: 10.1016/S0733-8619(05)70300-5. [PubMed] [Cross Ref]
21. Wolff HG. Pain-sensitive structures within the cranial cavity. In: Headache and other head pain. 2. Oxford University Press: New York; 1963. pp. 53–95.
22. Parish RC, Miller LJ. Adverse effects of angiotensin converting enzyme inhibitors. An update Drug Saf. 1992;7:14–31.
23. Chen YY, Lirng JF, Fuh JL, Chang FC, Cheng HC, Wang SJ. Primary cough headache is associated with posterior fossa crowdedness: a morphometric MRI study. Cephalalgia. 2004;24:694–699. doi: 10.1111/j.1468-2982.2004.00739.x. [PubMed] [Cross Ref]
24. Frese A, Eikermann A, Frese K, Schwaag S, Husstedt IW, Evers S. Headache associated with sexual activity: demographics, clinical features, and comorbidity. Neurology. 2003;23:796–800. [PubMed]
25. Evers S, Schmidt O, Frese A, Husstedt IW, Ringelstein EB. The cerebral hemodynamics of headache associated with sexual activity. Pain. 2003;102:73–78. doi: 10.1016/s0304-3959(02)00341-x. [PubMed] [Cross Ref]

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