Uncommon headaches: diagnosis and treatment.

Headaches associated with exercise, cough, and sexual activity may present a diagnostic challenge in the emergency room or primary care provider's office. The majority of these patients have no underlying intracranial pathologic condition and have a good prognosis. However, new onset of these types of headache, with or without accompanying neurologic deficit, is an indication to exclude life-threatening conditions such as subarachnoid bleeding with neuroimaging and CSF examination. Since the pathophysiology is poorly understood, treatment choices are limited. Further research is needed to elucidate the pathophysiologic mechanisms of these uncommon headaches and to assess the cost-effectiveness of various diagnostic and follow-up strategies.