Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-669899f699-chc8l Total loading time: 0 Render date: 2025-04-29T14:05:52.985Z Has data issue: false hasContentIssue false

9 - Other Primary Headache Disorders That Can Present to the Emergency Department

Published online by Cambridge University Press:  09 October 2017

By
Yasmin Idu Jion  and
Brian M. Grosberg
Edited by
Serena L. Orr ,
Benjamin W. Friedman  and
David W. Dodick
Serena L. Orr
Affiliation:
Children’s Hospital of Eastern Ontario, Ottawa
Benjamin W. Friedman
Affiliation:
Albert Einstein College of Medicine, New York
David W. Dodick
Affiliation:
Mayo Clinic, Phoenix, AZ
Get access

Summary

Abstract

Although other primary headache disorders such as cough headache, exercise headache, headache associated with sexual activity, thunderclap headache, hypnic headache, and new daily persistent headache are less common than migraine and tension-type headache, these disorders can be severe, disabling, and misdiagnosed. A good proportion of them coexist with other primary headache disorders. In addition, they may be associated with underlying structural pathology, and it is paramount that they are investigated for secondary causes. Diagnosis of the other primary headache disorders requires exclusion of secondary mimics, as stipulated in the International Classification of Headache Disorders, third edition beta version [1]. Treatment and prognosis are dependent on the diagnosis, and the majority are indomethacin responsive.

This chapter reviews the epidemiology, clinical features, pathophysiology, and management of these less common headache disorders that may present to the emergency department (ED).

Table 9.1Summary of epidemiology and headache features in other primary headache disorders
Primary cough headachePrimary exercise headachePrimary headache associated with sexual activityPrimary thunderclap headacheHypnic headacheNew daily persistent headache
Prevalence1%12%1%43/100,000 per year0.07–0.3%0.1%
Age of onset60s20s20s–40sNot available60s20s–30s
GenderM > FM > FM > FNot availableF > MF > M
Headache features
 OnsetSuddenSuddenGradual or explosiveExplosiveAbrupt, wakes patient from sleepStarts within 24 hours
 CharacterSharp, stabbingDull, diffuse, pulsatileDull and with increasing intensity with sexual activity orSevere in intensity, throbbingSevere intensityDull, throbbingTension or migraine phenotype
 Typical locationVertexFrontalOccipitalTemporalBilateralFrontalOccipitalDiffuseDiffuseOccipitalDiffuse, bilateralFrontotemporalUnilateral or generalized
 DurationSeconds to minutesHoursMinutes to hoursHours to few daysMinutes to few hoursDaily and continuous for ≥3 months
 TriggersCoughingSneezingStrainingLaughingSustained physical exertionShort burst of physical exertionSexual activityMasturbationSpontaneousValsalva maneuversSexExertionStressSleep (120–480 min into sleep)Antecedent viral illnessCranial surgeryMenarcheStressful life events
Type
Chapter
Information
Emergency Headache
Diagnosis and Management
 , pp. 88 - 98
Publisher: Cambridge University Press
Print publication year: 2017

