Primary exertional headache

What it is

Headache is pain due to irritation of structures such as the dura, cranial nerves, or extracranial structures, and the classification divides it into primary and secondary. The primary headaches named are migraine, tension-type and cluster, with one further group for the rest, whose example given is cold stimulus headache. Migraine and tension headaches are more common in females. A secondary headache is one attributed to another cause: head or neck trauma, cranial or cervical vascular disorder, nonvascular intracranial disorder, substance use or withdrawal, infection, disturbance of homeostasis, or psychiatric disorder. The same group also covers headache or facial pain attributed to disorder of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth, or other facial or cranial structures. Named secondary headaches include subarachnoid hemorrhage, meningitis, hydrocephalus, neoplasia, and giant cell (temporal) arteritis. Exertional headache is not one of the primary types named in that classification, and what the pages do say about exertion is that exertional provocation is one of the red flags for a secondary headache, so a headache provoked by exertion is worked up for a secondary cause.

Because exertional headache is set against the three named primary types, it helps to have them side by side. Tension-type headache is the most common primary headache: bilateral, pressing or tightening and non-pulsatile, frontal, occipital or temporal, of 30 minutes to 7 days, occasional to frequent and either episodic or chronic, with no nausea or vomiting and at most mild photophobia or phonophobia. Its triggers are stress, lack of sleep and poor posture; its pathophysiology is muscle contraction with heightened sensitivity in the CNS; its diagnosis is clinical with no specific tests; it is treated with NSAIDs, analgesics, muscle relaxants and lifestyle changes; and prophylaxis is rarely called for in it, other than in the chronic form. Migraine is the second most common and cluster the least common, and both are diagnosed clinically with imaging to rule out other causes.