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9 - Other Primary Headache Disorders That Can Present to the Emergency Department

Published online by Cambridge University Press:  09 October 2017

Serena L. Orr
Children’s Hospital of Eastern Ontario, Ottawa
Benjamin W. Friedman
Albert Einstein College of Medicine, New York
David W. Dodick
Mayo Clinic, Phoenix, AZ
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Although other primary headache disorders such as cough headache, exercise headache, headache associated with sexual activity, thunderclap headache, hypnic headache, and new daily persistent headache are less common than migraine and tension-type headache, these disorders can be severe, disabling, and misdiagnosed. A good proportion of them coexist with other primary headache disorders. In addition, they may be associated with underlying structural pathology, and it is paramount that they are investigated for secondary causes. Diagnosis of the other primary headache disorders requires exclusion of secondary mimics, as stipulated in the International Classification of Headache Disorders, third edition beta version [1]. Treatment and prognosis are dependent on the diagnosis, and the majority are indomethacin responsive.

This chapter reviews the epidemiology, clinical features, pathophysiology, and management of these less common headache disorders that may present to the emergency department (ED).

Table 9.1Summary of epidemiology and headache features in other primary headache disorders
Primary cough headachePrimary exercise headachePrimary headache associated with sexual activityPrimary thunderclap headacheHypnic headacheNew daily persistent headache
Prevalence1%12%1%43/100,000 per year0.07–0.3%0.1%
Age of onset60s20s20s–40sNot available60s20s–30s
GenderM > FM > FM > FNot availableF > MF > M
Headache features
 OnsetSuddenSuddenGradual or explosiveExplosiveAbrupt, wakes patient from sleepStarts within 24 hours
 CharacterSharp, stabbingDull, diffuse, pulsatileDull and with increasing intensity with sexual activity orSevere in intensity, throbbingSevere intensityDull, throbbingTension or migraine phenotype
 Typical locationVertexFrontalOccipitalTemporalBilateralFrontalOccipitalDiffuseDiffuseOccipitalDiffuse, bilateralFrontotemporalUnilateral or generalized
 DurationSeconds to minutesHoursMinutes to hoursHours to few daysMinutes to few hoursDaily and continuous for ≥3 months
 TriggersCoughingSneezingStrainingLaughingSustained physical exertionShort burst of physical exertionSexual activityMasturbationSpontaneousValsalva maneuversSexExertionStressSleep (120–480 min into sleep)Antecedent viral illnessCranial surgeryMenarcheStressful life events
Emergency Headache
Diagnosis and Management
, pp. 88 - 98
Publisher: Cambridge University Press
Print publication year: 2017

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