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Abstract

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 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
Headache features
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 orSevere in intensity, throbbing	Severe intensity	Dull, throbbing	Tension or migraine phenotype
Typical location	VertexFrontalOccipitalTemporal	Bilateral	FrontalOccipitalDiffuse	DiffuseOccipital	Diffuse, bilateralFrontotemporal	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	CoughingSneezingStrainingLaughing	Sustained physical exertionShort burst of physical exertion	Sexual activityMasturbation	SpontaneousValsalva maneuversSexExertionStress	Sleep (120–480 min into sleep)	Antecedent viral illnessCranial surgeryMenarcheStressful life events

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

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

Summary