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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 . 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).
Summary of epidemiology and headache features in other primary headache disorders
Primary cough headache
Primary exercise headache
Primary headache associated with sexual activity
Primary thunderclap headache
New daily persistent headache
43/100,000 per year
Age of onset
M > F
M > F
M > F
F > M
F > M
Gradual or explosive
Abrupt, wakes patient from sleep
Starts within 24 hours
Dull, diffuse, pulsatile
Dull and with increasing intensity with sexual activity orSevere in intensity, throbbing
Tension or migraine phenotype
Unilateral or generalized
Seconds to minutes
Minutes to hours
Hours to few days
Minutes to few hours
Daily and continuous for ≥3 months
Sustained physical exertionShort burst of physical exertion
Sleep (120–480 min into sleep)
Antecedent viral illnessCranial surgeryMenarcheStressful life events
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