Summary
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.
Similar content being viewed by others
References
Cypress BK. Patients’ Reasons for Visiting Physicians: National Ambulatory Medical Care Survey: United States, 1977–78. Vital and Health Statistics, Series 13, No. 56, DHHS publication no. (PHS) 82-1717. Washington, DC: U.S. Government Printing Office, 1981.
Stewart WF, Lipton RB, Celentano DD, Reed ML. Prevalence of migraine headache in the United States. Relation to age, income, race and other sociodemographic factors. JAMA. 1992;267:64–9.
Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia. 1988;8(suppl):12–73.
Rooke ED. Benign exertional headache. Med Clin North Am. 1968;52:801–8.
Diamond S. Prolonged benign exertional headache; its clinical characteristics and response to indomethacin. Headache. 1981;22:96–8.
Powell B. Weight lifter’s cephalgia. Ann Emerg Med. 1982;11:449–51.
Rushton JG, Rooke Ed. Brain tumor headache. Headache. 1962;2:147–52.
Klara PM, George ED. Warning leaks and sentinel headaches associated with subarachnoid hemorrhage. Mili Med. 1982;147:660–2.
Duffy GP. The “warning leak” in spontaneous subarachnoid hemorrhage. Med J Aust. 1983;1:514–6.
Hatfield WB. Headache associated with metabolic and systemic disorders. Med Clin North Am. 1978;62:451–8.
Lance WJ, Hinterberger H. Symptoms of pheochromocytoma, with particular reference to headache, correlated with catechol-amine production. Arch Neurol. 1976;33:281–8.
Thomas JE, Rooke DE, Kvale WF. The neurologist’s experience with pheochromocytoma. A review of 100 cases. JAMA. 1966;197:754–8.
Paulson GW, Zipf RE, Beekman JF. Pheochromocytoma causing exercise-related headache and pulmonary edema. Ann Neurol. 1979;5:96–9.
Shapiro A, Wolf E, Ferber I, Merin S. The effect of physical activity on the intraocular pressure of glaucomatous patients. Eur J Appl Occup Physiol. 1983;52:136–8.
Symonds C. Cough headache. Brain. 1956;79:557–68.
Hazelrigg RL. Exertional headache. Headache Q. 1990;1:244–50.
Johnson CE, Zimmerman RD. Imaging decisions in the evaluation of headache. Magn Reson Imaging Decis. 1989;3:2–16.
Leblanc R. The minor leak preceding subarachnoid hemorrhage. J Neuro surg. 1987;66:35–9.
Sands GH, Newman L, Lipton R. Cough, exertional, and other miscellaneous headaches. Med Clin North Am. 1991;75:733–47.
Raskin N. Headaches associated with organic disease of the nervous system. Med Clin North Am. 1978;62:459–66.
Raskin NH. The indomethacin-responsive syndromes. In: Headache. New York: Churchill Livingstone, 1988;255–68.
Williams B. Cough headache due to craniospinal pressure dissociation. Arch Neurol. 1980;37:226–30.
Williams B. Cerebrospinal fluid pressure changes in response to coughing. Brain. 1976;99:331–46.
Ekbom K. Cough headache. In: Rose FC (ed). Headache (Handbook of Clinical Neurology Vol. 48). New York: Elsevier Science Publishing, 1986;367–71.
Britton TC, Guiloff RJ. Carotid artery disease presenting as cough headache. Lancet. 1988;1:1406–7.
Mathew NT. Indomethacin responsive headache syndromes. Headache. 1981;21:147–50.
Lance JW. Headaches related to sexual activity. J Neurol Neurosurg Psychiatry. 1976;39:1226–30.
Masters WH, Johnson VE. Human Sexual Response. Boston: Little Brown, 1966;294–300.
Johns DR. Benign sexual headache within a family. Arch Neurol. 1986;43:1158–60.
Silbert PL, Edis RH, Steward-Wynne EG, Gubbay SS. Benign vascular sexual headache and exertional headache: interrelationships and long-term prognosis. J Neurol Neurosurg Psychiatry. 1991;54:417–21.
Paulson GW, Klawans HL. Benign orgasmic cephalgia. Headache. 1974;13:181–7.
Staunton HP, Moore J. Coital cephalgia and ischemic muscular work of the lower limbs. J Neurol Neurosurg Psychiatry. 1978;41:930–3.
Levy RL. Stroke and orgasmic cephalalgia. Headache. 1981;21:12–3.
Martinez JM, Roig C, Arboix A. Complicated coital cephalalgia. Three cases with benign evolution. Cephalalgia. 1988;8:265–8.
Locksley HB. Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations: based on 6,368 cases in the cooperative study. J Neurosurg. 1966;25:219–39.
Lundberg PO, Osterman PO. The benign and malignant forms of orgasmic cephalalgia. Headache. 1974;13:164–5.
Day JW, Raskin NHY. Thunderclap headache: symptom of unruptured cerebral aneurysm. Lancet. 1986;2:1247–8.
Wijdicks EF, Kerkhoff H, Van Grijn. Long-term follow-up of 71 patients with thunderclap headache mimicking subarachnoid hemorrhage. Lancet. 1988;1:68–70.
Harling DW, Peatfield RC, Van Hille PT, et al. Thunderclap headache: is it migraine? Cephalalgia. 1989;9:87–90.
Koller R, Kennedy JW, Butler JC, Wagner NN. Counseling the coronary patient on sexual activity. Postgrad Med. 1972;51:133–6.
Massie E, Rose EF, Rupp JC, Whelton RW. Sudden death during coitus—fact or fiction? Med Aspects Hum Sexuality. 1969;3:22–6.
Porter M, Jankovic J. Benign coital cephalalagia. Differential diagnosis and treatment. Arch Neurol. 1981;38:710–2.
Vincent FM. Benign masturbatory cephalalgia. Arch Neurol. 1982;39:673.
Akpunonu BE, Ahrens J. Sexual headache: case report, review, and treatment with calcium blocker. Headache. 1991;31:141–5.
Meyer, JS, Hardenberg J. Clinical effectiveness of calcium entry blockers in prophylactic treatment of migraine and cluster headaches. Headache. 1983;23:266–77.
Lansche RK. Ophthalmodynia periodica. Headache. 1964;4:247–9.
Raskin NH, Schwartz RK. Ice pick-like pain. Neurology. 1980;30:203–5.
Ekbom K. Some observations on pain in cluster headache. Headache. 1975;14:219–25.
Raskin NH, Knittle SC. Ice cream headache and orthostatic symptoms in patients with migraine. Headache. 1976;16:222–5.
Frushtorfer H, Lindblom U. Vascular participation in deep cold pain. Pain. 1983;17:235–41.
Wolf S, Hardy JD. Studies on pain. Observations on pain due to local cooling and on factors involved in the “cold pressor” effect. J Clin Invest. 1941;20:521–33.
Author information
Authors and Affiliations
Additional information
Received from the Section of General Medicine, Medical Service, Veterans Affairs Medical Center, Division of General Medicine, Department of Medicine, Oregon Health Sciences University, Portland, Oregon.
Rights and permissions
About this article
Cite this article
Kumar, K.L., Reuler, J.B. Uncommon headaches. J Gen Intern Med 8, 333–341 (1993). https://doi.org/10.1007/BF02600150
Issue Date:
DOI: https://doi.org/10.1007/BF02600150