Benign Exertional Headache

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    Before computed tomography (CT) and MRI availability, series concluded that only approximately 20% of patients with cough headache had structural lesions, most of them a Chiari type I deformity (Fig. 1). In the MRI era, the proportion of patients who have an underlying structural cause has varied between 11% and 59% in different studies.3–7 In consequence, structural lesions should be ruled out before making the diagnosis of primary cough headache.1,8

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    The headaches lasts from minutes43 up to 48 hours, occur particularly at high altitude or in hot weather,2 arise from sustained physical exercise, and may be prevented by avoidance of excessive physical exertion.5 Although not usually associated with nausea or vomiting,6 migraine has often been associated with exercise headache.45,46 Previously the defining features arose from a small number of cases.6,25,47–49

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