The “Other” Headaches: Primary Cough, Exertion, Sex, and Primary Stabbing Headaches Authors
First Online: 16 January 2010 DOI:
Cite this article as: Wang, S. & Fuh, J. Curr Pain Headache Rep (2010) 14: 41. doi:10.1007/s11916-009-0083-0 Abstract
Primary cough headache, primary exertional headache, primary sexual headache, and idiopathic stabbing headache are included in “Other Primary Headaches” (Group 4) in the International Classification of Headache Disorders, 2nd edition (ICHD-II). Headaches provoked by cough, exertion, and sex have different age distributions, but they do share some clinical and pathogenic characteristics. The triggering activities frequently involve Valsalva-like maneuvers, which may explain part of the pathogenesis. Primary stabbing headache is common and characterized by ultra-short stabbing headaches. All these headache disorders respond well to indomethacin, and they are commonly comorbid with migraine except for primary cough headache. Of note, some patients with sexual headache had reversible cerebral vasoconstriction syndromes. Recent large-scaled studies have revealed that the ICHD-II criteria of these four headache disorders cannot be completely fulfilled. Further revisions for the ICHD-II criteria are required based on these results of the evidence-based studies.
Keywords Primary cough headache Primary exertional headache Primary stabbing headache Sex-induced headache References Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Pascual J, Iglesias F, Oterino A, et al.: Cough, exertional, and sexual headaches: an analysis of 72 benign and symptomatic cases. Neurology 1996, 46:1520–1524.
Queiroz LP: Symptoms and therapies: exertional and sexual headaches. Curr Pain Headache Rep 2001, 5:275–278.
Dodick DW: Indomethacin-responsive headache syndromes. Curr Pain Headache Rep 2004, 8:19–26.
Selekler HM, Budak F: Idiopathic stabbing headache and experimental ice cream headache (short-lived headaches). Eur Neurol 2004, 51:6–9.
Pareja JA, Ruiz J, de Isla C, et al.: Idiopathic stabbing headache (jabs and jolts syndrome). Cephalalgia 1996, 16:93–96.
Raskin NH, Schwartz RK: Ice pick-like pain. Neurology 1980, 30:203–205.
Headache Classification Subcommittee of the International Headache Society Classification Subcommittee: The International Classification of Headache Disorders, 2nd edn. Cephalalgia 2004, 24(Suppl 1):1–160.
•• Pascual J, González-Mandly A, Martín R, Oterino A: Headaches precipitated by cough, prolonged exercise or sexual activity: a prospective etiological and clinical study. J Headache Pain 2008, 9:259–266.
This study prospectively evaluated a large sample of patients with these headache disorders and comprehensively recorded the clinical pictures
•• Chen PK, Fuh JL, Wang SJ: Cough headache: a study of 83 consecutive patients. Cephalalgia 2009, 29:1079–1085.
This most recent large-scaled study provided the differences between primary and secondary cough headaches and field-tested the ICHD-II criteria of PCH
Sjaastad O, Bakketeig LS: Exertional headache I. The Vågå study of headache epidemiology. Cephalalgia 2002, 22:784–790.
•• Chen SP, Fuh JL, Lu SR, Wang SJ: Exertional headache: a survey of 1963 adolescents. Cephalalgia 2009, 29:401–407.
This is the first large-scaled epidemiologic study of EH in adolescence. It is also the first systematic study to investigate the applicability of ICHD-II criteria for this headache disorder
Sjaastad O, Bakketeig LS: Exertional headache-II. Clinical features Vågå study of headache epidemiology. Cephalalgia 2003, 23:803–807.
Frese A, Eikermann A, Frese K, et al.: Headache associated with sexual activity: demography, clinical features and comorbidity. Neurology 2003, 61:796–800.
Sjaastad O, Pettersen H, Bakketeig LS: The Vågå study of headache epidemiology II. Jabs: clinical manifestations. Acta Neurol Scand 2002, 105:25–31.
•• Fuh JL, Kuo KH, Wang SJ: Primary stabbing headache in a headache clinic. Cephalalgia 2007; 27:1005–1009.
This article presents the most recent large-scale comprehensive and prospective study in the headache clinic
Rasmussen BK, Olesen J: Symptomatic and nonsymptomatic headaches in a general population. Neurology 1992, 42:1225–1231.
