title: Chiari-associated exertional, cough, and sneeze headache responsive to medical therapy.
abstract: Benign exertional headache is coded as a separate entity within the International Headache Society's classification system, but the pathophysiological mechanisms underlying this clinical headache subtype are unknown and possibly are similar to those generating migraine. Coexistence of migraine and benign exertional headache in the same patient is not unusual, and antimigraine pharmacologic treatments are often effective in both headache types. Regardless, optimal management mandates that the clinician exclude any intracranial or systemic disease that could mimic "primary" exertional headache. The same holds for primary headaches induced by coughing or sneezing; congenital malformations or neoplasms, particularly within the posterior fossa, are not rare in these patients. The neurologic examination may not be sufficiently sensitive to detect the offending lesion. We describe a patient with migraine without aura and exertional secondary headache due to Chiari malformation type I whose headaches responded to treatment with propranolol and indomethacin.
authors.affiliation: IRCCS Santa Lucia Foundation, Via Ardeatina 306, Pozzilli (IS), 00179 Rome, Italy.
authors.forename: M Gabriella
authors.initials: MG
authors.lastname: Buzzi
authors.forename: Rita
authors.initials: R
authors.lastname: Formisano
authors.forename: Claudio
authors.initials: C
authors.lastname: Colonnese
authors.forename: Francesco
authors.initials: F
authors.lastname: Pierelli
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D001139:Arnold-Chiari Malformation / Q000150:complications*; D003371:Cough / Q000150:complications*; D005260:Female; D006261:Headache / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use; D008875:Middle Aged; D020326:Migraine without Aura / Q000150:complications*; D005082:Physical Exertion; D011433:Propranolol / Q000627:therapeutic use; D012912:Sneezing
chemical_list: D000319:Adrenergic beta-Antagonists; D011433:Propranolol; D007213:Indomethacin