Primary cough headache, primary exertional headache, and primary headache associated with sexual activity: a clinical and radiological study
- 774 Downloads
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.
KeywordsCough headache Exertional headache Headache related to sexual activity MR-venography
Conflict of interest
We declare that we have no conflict of interest.
- 3.Tinel J (1932) La céphalée à l’effort - syndrome de distension douloureuse des veines intracrâniennes. La Médecine 18:113–118Google Scholar
- 8.Headache Classification Committee of the International Headache Society (2004) Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain, second edition. Cephalalgia 24(Suppl 1):1–160Google Scholar
- 13.Lanteri-Minet M et al (2005) French survey network on headaches and facial pains. In: Olesen J (ed) The classification and diagnosis of headache disorders. Oxford University Press, New York, pp 287–293Google Scholar
- 25.Koerte IK, Schankin CJ, Immler S, Lee S, Laubender RP, Grosse C, Eftimov L, Milde-Busch A, Reiser M, Straube A, Heinen F, Alperin N, Ertl-Wagner B (2011) Altered cerebrovenous drainage in patients with migraine as assessed by phase-contrast magnetic resonance imaging. Invest Radiol 46(7):434–440PubMedCrossRefGoogle Scholar
- 26.Ertl-Wagner B, Koerte I, Kümpfel T, Blaschek A, Laubender RP, Schick M, Steffinger D, Kaufmann D, Heinen F, Reiser M, Alperin N, Hohlfeld R (2012) Non-specific alterations of craniocervical venous drainage in multiple sclerosis revealed by cardiac-gated phase-contrast MRI. Mult Scler 18(7):1000–1007PubMedCrossRefGoogle Scholar