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Update on headaches associated with physical exertion.

Vicente González-Quintanilla1, Jorge Madera1, Julio Pascual1

  • 1University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Santander, Spain.

Cephalalgia : an International Journal of Headache
|February 14, 2023
PubMed
Summary

Headaches from exertion, like cough, exercise, or sexual headaches, can be primary or secondary. Cardiac cephalalgia, a heart-related headache, also occurs with exertion.

Keywords:
Cardiac cephalalgiacough headacheexercise headachesexual headache

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Area of Science:

  • Neurology
  • Cardiology

Background:

  • Exertional headaches encompass various types, including those triggered by coughing, Valsalva maneuvers, prolonged physical activity, sexual activity, and cardiac ischemia.
  • These headaches present distinct clinical profiles and potential etiologies.

Purpose of the Study:

  • To provide an updated review of the clinical characteristics, etiologies, pathophysiology, and management of exertion-related headaches.
  • To differentiate between primary and secondary causes and guide diagnostic approaches.

Main Methods:

  • Comprehensive literature review of publications in PubMed and major medical textbooks.
  • Analysis of clinical characteristics, diagnostic studies, and treatment responses for different exertional headache types.

Main Results:

  • Cough, exercise, and sexual headaches can be primary or secondary, necessitating investigations to exclude structural lesions.
  • Clinical clues like age and response to specific medications (indomethacin, beta-blockers) aid in diagnosing primary exertional headaches.
  • Secondary causes include posterior fossa lesions (cough headache) and vascular malformations (exercise/sexual headaches).
  • Cardiac cephalalgia, linked to myocardial ischemia, typically presents as short-lasting headaches relieved by nitroglycerin, often occurring during exertion.

Conclusions:

  • Primary and secondary cough headaches are often distinguishable from exercise and sexual headaches based on clinical features.
  • Exercise and sexual headaches share overlapping characteristics, complicating differentiation.
  • Cardiac cephalalgia should be considered in adults with brief headaches and cardiovascular risk factors, even if not strictly exertional.