Headache Currents
HEADACHE CURRENTS
Editorial: Valuable Reviews of Activity-Related Headaches F. Michael Cutrer, MD; Justin M. DeLange, DO
Coughing, physical exertion, sexual intercourse, and sleep are among the most common elements of the human experience. It is not surprising that given the high prevalence of headache among our species that headaches may arise in the context of these activities in some individuals. With the lifetime prevalence of these disorders ranging from 1% for cough headache and sexual headaches1 to over 12% for exertional headache in the general population and up to 26% in athletes, it is very likely that most physicians in a general neurology practice will encounter patients with these headache types.1-3 Hypnic headache is much rarer, accounting for about 0.17% of headaches treated in our tertiary headache center in Rochester, MN. The diagnostic criteria and category assignment of these disorders has evolved over the past decade due to focused research. Two points related to the importance of recognizing the disorders should be emphasized: first, all occur in primary and symptomatic (secondary) forms, and appropriate investigations for an ominous underlying process must be undertaken, and second, many of these disorders are eminently treatable. Therefore, a lack of recognition robs the patient of potentially effective treatment. This issue of Headache Currents contains 2 very interesting review papers addressing the activity-related headache syndromes. Both provide valuable information as to the likely status of the disorders in the upcoming International Classification of Headache Disorders 3rd edition (ICHD-3) criteria and useful overviews of currently available treatment. In the first of 2 articles, Drs. Alvarez, Ramon, and Pascual turn their attention to clinical characteristics that are useful in differentiating primary cough, sexual, and exercise headaches from those symptomatic of structural abnormalities.4 This group is particularly well qualified to provide this guide as Dr. Pascual has written extensively on this subject since the mid-1990s and undoubtedly has broad experience in the diagnosis and management of these uncommon headache disorders. The authors point out that up to 50% of cough headaches are indeed symptomatic,
From the Mayo Clinic, Rochester, MN, USA. Address all correspondence to F.M. Cutrer, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Accepted for publication August 5, 2014. ............. Headache © 2014 American Headache Society
and they include several practical demographic and historical characteristics that can be used to differentiate primary from secondary cough headache. In addition, they present five useful signs and symptoms to distinguish primary exercise/sexual headaches from the symptomatic (secondary) form. Also of importance is their recommendation for imaging patients with cough, exercise, and sexual headache to rule out the presence of a mass, vascular lesion, or Chiari type 1 malformation. Additionally, of great interest in this Headache Currents is a review by Dr. Michel Lanteri-Minet of the uncommon hypnic headache syndrome.5 Particularly helpful to the headache specialist is the detailed discussion of how the diagnostic criteria of hypnic headache have evolved in the new proposed ICHD-3 criteria. The discussion of pathophysiology and treatment is a very nice summary of the current state of knowledge in these areas and highlights just how far we have to go in understanding and managing this unusual headache syndrome. The advisability for adequate magnetic resonance imaging in patients with this disorder to rule out symptomatic headache that may mimic hypnic headache is also emphasized. References 1. Rasmussen BK, Olesen J. Symptomatic and non-symptomatic headaches in a general population. Neurology. 1992;42:1225-1231. 2. Sjaastad O, Bakketeig LS. Exertional headache. I. Vågå study of headache epidemiology. Cephalalgia. 2002;22:784-790. 3. van der Ende-Kastelijn K, Oerlemans W, Goedegebuure S. An online survey of exercise-related headaches among cyclists. Headache. 2012; 52:1566-1573. 4. Alvarez R, Ramon C, Pascual J. Clues in the differential diagnosis of primary verses secondary cough, exercise, and sexual headache. Headache. 2014;54:1560-1562. 5. Lanteri-Minet M. Hypnic headache. Headache. 2014;54:15561559.
............. Conflict of Interests: None.
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HEADACHE CURRENTS
Editorial: Valuable Reviews of Activity-Related Headaches F. Michael Cutrer, MD; Justin M. DeLange, DO
Coughing, physical exertion, sexual intercourse, and sleep are among the most common elements of the human experience. It is not surprising that given the high prevalence of headache among our species that headaches may arise in the context of these activities in some individuals. With the lifetime prevalence of these disorders ranging from 1% for cough headache and sexual headaches1 to over 12% for exertional headache in the general population and up to 26% in athletes, it is very likely that most physicians in a general neurology practice will encounter patients with these headache types.1-3 Hypnic headache is much rarer, accounting for about 0.17% of headaches treated in our tertiary headache center in Rochester, MN. The diagnostic criteria and category assignment of these disorders has evolved over the past decade due to focused research. Two points related to the importance of recognizing the disorders should be emphasized: first, all occur in primary and symptomatic (secondary) forms, and appropriate investigations for an ominous underlying process must be undertaken, and second, many of these disorders are eminently treatable. Therefore, a lack of recognition robs the patient of potentially effective treatment. This issue of Headache Currents contains 2 very interesting review papers addressing the activity-related headache syndromes. Both provide valuable information as to the likely status of the disorders in the upcoming International Classification of Headache Disorders 3rd edition (ICHD-3) criteria and useful overviews of currently available treatment. In the first of 2 articles, Drs. Alvarez, Ramon, and Pascual turn their attention to clinical characteristics that are useful in differentiating primary cough, sexual, and exercise headaches from those symptomatic of structural abnormalities.4 This group is particularly well qualified to provide this guide as Dr. Pascual has written extensively on this subject since the mid-1990s and undoubtedly has broad experience in the diagnosis and management of these uncommon headache disorders. The authors point out that up to 50% of cough headaches are indeed symptomatic,
From the Mayo Clinic, Rochester, MN, USA. Address all correspondence to F.M. Cutrer, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Accepted for publication August 5, 2014. ............. Headache © 2014 American Headache Society
and they include several practical demographic and historical characteristics that can be used to differentiate primary from secondary cough headache. In addition, they present five useful signs and symptoms to distinguish primary exercise/sexual headaches from the symptomatic (secondary) form. Also of importance is their recommendation for imaging patients with cough, exercise, and sexual headache to rule out the presence of a mass, vascular lesion, or Chiari type 1 malformation. Additionally, of great interest in this Headache Currents is a review by Dr. Michel Lanteri-Minet of the uncommon hypnic headache syndrome.5 Particularly helpful to the headache specialist is the detailed discussion of how the diagnostic criteria of hypnic headache have evolved in the new proposed ICHD-3 criteria. The discussion of pathophysiology and treatment is a very nice summary of the current state of knowledge in these areas and highlights just how far we have to go in understanding and managing this unusual headache syndrome. The advisability for adequate magnetic resonance imaging in patients with this disorder to rule out symptomatic headache that may mimic hypnic headache is also emphasized. References 1. Rasmussen BK, Olesen J. Symptomatic and non-symptomatic headaches in a general population. Neurology. 1992;42:1225-1231. 2. Sjaastad O, Bakketeig LS. Exertional headache. I. Vågå study of headache epidemiology. Cephalalgia. 2002;22:784-790. 3. van der Ende-Kastelijn K, Oerlemans W, Goedegebuure S. An online survey of exercise-related headaches among cyclists. Headache. 2012; 52:1566-1573. 4. Alvarez R, Ramon C, Pascual J. Clues in the differential diagnosis of primary verses secondary cough, exercise, and sexual headache. Headache. 2014;54:1560-1562. 5. Lanteri-Minet M. Hypnic headache. Headache. 2014;54:15561559.
............. Conflict of Interests: None.
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