University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Santander, Spain.
Cephalalgia. 2023 Mar;43(3):3331024221146989. doi: 10.1177/03331024221146989.
Headaches associated with physical exertion include headache precipitated by coughing or other Valsalva maneuvers, headache brought on by prolonged physical exercise, sexual headaches and cardiac cephalalgia.
To review and update the clinical characteristics, etiologies, pathophysiology and management of these headaches related to exertion.
In depth review of the publications, both in PubMed and in the main textbooks, of the different headaches induced by physical exercise.
Cough, exercise and sexual headaches can be primary or secondary; therefore, complementary studies are mandatory to rule out structural lesions. However, clinical characteristics, such as an old age and response to indomethacin for cough headache or being a young male and response to beta-blockers for exercise and sexual headaches, plus a normal examination are suggestive of a primary etiology. Etiology for secondary varieties, as posterior fossa lesions for cough headache or vascular malformations for exercise and sexual headaches, are also different. Finally, headache as a distant manifestation of myocardial ischemia, also known as "cardiac cephalalgia", appears at exertion in around two-thirds of cases and typically lasts less than 30 minutes and is relieved by nitroglycerine.
Primary and secondary cough headache can usually be suspected based on clinical characteristics and separated from exercise and sexual headaches, which share many aspects. Cardiac cephalalgia is not necessarily an exertional headache and should be considered in adult patients with short lasting headaches and patent vascular risk factors.
与体力活动相关的头痛包括咳嗽或其他瓦尔萨尔瓦动作诱发的头痛、长时间体力活动引起的头痛、性头痛和心源性头痛。
综述和更新与体力活动相关的这些头痛的临床特征、病因、病理生理学和治疗方法。
深入回顾发表在 PubMed 和主要教科书上的关于不同类型的体力活动诱发头痛的文献。
咳嗽、运动和性头痛可分为原发性或继发性；因此，必须进行补充检查以排除结构损伤。然而，临床特征，如年龄较大、对咳嗽性头痛的吲哚美辛有反应或为年轻男性、对运动和性头痛的β受体阻滞剂有反应，以及体格检查正常，提示病因可能为原发性。继发性头痛的病因也不同，如咳嗽性头痛的后颅窝病变或运动和性头痛的血管畸形。最后，头痛作为心肌缺血的一种远隔表现，也称为“心源性头痛”，在大约三分之二的病例中在体力活动时出现，通常持续不到 30 分钟，硝酸甘油可缓解。
原发性和继发性咳嗽性头痛通常可根据临床特征进行怀疑，并与运动性和性头痛相区分，后者具有许多共同特征。心源性头痛不一定是体力性头痛，应考虑到伴有短暂性头痛和已知血管危险因素的成年患者。