Tuğba T, Serap U, Esra O, et al.: Features of stabbing, cough, exertional and sexual headaches in a Turkish population of headache patients. J Clin Neurosci 2008, 15:774–777.
Rooke D: Benign exertional headache. Med Clin North Am 1968, 52:801–808.
Ostergaard JR, Kraft M: Benign coital headache. Cephalalgia 1992, 12:353–355.
• Frese A, Rahmann A, Gregor N, et al.: Headache associated with sexual activity: prognosis and treatment options. Cephalalgia 2007, 27:1265–1270.
This is the most recent large-scaled study for long-term prognosis and treatment outcome in patients with primary sexual headache
Silbert PL, Edis RH, Stewart-Wynne EG, Gubbay SS: Benign vascular sexual headache and exertional headache: interrelationships and long term prognosis. J Neurol Neurosurg Psychiatry 1991, 54:417–421.
Olesen J: The future of headache classification and classification research. Cephalalgia 2009 Aug 10 (Epub ahead of print).
Paulson GW, Klawns HL: Benign orgasmic cephalgia. Headache 1974, 13:181–187.
Lance JW: Benign masturbatory cephalalgia. Arch Neurol 1983, 40:393.
Østergaard JR, Kraft M: Natural course of benign coital headache. BMJ 1992, 305:1129.
Østergaard JR, Kraft M: Benign coital headache. Cephalalgia 1992, 12:353–355.
Sjaastad, O, Pettersen, H, Bakketeig LS: Long-lasting cephalic jabs (?) The Vågå study of headache epidemiology. Cephalalgia 2005, 25:581–592.
Ammache Z, Graber M, Davis P: Idiopathic stabbing headache associated with monocular visual loss. Arch Neurol 2000, 57:745–746.
Raskin NH: Short-lived head pains. Neurol Clin 1997, 15:143–152.
Chen YY, Ling JF, Fuh JL, et al.: Primary cough headache is associated with posterior fossa crowdedness: a morphometric MRI study. Cephalalgia 2004, 24:694–699.
Wang SJ, Fuh JL, Lu SR: Benign cough headache is responsive to acetazolamide. Neurology 2000, 55:149–150.
Raskin NH: The cough headache syndrome: treatment. Neurology 1995, 45:1784.
Heckmann JG, Hilz MJ, Mück-Weymann M, Neundörfer B: Benign exertional headache/benign sexual headache: a disorder of myogenic cerebrovascular autoregulation? Headache 1997, 37:597–598.
Doepp F, Valdueza JM, Schreiber SJ: Incompetence of internal jugular valve in patients with primary exertional headache: a risk factor? Cephalalgia 2008, 28:182–185.
Lance JW: Headaches related to sexual activity. J Neurol Neurosurg Psychiatry 1976, 39:1226–1230.
Evers S, Schmidt O, Frese A, et al.: The cerebral hemodynamics of headache associated with sexual activity. Pain 2003, 102:73–78.
Silbert PL, Hankey GJ, Prentice DA, Apsimon HT: Angiographically demonstrated arterial spasm in a case of benign sexual headache and benign exertional headache. Aust N Z Med 1989, 19:466–468.
Chen SP, Fuh JL, Lirng JF, et al.: Recurrent primary thunderclap headache and benign CNS angiopathy: spectra of the same disorder? Neurology 2006, 67:2164–2169.
Keyrouz S, Dhar R, Axelrod Y: Call-Fleming syndrome and orgasmic cephalalgia. Headache 2008, 48:967–971.
Diamond S: Prolonged benign exertional headache: its clinical characteristics and response to indomethacin. Headache 1982, 22:96–98.
Jacome DE: Exploding head syndrome and idiopathic stabbing headache relieved by nifedipine. Cephalalgia 2001; 21:617–618.
Rozen TD: Melatonin as a treatment for indomethacin-responsive headaches. Neurology 2003, 61:865–866.
Piovesan EJ, Zukerman E, Kowacs PA, Werneck LC: COX-2 inhibitor for the treatment of idiopathic stabbing headache secondary to cerebrovascular diseases. Cephalalgia 2002, 22:197–200.
Franca MC Jr, Costa AL, Maciel JA Jr: Gabapentin-responsive idiopathic stabbing headache. Cephalalgia 2004, 24:993–996.
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