Unusual Headache Disorders

PURPOSE OF REVIEW Unusual headache disorders are less commonly discussed and may be misdiagnosed. These headache disorders frequently have a benign natural history; however, without reassurance, therapeutic education, and treatment, they can negatively affect the health and function of patients.

RECENT FINDINGS This article reviews the clinical features, diagnosis, workup, and proposed treatments for several unusual headache disorders including primary cough headache, primary headache associated with sexual activity, primary exercise headache, cold-stimulus headache, primary stabbing headache, nummular headache, hypnic headache, and headache attributed to travel in space. Exploding head syndrome is also discussed, which is a sleep disorder commonly confused with a headache disorder.

SUMMARY Unusual headache disorders are usually benign, yet without the correct diagnosis can be very worrisome for many patients. Through greater awareness of these headache disorders, neurologists can evaluate and effectively manage unusual headache disorders, which offers significant benefits to patients and practice satisfaction to neurologists.

Address correspondence to Dr Amaal Jilani Starling, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ 85259, [email protected].

RELATIONSHIP DISCLOSURE: Dr Starling has received personal compensation for serving on the medical advisory boards of Alder BioPharmaceuticals, Inc; Amgen Inc; Eli Lilly and Company; and eNeura Inc and as a consultant for Amgen Inc and Eli Lilly and Company. Dr Starling receives research/grant support from the Mayo Clinic and the Migraine Research Foundation.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Starling discusses the unlabeled/investigational use of acetazolamide, beta-blockers including nadolol and propranolol, caffeine, celecoxib, clomipramine, clonazepam, cyclobenzaprine, ergotamine, flunarizine, gabapentin, indomethacin, lithium, melatonin, nifedipine, nonsteroidal anti-inflammatory drugs, onabotulinumtoxinA, topiramate, and tricyclic antidepressants including amitriptyline for the treatment of unusual headache disorders.

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