Exertional Headache

Aka: Exertional Headache, Sexual Headache, Orgasmic Headache, Coital Headache

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II. Symptoms

  1. Bilateral throbbing, pulsating or pressure Headache
  2. Headache duration: minutes to 2 days
  3. Provocative factors
    1. Exercise
    2. Coughing, sneezing, blowing
    3. Lifting weight
    4. Straining at stool
    5. Crying
    6. Singing
    7. Sexual activity (intercourse, masturbation)
      1. May peak with orgasm
      2. May also be trigger in Migraine Headache

III. Differential Diagnosis

  1. Benign Cough Headache
  2. Cerebral Aneurysm
  3. Posterior fossa lesion
    1. Meningioma
    2. Acoustic Neuroma
    3. Chiari Malformation
    4. Midbrain lesion

IV. Evaluation

  1. Exertional Headache is a Headache Red Flag
  2. Rule-out Organic Headache in all cases

V. Imaging

  1. CT Head or MRI Head (consider with CT angiogram or MR angiogram)

VI. Management

  1. Evaluate all cases for Organic Headache first
  2. Consider prophylaxis prior to exertion or intercourse
    1. Indomethacin
    2. Ergotamine

VII. References

  1. Cutrer in Goldman (2000) Cecil Medicine, p. 2066
  2. Goetz (1999) Clinical Neurology, p. 1101
  3. (2004) Cephalgia 24(suppl 1): 9-160 [PubMed]

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