[Headaches due to cough, exertion and sexual intercourse]

The aim of this study was to review the advances in cough, exertional and sexual headaches. We perform a critical analysis of the literature and of our experience with 72 patients. About one-half of patients having cough headache will have benign cough headache. The remaining half suffer from Chiari type I malformation. Benign cough headache begins typically in men above age 50, while symptomatic cough headache begins under 50 and appears with the same frequency in both sexes. Indomethacin is the treatment of choice of benign cough headache, but has no effect in symptomatic cases, which respond to suboccipital craniectomy. Although also showing male predominance, exertional and sexual headaches begin under age 50. Subarachnoid bleeding due to aneurism is the most frequent etiology for exertional and sexual headaches. Cough headache and exertional headache are separate clinical entities, whereas exertional headache and sexual headache seem to be different expressions of the same clinical entity. These data allow, in addition, the clinical differentiation between benign and symptomatic cough headache.