Published online by Cambridge University Press: 09 October 2017
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 . 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).
|Primary cough headache||Primary exercise headache||Primary headache associated with sexual activity||Primary thunderclap headache||Hypnic headache||New daily persistent headache|
|Prevalence||1%||12%||1%||43/100,000 per year||0.07–0.3%||0.1%|
|Age of onset||60s||20s||20s–40s||Not available||60s||20s–30s|
|Gender||M > F||M > F||M > F||Not available||F > M||F > M|
|Onset||Sudden||Sudden||Gradual or explosive||Explosive||Abrupt, wakes patient from sleep||Starts within 24 hours|
|Character||Sharp, stabbing||Dull, diffuse, pulsatile||Dull and with increasing intensity with sexual activity or||Severe intensity||Dull, throbbing||Tension or migraine phenotype|
|Typical location||Vertex||Bilateral||Frontal||Diffuse||Diffuse, bilateral||Unilateral or generalized|
|Duration||Seconds to minutes||Hours||Minutes to hours||Hours to few days||Minutes to few hours||Daily and continuous for ≥3 months|
|Triggers||Coughing||Sustained physical exertion||Sexual activity||Spontaneous||Sleep (120–480 min into sleep)||Antecedent viral illness|
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