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Julio Pascual - One of the best experts on this subject based on the ideXlab platform.
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Oxford Textbook of Headache Syndromes - Exertional and sex Headache
Oxford Textbook of Headache Syndromes, 2020Co-Authors: Shih-pin Chen, Julio Pascual, Shuu-jiun WangAbstract:Exertional Headache and sexual Headache are Headache disorders that share some clinical and pathophysiological characteristics. These two Headache disorders are both provoked by specific triggers and are highly comorbid with migraine. They account for a small proportion of Headache consultations, but potentially devastating secondary causes such as subarachnoid haemorrhage or reversible cerebral vasoconstriction syndromes should be considered. Structural neuroimaging studies, as well as comprehensive vascular imaging of head and neck, are necessary to exclude secondary causes. The diagnosis of primary Exertional Headache and primary sexual Headache should be based on the criteria proposed in the International Classification of Headache Disorders, 3rd edition (beta version). Impaired cerebral autoregulation or venous stenosis has been proposed as possible pathophysiology. Beta blocker and indomethacin might be effective treatment, but large-scale randomized placebo-controlled studies are required to provide solid evidence.
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Clues in the Differential Diagnosis of Primary vs Secondary Cough, Exercise, and Sexual Headaches
Headache, 2014Co-Authors: Rocío Alvarez, César Ramón, Julio PascualAbstract:Activity-related Headaches can be provoked by Valsalva maneuvers ("cough Headache"), prolonged exercise ("Exertional Headache") and sexual excitation ("sexual Headache"). These entities are a challenging diagnostic problem as can be primary or secondary and the etiologies for secondary cases differ depending on the Headache type. In this paper we review the clinical clues which help us in the differential diagnosis of patients consulting due to activity-related Headaches. Cough Headache is the most common in terms of consultation. Primary cough Headache should be suspected in patients older than 50 years, if pain does not predominate in the occipital area, if pain lasts seconds, when there are no other symptoms/signs and if indomethacin relieves the Headache attacks. Almost half of cough Headaches are secondary, usually to a Chiari type I malformation. Secondary cough Headache should be suspected in young people, when pain is occipital and lasts longer than one minute, and especially if there are other symptoms/signs and if there is no response to indomethacin. Every patient with cough Headache needs cranio-cervical MRI. Primary exercise/sexual Headaches are more common than secondary, which should be suspected in women especially with one episode, when there are other symptoms/signs, in people older than 40 and if the Headache lasts longer than 24 hours. These patients must have quickly a CT and then brain MRI with MRA or an angioCT to exclude space-occupying lesions or subarachnoid hemorrhage.
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Fusiform aneurysms of the vertebral artery: A hidden cause of Exertional Headache?:
Cephalalgia : an international journal of headache, 2012Co-Authors: Gerard Mauri, Pedro Vega, Eduardo Murias, Juan Vega, César Ramón, Julio PascualAbstract:Background: There is only one reported case of recurrent coital Headache related to an unruptured saccular aneurysm of the carotid artery.Case reports: We report on two cases of isolated recurrent coital/Exertional Headaches ipsilateral to unruptured fusiform aneurysms of the vertebral artery diagnosed by CT angiography. While one case is being managed conservatively, a vertebral stent has been set in the other.Conclusions: CT angiography with full visualisation of intracranial and upper cervical arteries could be used as a screening diagnostic procedure in these cases. Together with saccular aneurysms, fusiform aneurysms should be added to the IHS classification as aetiology for Exertional recurrent Headaches.
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Primary cough Headache, primary Exertional Headache, and primary Headache associated with sexual activity.
Handbook of clinical neurology, 2010Co-Authors: Julio Pascual, Andrés González-mandly, Agustín Oterino, Rubén MartínAbstract:Abstract Activity-related Headaches can be brought on by Valsalva maneuvers (“cough Headache”), prolonged exercise (“Exertional Headache”), and sexual excitation (“orgasmic Headache”). These Headaches account for 1–2% of the consultations due to Headache in a general neurological department. These entities are a challenging diagnostic problem as they can be primary or secondary and as their etiologies differ depending on the Headache type. About 50% of patients with cough Headache will show no demonstrable etiology, while the other half will be secondary to structural lesions, mostly a Chiari type I malformation at the foramen magnum level. As compared to the primary variety, secondary cough Headache begins earlier (average 40 versus 60 years), is located posteriorly, lasts longer (years versus months), is associated with posterior fossa symptoms/signs, and does not respond to indomethacin. Patients with secondary cough Headache show difficulties in cerebrospinal fluid circulation in the foramen magnum region in dynamic magnetic resonance imaging studies and preoperative plateau waves, which disappear after posterior fossa reconstruction. Headaches provoked by physical exercise and sexual Headache have many points in common. In contrast to cough Headache, secondary cases are rare, and sentinel subarachnoid bleeding is the most frequent etiology. The mean age at onset for primary Headaches provoked by physical exercise and sexual activity is similar (40 years); they share clinical characteristics (bilateral, pulsating) and respond to beta-blockers. In conclusion, provoked Headaches account for a low proportion of Headache consultations. Cough Headache is a different condition when compared to Headache due to physical exercise and sexual activity, which are clinical variants of the same entity.
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Other primary Headaches.