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

1.Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33(9):629–808.CrossRefGoogle Scholar
2.Symonds, C. Cough headache. Brain. 1956;79(4):557–68.CrossRefGoogle ScholarPubMed
3.Boes, CJ, Matharu, MS, Goadsby, PJ. Benign cough headache. Cephalalgia. 2002;22(10):772–9.CrossRefGoogle ScholarPubMed
4.Rasmussen, BK, Olesen, J. Symptomatic and nonsymptomatic headaches in a general population. Neurology. 1992;42(6):1225–31.CrossRefGoogle ScholarPubMed
5.Pascual, J, Iglesias, F, Oterino, A, Vazquez-Barquero, A, Berciano, J. Cough, exertional, and sexual headaches: an analysis of 72 benign and symptomatic cases. Neurology. 1996;46(6):1520–4.CrossRefGoogle ScholarPubMed
6.Chen, PK, Fuh, JL, Wang, SJ. Cough headache: a study of 83 consecutive patients. Cephalalgia. 2009;29(10):1079–85.CrossRefGoogle ScholarPubMed
7.Cutrer, FM, DeLange, J. Cough, exercise, and sex headaches. Neurol Clin. 2014;32(2):433–50.CrossRefGoogle ScholarPubMed
8.Ko, J, Rozen, TD. Valsalva-induced cluster: a new subtype of cluster headache. Headache. 2002;42(4):301–2.CrossRefGoogle Scholar
9.Mateo, I, Pascual, J. Coexistence of chronic paroxysmal hemicrania and benign cough headache. Headache. 1999;39(6):437–8.CrossRefGoogle ScholarPubMed
10.Williams, B. Cerebrospinal fluid pressure changes in response to coughing. Brain. 1976;99(2):331–46.CrossRefGoogle ScholarPubMed
11.Chen, YY, Lirng, JF, Fuh, JL, et al. Primary cough headache is associated with posterior fossa crowdedness: a morphometric MRI study. Cephalalgia. 2004;24(9):694–9.CrossRefGoogle ScholarPubMed
12.Cordenier, A, De Hertogh, W, De Keyser, J, Versijpt, J. Headache associated with cough: a review. J Headache Pain. 2013;14:42.CrossRefGoogle ScholarPubMed
13.Alvarez, R, Ramón, C, Pascual, J. Clues in the differential diagnosis of primary vs secondary cough, exercise, and sexual headaches. Headache. 2014;54(9):1560–2.CrossRefGoogle ScholarPubMed
14.Lane, RJ, Davies, PT. Modified Valsalva test differentiates primary from secondary cough headache. J Headache Pain. 2013;14(1):31.CrossRefGoogle ScholarPubMed
15.Raskin, NH. The cough headache syndrome: treatment. Neurology. 1995;45(9):1784.CrossRefGoogle ScholarPubMed
16.Buzzi, MG, Formisano, R, Colonnese, C, Pierelli, F. Chiari-associated exertional, cough, and sneeze headache responsive to medical therapy. Headache. 2003;43(4):404–6.CrossRefGoogle ScholarPubMed
17.Rooke, ED. Benign exertional headache. Med Clin North Am. 1968;52(4):801–8.Google ScholarPubMed
18.Queiroz, LP. Symptoms and therapies: exertional and sexual headaches. Curr Pain Headache Rep. 2001;5(3):275–8.CrossRefGoogle ScholarPubMed
19.Sjaastad, O, Bakketeig, LS. Exertional headache: I. Vaga study of headache epidemiology. Cephalalgia. 2002;22(10):784–90.CrossRefGoogle ScholarPubMed
20.Chen, SP, Fuh, JL, Lu, SR, Wang, SJ. Exertional headache: a survey of 1963 adolescents. Cephalalgia. 2009;29(4):401–7.CrossRefGoogle ScholarPubMed
21.van der Ende-Kastelijn, K, Oerlemans, W, Goedegebuure, S. An online survey of exercise-related headaches among cyclists. Headache. 2012;52(10):1566–73.CrossRefGoogle ScholarPubMed
22.Wang, SJ, Fuh, JL. The “other” headaches: primary cough, exertion, sex, and primary stabbing headaches. Curr Pain Headache Rep. 2010;14(1):41–6.CrossRefGoogle Scholar
23.Koppen, H, van Veldhoven, PL. Migraineurs with exercise-triggered attacks have a distinct migraine. J Headache Pain. 2013;14:99.CrossRefGoogle ScholarPubMed
24.Singh, RK, Martinez, A, Baxter, P. Head cooling for exercise-induced headache. J Child Neurol. 2006;21(12):1067–8.CrossRefGoogle ScholarPubMed
25.Evers, S, Schmidt, O, Frese, A, Husstedt, I-W, Ringelstein, EB. The cerebral hemodynamics of headache associated with sexual activity. Pain. 2003;102(1):73–8.CrossRefGoogle ScholarPubMed
26.Frese, A, Eikermann, A, Frese, K, et al. Headache associated with sexual activity: demography, clinical features, and comorbidity. Neurology. 2003;61(6):796–800.CrossRefGoogle ScholarPubMed
