Other primary headaches. Cough headache, nummular headache and primary exercise headache: a secondary point of view
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MIGRAINE AND PRIMARY HEADACHES
Other primary headaches. Cough headache, nummular headache and primary exercise headache: a secondary point of view Bruno Colombo 1 & Massimo Filippi 1
# Fondazione Società Italiana di Neurologia 2020
According to the 2018 classification of International Headache Society (IHS), a group of clinically heterogeneous headache phenotypes are defined as “other primary headaches”. They are a miscellaneous of largely paroxysmal headache disorders, mostly short-lived and precipitated by particular circumstances. They are classified in a specific syndromic way, grouped and coded as primary headaches in section 4 of the IHS classification. In particular, primary cough headache (4.1), primary exercise headache (4.2), primary headache associated with sexual activity (4.3), primary thunderclap headache (4.4), cold stimulus headache (4.5), external pressure headache (4.6), primary stabbing headache (4.7), nummular headache (4.8), hypnic headache (4.9) and new daily persistent headache (4.10) are recognized and classified with specific diagnostic criteria as peculiar entities. Considering that all these headaches may have the potentiality to be symptomatic of other pathologies or of brain structural lesions, an accurate evaluation and appropriate neuroimaging tests are mostly requested for a correct diagnosis. It is noteworthy that a history of headache worsening with Valsalva manoeuver (as in cough headache or primary exercise headache) significantly increased the odds of finding a secondary headache, i.e. Chiari malformation or a neoplasm. The same dilemma is for a first episode of thunderclap headache, the most common headache associated with a secondary cause. For these reasons, when in daily practice a diagnosis of a new headache is challenging on clinical basis, a neuroimaging approach is warmly suggested [1].
* Bruno Colombo [email protected] 1
Department of Neurology, IRCCS San Raffaele Hospital, Vita-Salute University, Via Olgettina 48, 20100 Milan, Italy
Cough headache Cough headache is defined as a sudden onset headache, bilateral in distribution, precipitated only in association with coughing, straining, and/or other Valsalva manoeuvers, lasting between 1 s and 2 h, not associated with autonomic symptoms. The diagnosis requires the absence of any other intracranial pathology. According to this statement, for a definite diagnosis, a neuroimaging study is suggested, considering that the proportion of patients affected by cough headache who have a structural brain lesion (secondary cough headache) varied between 11 and 59% in recent series. The lifetime prevalence of primary cough headache is about 1% and most often affect people older than 40 years. The most frequent causes of secondary cough headaches are Chiari type I malformation (caudal displacement of one cerebellar tonsil by > 5 mm or both tonsils by 3–5 mm below the foramen magnum), posterior fossa lesions (i.e. arachnoid cysts or meningiomas) and acquired tonsillar descent due to low intracranial pressure (i.e. after lumbop
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