Cough, exertional, and sex headaches

Cough, Exertional, and Sex Headaches

In this article, the authors review the most common presentations of cough and exertional headaches and headaches associated with sexual activity. The authors elaborate on the most commonly described etiologies and identify those which are most critical to treat. The authors outline the recommendations for further evaluation and discuss effective treatment modalities for each headache type.

Primary Headaches Associated with Sexual Activity—some Observations in Indian Patients

Primary headache associated with sexual activity appears to be relatively uncommon in a clinic-based study in Indian patients. Only 24 patients (M : F 18 : 6) were encountered over a 20-year period (1985–2004). Of the 18 male patients, 14 (age 33–42 years) had preorgasmic headache of tension-headache type for 2–8 months, one patient (age 58 years) had orgasmic headache of vascular type for 1 month and three subjects (age 19–23 years) had masturbatory headache also simulating tension-type headache for 3–7 weeks. These observations are at variance with those generally reported from western countries. Of the six female patients, four (age 26–32 years) had typical orgasmic headache of the vascular type (for a few months to a few years), only one of whom had been a migraine sufferer. One patient (age 35 years) presented with a single episode of thunderclap headache where angiography had been negative. Another female subject (age 30 years) experienced typical orgasmic headache only during masturbation but not during actual sexual intercourse. Occurrence of sexual headaches in both male and female subjects had been unpredictable. Few had associated migraine and none ever experienced exertional headache.

Subarachnoid hemorrhage of unknown etiology along the cortical convexity

BACKGROUND

Only 8% to 22% of cases of subarachnoid hemorrhage (SAH) are of nonaneurysmal origin. Among these, perimesencephalic nonaneurysmal SAH is a distinct clinical and radiologic entity with normal angiographic findings and a good prognosis. In contrast, SAH of nonaneurysmal origin occurring along the cortical convexity is rare and poorly understood. We report 2 cases of subarachnoid hemorrhage along the cortical convexity and discuss their possible etiologies.

METHODS

In a retrospective analysis of 234 patients with SAH, we identified 2 patients with a typical computed tomographic pattern of convexity SAH that was associated with no known etiology.

RESULTS

In these 2 cases, the source of hemorrhage could not be identified with computed tomography, magnetic resonance imaging, or digital subtraction angiography, although neurovascular outcomes were good. The patients reported such incidents as coughing or exertion immediately before headache developed. These incidents may have caused increased intracranial pressure.

CONCLUSION

We suggest the possible involvement of a brief increase in intracranial pressure, such as that accompanying coughing or exertion, in the occurrence of SAH along the cortical convexity.

Primary headache syndromes in systemic mastocytosis

Aim: To investigate the relationship between clinical mast cell activity and primary headache syndromes.

Methods: We surveyed individuals with systemic mastocytosis, an uncommon disorder associated with increased mast cell activity. Diagnoses of primary headache syndromes in addition to the relationship of headache and symptoms of mastocytosis were ascertained.

Results: A response rate of 64/148 (43.2%) was achieved. Headache diagnoses in our respondents (n = 64) were largely migraine (37.5%) and tension-type headaches (17.2%). Typical aura with and without migraine headache was highly represented in our patient population (n = 25, 39%). Three individuals met criteria for primary cough headache (4.7%). Symptoms reflective of mast cell activity were significantly greater in individuals reporting headaches. Patients experiencing headache concurrently with mastocytosis flairs were more likely to be male (p = 0.002), have histaminergic symptoms, such as itching (p = 0.02) and runny nose (p = 0.03), and have unilateral cranial autonomic features (p = 0.04). However, using standardized International Headache Society criteria, we did not identify individuals with cluster headache or other trigeminal autonomic cephalalgias in this population.

Conclusions: Our observational survey-based data supports a clinical relationship between mast cell activity and primary headache syndromes. Generalizability of our results is limited by the low response rate and possible tertiary referral bias.

Medical causes of headache in children

Headache may be considered primary or secondary, and secondary headaches may be caused by intracranial disorders or medical/systemic disorders. In many cases, headache may be a presenting symptom of the medical disorder, and accurate diagnosis will lead to specific treatment. In other cases, the headache may be a known complication of the disorder, but the underlying disorder must be considered in management plans. Medical causes of headache are so diverse that uniform screening tests are not useful. History and examination must guide the differential diagnosis, and management plans must be individualized.

Must All Patients With Headaches Associated With Sexual Activity Fulfill ICHD-2 Criteria?

Primary headaches associated with sexual activity (more commonly referred to as Benign Sexual Headaches) are uncommon. The International Headache Society has provided diagnostic criteria for such forms of headaches. This article presents 2 case reports of headache occurring in close temporal association with sexual activity but which do not conform to the diagnostic criteria laid down in ICHD-2. Nosological and other issues raised by these cases are discussed and inclusion of such cases within the rubric of Benign Sexual Headaches is argued.

Case studies of uncommon headaches

The following interesting and uncommon headache disorders are presented through case studies: exploding head syndrome, hypnic headache, neck-tongue syndrome, "Alice in Wonderland" syndrome, nummular headache, red ear syndrome, burning mouth syndrome, spontaneous intracranial hypotension syndrome, and cardiac cephalalgia.

Exertional headache and coronary ischemia despite normal electrocardiographic stress testing

Exertional headaches may under certain conditions reflect coronary ischemia. We report the case of a patient seen in a neurology referral practice whose exertional headaches, even in the face of two normal electrocardiographic stress tests and in the absence of underlying chest pain were the sole symptoms of coronary ischemia as detected by Tc-99m Sestamibi testing SPECT stress testing. Stent placement resulted in complete resolution of headaches. Exertional headache in the absence of chest pain may reflect underlying symptomatic coronary artery disease (CAD) even when conventional electrocardiographic stress testing does not indicate ischemia.

Isolated hypoplasia of the tentorium

Developmental defects of the tentorium represent a spectrum of disease with small defects and apertures that have little clinical significance on one end and hypoplasia or aplasia on the other. The latter is associated with serious central nervous system malformations, it is seldom isolated, and aside from the 3 cases described below, there have only been 2 case reports published on isolated hypoplasia. This condition is important to recognize so as to avoid unnecessary investigations and interventions.