Cough, exertional, and sex headaches

Headaches associated with sexual activity, cough and exertion are rare headache syndromes that show distinct but overlapping clinical features. Here, the current pathophysiological models that have facilitated our understanding of these headache types are reviewed. Although the exact pathophysiological mechanisms are yet to be defined, these headaches share the trigger mechanism of raised intra-abdominal pressure, with the sequelae of raised intracranial pressure leading to irritation of pain-sensitive intracranial structures such as the dura mater and venous sinus. The incidence of underlying symptomatic forms such as subarachnoid haemorrhage (SAH) or Chiari-l-Malformation is relatively high, so the importance of differential diagnosis and diagnostic evaluation of these headaches is discussed. The role of these headaches in the revised headache classification scheme of the international Headache Society (IHS) is considered. in view of recent clinical and experimental data highlighting the clinical spectrum of these headaches, current therapeutic options and prognostic outcome are explored.