What is primary exertion headache?
Some headaches only occur with exertion, particularly with activities that involve tensing the abdominal muscles or increasing the pressure in the chest, such as straining on the toilet, heavy lifting, coughing, sneezing or even sexual intercourse.
Primary exertion headaches begin during or shortly after the provoking activity, and usually last seconds to minutes. With repeated exertion, the intensity may build and become longer in duration.
Primary Exertion Headache Diagnosis
When first evaluating a patient with these symptoms, we generally obtain a brain MRI to rule out any serious underlying cause such as a blocked vein, or a problem at the back of the brain such as a tumor, cyst, or an Arnold-Chiari I malformation.
Once these potentially dangerous conditions are ruled out, meaning that the exertion headache is primary and not secondary, the headaches often respond to the prescription anti-inflammatory medication indomethacin or the hormonal food supplement melatonin.