Other primary headaches. Cough headache, nummular headache and primary exercise headache: a secondary point of view

Excerpt

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]. …