, Volume 55, Issue 3, pp 297–305 | Cite as

Primary cough headache, primary exertional headache, and primary headache associated with sexual activity: a clinical and radiological study

  • Anne Donnet
  • Dominique Valade
  • Emmanuel Houdart
  • Michel Lanteri-Minet
  • Charles Raffaelli
  • Geneviève Demarquay
  • Marc Hermier
  • Evelyne Guegan-Massardier
  • Emmanuel Gerardin
  • Gilles Geraud
  • Christophe Cognard
  • Olivier Levrier
  • Pierre Lehmann
Diagnostic Neuroradiology



The purposes of this study are to describe clinical features of primary cough headache, primary exertional headache, and primary headache associated with sexual activity and to evaluate potential association with abnormalities in the cerebral or cervical venous circulation.


This multicentre, observational, non-interventional consecutive cohort study included patients fulfilling ICHD-II criteria for primary cough headache (N = 10), primary exertional headache (N = 11), or primary headache associated with sexual activity (N = 20), as well as 16 headache-free controls. Each patient was evaluated clinically and underwent craniocervical MRV of the cranial circulation. All scans were interpreted centrally by blinded raters, using the Farb criteria proposed for idiopathic intracranial hypertension. Stenosis was defined as a Farb score <3 in left or right transverse sinuses or jugular veins.


In all primary headache groups, headaches were most frequently diffuse, severe, or very severe. Headache duration was significantly shorter in patients with cough headache (median 6.5 versus 20 and 60 min). An exploitable magnetic resonance venogram was obtained for 36 patients. Stenosis was detected in none of the control group, but in 5/7 patients with primary cough headache group, 2/10 patients with primary exertion headache, and 12/19 patients with primary headache associated with sexual activity. The frequency of stenosis was significantly different from the control group in the primary cough headache and primary headache associated with sexual activity groups.


Headaches provoked by cough and sexual activity are possibly associated with venous abnormalities in a significant subgroup of affected patients. As the literature shows conflicting results, this venous stenosis can be considered as a promoting factor.


Cough headache Exertional headache Headache related to sexual activity MR-venography 


Conflict of interest

We declare that we have no conflict of interest.

Supplementary material

234_2012_1110_MOESM1_ESM.doc (33 kb)
Supplementary Table 1 Magnetic resonance imaging protocols used for venography (DOC 33 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Anne Donnet
    • 1
    • 2
  • Dominique Valade
    • 3
  • Emmanuel Houdart
    • 4
  • Michel Lanteri-Minet
    • 2
    • 5
  • Charles Raffaelli
    • 6
  • Geneviève Demarquay
    • 7
  • Marc Hermier
    • 8
  • Evelyne Guegan-Massardier
    • 9
  • Emmanuel Gerardin
    • 10
  • Gilles Geraud
    • 11
  • Christophe Cognard
    • 12
  • Olivier Levrier
    • 13
  • Pierre Lehmann
    • 13
  1. 1.Service de Neurologie et Pathologie du Mouvement, Pole Neurosciences CliniquesHôpital TimoneMarseille Cedex 05France
  2. 2.INSERM/UdA, U1107, Neuro-DolClermont-FerrandFrance
  3. 3.Centre Urgences CéphaléesHôpital LariboisièreParisFrance
  4. 4.Service de NeuroradiologieHôpital LariboisièreParisFrance
  5. 5.Département d’Evaluation et Traitement de la Douleur, Pole Neurosciences CliniquesHôpital CimiezNiceFrance
  6. 6.Service de NeuroradiologieHôpital PasteurNiceFrance
  7. 7.Service de NeurologieHôpital Croix RousseLyonFrance
  8. 8.Service de NeuroradiologieHôpital NeurologieLyonFrance
  9. 9.Service de NeurologieHôpital Charles NicoleRouenFrance
  10. 10.Service de NeuroradiologieHôpital Charles NicoleRouenFrance
  11. 11.Service de NeurologieHôpital RangueilToulouseFrance
  12. 12.Service de NeuroradiologieHôpital PurpanToulouseFrance
  13. 13.Service de NeuroradiologieHôpital TimoneMarseilleFrance

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