Neurologic Clinics, 2009Co-Authors: Julio PascualAbstract:This article reviews "other primary Headaches," a classification of the International Headache Society that includes primary stabbing Headaches, primary cough Headache, primary Exertional Headache, primary Headache associated with sexual activity, hypnic Headache, primary thunderclap Headache, and new daily persistent Headache. Clinicians should be aware that these Headaches may be symptomatic to structural lesions and therefore usually require careful neuroimaging evaluation.
Gilles Geraud - One of the best experts on this subject based on the ideXlab platform.
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Primary cough Headache, primary Exertional Headache, and primary Headache associated with sexual activity: a clinical and radiological study
Neuroradiology, 2013Co-Authors: Anne Donnet, Dominique Valade, Emmanuel Houdart, Michel Lanteri-minet, Charles Raffaelli, Geneviève Demarquay, Marc Hermier, Evelyne Guegan-massardier, Emmanuel Gerardin, Gilles GeraudAbstract:Introduction 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. Methods 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
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Primary cough Headache, primary Exertional Headache, and primary Headache associated with sexual activity: a clinical and radiological study
Neuroradiology, 2012Co-Authors: Anne Donnet, Dominique Valade, Emmanuel Houdart, Michel Lanteri-minet, Charles Raffaelli, Geneviève Demarquay, Marc Hermier, Evelyne Guegan-massardier, Emmanuel Gerardin, Gilles GeraudAbstract:Introduction 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.
Jong-ling Fuh - One of the best experts on this subject based on the ideXlab platform.
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The “Other” Headaches: Primary Cough, Exertion, Sex, and Primary Stabbing Headaches
Current Pain and Headache Reports, 2010Co-Authors: Shuu-jiun Wang, Jong-ling FuhAbstract: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.
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Exertional Headache a survey of 1963 adolescents
Cephalalgia, 2009Co-Authors: Shih-pin Chen, Jong-ling Fuh, Shuu-jiun WangAbstract:We employed a self-administered questionnaire to investigate Exertional Headache (EH) in students (ages 13–15 years) from two middle schools in Taiwan. In this study, the diagnosis of EH was made i...
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Exertional Headache—a survey of 1963 adolescents
Cephalalgia : an international journal of headache, 2008Co-Authors: Shih-pin Chen, Jong-ling Fuh, Shuu-jiun WangAbstract:We employed a self-administered questionnaire to investigate Exertional Headache (EH) in students (ages 13–15 years) from two middle schools in Taiwan. In this study, the diagnosis of EH was made i...
Shuu-jiun Wang - One of the best experts on this subject based on the ideXlab platform.
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Oxford Textbook of Headache Syndromes - Exertional and sex Headache
Oxford Textbook of Headache Syndromes, 2020Co-Authors: Shih-pin Chen, Julio Pascual, Shuu-jiun WangAbstract:Exertional Headache and sexual Headache are Headache disorders that share some clinical and pathophysiological characteristics. These two Headache disorders are both provoked by specific triggers and are highly comorbid with migraine. They account for a small proportion of Headache consultations, but potentially devastating secondary causes such as subarachnoid haemorrhage or reversible cerebral vasoconstriction syndromes should be considered. Structural neuroimaging studies, as well as comprehensive vascular imaging of head and neck, are necessary to exclude secondary causes. The diagnosis of primary Exertional Headache and primary sexual Headache should be based on the criteria proposed in the International Classification of Headache Disorders, 3rd edition (beta version). Impaired cerebral autoregulation or venous stenosis has been proposed as possible pathophysiology. Beta blocker and indomethacin might be effective treatment, but large-scale randomized placebo-controlled studies are required to provide solid evidence.
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The “Other” Headaches: Primary Cough, Exertion, Sex, and Primary Stabbing Headaches
Current Pain and Headache Reports, 2010Co-Authors: Shuu-jiun Wang, Jong-ling FuhAbstract: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.
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Exertional Headache a survey of 1963 adolescents
Cephalalgia, 2009Co-Authors: Shih-pin Chen, Jong-ling Fuh, Shuu-jiun WangAbstract:We employed a self-administered questionnaire to investigate Exertional Headache (EH) in students (ages 13–15 years) from two middle schools in Taiwan. In this study, the diagnosis of EH was made i...
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Exertional Headache—a survey of 1963 adolescents
Cephalalgia : an international journal of headache, 2008Co-Authors: Shih-pin Chen, Jong-ling Fuh, Shuu-jiun WangAbstract:We employed a self-administered questionnaire to investigate Exertional Headache (EH) in students (ages 13–15 years) from two middle schools in Taiwan. In this study, the diagnosis of EH was made i...
Anne Donnet - One of the best experts on this subject based on the ideXlab platform.
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Primary cough Headache, primary Exertional Headache, and primary Headache associated with sexual activity: a clinical and radiological study
Neuroradiology, 2013Co-Authors: Anne Donnet, Dominique Valade, Emmanuel Houdart, Michel Lanteri-minet, Charles Raffaelli, Geneviève Demarquay, Marc Hermier, Evelyne Guegan-massardier, Emmanuel Gerardin, Gilles GeraudAbstract:Introduction 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. Methods 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
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Primary cough Headache, primary Exertional Headache, and primary Headache associated with sexual activity: a clinical and radiological study
Neuroradiology, 2012Co-Authors: Anne Donnet, Dominique Valade, Emmanuel Houdart, Michel Lanteri-minet, Charles Raffaelli, Geneviève Demarquay, Marc Hermier, Evelyne Guegan-massardier, Emmanuel Gerardin, Gilles GeraudAbstract:Introduction 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.