Benign Exertional Headache

For 4 solid months, I get a headache when I move quickly, constrict my abdominal area, sneeze, blow my nose, turn over in bed, etc. It started as a constant, low grade headache, and has gradually morphed into a reaction to these movements. It feels related to something vascular and subsides once the pressure evens out in my head. I've ruled out all things life threatening with a CT scan, MRI and MRV. I've been to a neurologist, cardiologist, and physical therapist. I would like to know what is causing this change in me, and if there is a way to get beyond this problem. Thank you!

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

There are several causes of headaches. Headaches can be divided into primary and secondary. Primary headache disorders are headaches without a direct cause. These are diagnosed after secondary causes have been excluded. Secondary headache disorders are due to an underlying problem, there are many causes but some include medication side effects, systemic illness, nervous system infection, tumors, bleeds in the brain or clots in the veins of the brain, increased CSF pressure (pseudotumor cerebri), and others.

Primary headache disorders are much more common than secondary ones. There are several primary headache disorders, over 50 different types.  For example  migraines, which usually a pulsating throbbing one-sided pain with nausea and discomfort in bright lights that lasts several hours. Another type is cluster headaches, which are sharp pains that occur around and behind the eye often at night and are associated with tearing of the eye and running of the nose. In primary stabbing headache, sharp or jabbing pain in the head occur, either as a single stab or a series of brief repeated volleys of pain. Primary stabbing headache often occurs in people with migraine. The pain itself generally lasts a fraction of a second but can last for up to one minute in some people. Another type of stabbing headache is called paroxysmal hemicrania. This is marked by episodes of stabbing or sharp pains that occur on one side of the head and may be associated with eye tearing or runny nose. Episodes may occur several times and last 30 seconds to a minute. Yet another type of stabbing headache is abbreviated SUNCT; 100s of stabbing pains lasting seconds occur and are associated with red eye and tearing.

The symptoms you provided are worrisome, but it is reassuring now that you have had neuroimaging of your brain. If you have not had one performed, it may be worthwhile to have a lumbar puncture performed to look for opening pressure of the CSF (fluid around the brain and spinal cord) and also for inflammatory markers. These all could cause headaches as well.

Without further information about your headache, it is difficult to provide you with adequate information. It may be a primary exertional headache, but to make this diagnosis, all others need to be ruled out.  The treatment options typically include preventive treatment with a beta-blocker or indomethacin and/or migraine treatment.

You should continue working with your neurologist on this. If no answer is found, you may benefit from seeing a headache specialist.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.