27.Frese, A, Rahmann, A, Gregor, N, et al. Headache associated with sexual activity: prognosis and treatment options. Cephalalgia. 2007;27(11):1265–70.CrossRefGoogle ScholarPubMed
28.Yeh, Y-C, Fuh, J-L, Chen, S-P, Wang, S-J. Clinical features, imaging findings and outcomes of headache associated with sexual activity. Cephalalgia. 2010;30:1329–35.CrossRefGoogle ScholarPubMed
29.Frese, A, Gantenbein, A, Marziniak, M, et al. Triptans in orgasmic headache. Cephalalgia. 2006;26(12):1458–61.CrossRefGoogle ScholarPubMed
30.Dilli, E. Thunderclap headache. Curr Neurol Neurosci Rep. 2014;14(4):437.CrossRefGoogle ScholarPubMed
31.Dodick, DW. Thunderclap headache. Curr Pain Headache Rep. 2002;6(3):226–32.CrossRefGoogle ScholarPubMed
32.Ducros, A, Bousser, MG. Thunderclap headache. BMJ. 2013;346:e8557.CrossRefGoogle ScholarPubMed
33.Linn, FHH. Primary thunderclap headache. Handb Clin Neurol. 2010;97:473–81.CrossRefGoogle ScholarPubMed
34.van Gijn, J, van Dongen, KJ. The time course of aneurysmal haemorrhage on computed tomograms. Neuroradiology. 1982;23(3):153–6.CrossRefGoogle ScholarPubMed
35.Mitchell, P, Wilkinson, ID, Hoggard, N, et al. Detection of subarachnoid haemorrhage with magnetic resonance imaging. J Neurol Neurosurg Psychiatry. 2001;70(2):205–11.CrossRefGoogle ScholarPubMed
36.Lu, SR, Liao, YC, Fuh, JL, Lirng, JF, Wang, SJ. Nimodipine for treatment of primary thunderclap headache. Neurology. 2004;62(8):1414–16.CrossRefGoogle ScholarPubMed
37.Raskin, NH. The hypnic headache syndrome. Headache. 1988;28(8):534–6.CrossRefGoogle ScholarPubMed
38.Obermann, M, Holle, D. Hypnic headache. Expert Rev Neurother. 2010;10(9):1391–7.CrossRefGoogle ScholarPubMed
39.Evers, S, Goadsby, PJ. Hypnic headache: clinical features, pathophysiology, and treatment. Neurology. 2003;60(6):905–9.CrossRefGoogle ScholarPubMed
40.Holle, D, Naegel, S, Obermann, M. Hypnic headache. Cephalalgia. 2013;33(16):1349–57.CrossRefGoogle ScholarPubMed
41.Holle, D, Naegel, S, Obermann, M. Pathophysiology of hypnic headache. Cephalalgia. 2014;34(10):806–12.CrossRefGoogle ScholarPubMed
42.Holle, D, Naegel, S, Krebs, S, et al. Clinical characteristics and therapeutic options in hypnic headache. Cephalalgia. 2010;30(12):1435–42.CrossRefGoogle ScholarPubMed
43.Dodick, DW, Jones, JM, Capobianco, DJ. Hypnic headache: another indomethacin-responsive headache syndrome? Headache. 2000;40(10):830–5.Google ScholarPubMed
44.Bigal, ME, Lipton, RB. The differential diagnosis of chronic daily headaches: an algorithm-based approach. J Headache Pain. 2007;8(5):263–72.CrossRefGoogle ScholarPubMed
45.Vanast, WJ. New daily persistent headaches: definition of a benign syndrome. Headache. 1986;26(6):318.Google Scholar
46.Pascual, J, Colás, R, Castillo, J. Epidemiology of chronic daily headache. Curr Pain Headache Rep. 2001;5(6):529–36.CrossRefGoogle ScholarPubMed
47.Robbins, MS, Grosberg, BM, Napchan, U, Crystal, SC, Lipton, RB. Clinical and prognostic subforms of new daily-persistent headache. Neurology. 2010;74(17):1358–64.CrossRefGoogle ScholarPubMed
48.Evans, RW. New daily persistent headache. Headache. 2012;52(Suppl. 1):40–4.CrossRefGoogle ScholarPubMed
49.Goadsby, PJ. New daily persistent headache: a syndrome, not a discrete disorder. Headache. 2011;51(4):650–3.CrossRefGoogle Scholar
50.Evans, RW, Seifert, TD. The challenge of new daily persistent headache. Headache. 2011;51(1):145–54.CrossRefGoogle ScholarPubMed
51.Robbins, MS, Evans, RW. The heterogeneity of new daily persistent headache. Headache. 2012;52(10):1579–89.CrossRefGoogle ScholarPubMed
52.Mack, KJ. What incites new daily persistent headache in children? Pediatr Neurol. 2004;31(2):122–5.CrossRefGoogle ScholarPubMed
53.Rozen, TD. New daily persistent headache: clinical perspective. Headache. 2011;51(4):641–9.CrossRefGoogle ScholarPubMed
54.Nagy, AJ, Gandhi, S, Bhola, R, Goadsby, PJ. Intravenous dihydroergotamine for inpatient management of refractory primary headaches. Neurology. 2011;77(20):1827–32.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×