title: Primary cough headache, primary exertional headache, and primary headache associated with sexual activity: a clinical and radiological study.
abstract: BACKGROUND
  The purposes of this study are to describe clinical features of primary cough headache, primary exertional headache, and primary headache associated with sexual activity and to evaluate potential association with abnormalities in the cerebral or cervical venous circulation.
  
  
  METHODS
  This multicentre, observational, non-interventional consecutive cohort study included patients fulfilling ICHD-II criteria for primary cough headache (N = 10), primary exertional headache (N = 11), or primary headache associated with sexual activity (N = 20), as well as 16 headache-free controls. Each patient was evaluated clinically and underwent craniocervical MRV of the cranial circulation. All scans were interpreted centrally by blinded raters, using the Farb criteria proposed for idiopathic intracranial hypertension. Stenosis was defined as a Farb score <3 in left or right transverse sinuses or jugular veins.
  
  
  RESULTS
  In all primary headache groups, headaches were most frequently diffuse, severe, or very severe. Headache duration was significantly shorter in patients with cough headache (median 6.5 versus 20 and 60 min). An exploitable magnetic resonance venogram was obtained for 36 patients. Stenosis was detected in none of the control group, but in 5/7 patients with primary cough headache group, 2/10 patients with primary exertion headache, and 12/19 patients with primary headache associated with sexual activity. The frequency of stenosis was significantly different from the control group in the primary cough headache and primary headache associated with sexual activity groups.
  
  
  CONCLUSIONS
  Headaches provoked by cough and sexual activity are possibly associated with venous abnormalities in a significant subgroup of affected patients. As the literature shows conflicting results, this venous stenosis can be considered as a promoting factor.
authors.affiliation: Service de Neurologie et Pathologie du Mouvement, Pole Neurosciences Cliniques, Hôpital Timone, 264 Boulevard Saint-Pierre, 13385 Marseille Cedex 05, France. adonnet@ap-hm.fr
authors.forename: Anne
authors.initials: A
authors.lastname: Donnet
authors.forename: Dominique
authors.initials: D
authors.lastname: Valade
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Houdart
authors.forename: Michel
authors.initials: M
authors.lastname: Lanteri-Minet
authors.forename: Charles
authors.initials: C
authors.lastname: Raffaelli
authors.forename: Geneviève
authors.initials: G
authors.lastname: Demarquay
authors.forename: Marc
authors.initials: M
authors.lastname: Hermier
authors.forename: Evelyne
authors.initials: E
authors.lastname: Guegan-Massardier
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Gerardin
authors.forename: Gilles
authors.initials: G
authors.lastname: Geraud
authors.forename: Christophe
authors.initials: C
authors.lastname: Cognard
authors.forename: Olivier
authors.initials: O
authors.lastname: Levrier
authors.forename: Pierre
authors.initials: P
authors.lastname: Lehmann
mesh_terms: D002560:Cerebrovascular Circulation; D005260:Female; D005602:France; D051270:Headache Disorders, Primary / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012725:Sexual Behavior; D014689:Venous Insufficiency / Q000150:complications / Q000503:physiopathology*