21 years
Its been over a week now. whenever I laugh a bit not too much my head hearts like its bleeding pain. why is this happening? should I be worried?
Sep 2, 2014
Exertional headaches are an umbrella of headache syndromes, usually associated with physical activity. These headaches typically become severe very quickly after strenuous activity. Headaches that are provoked by exertion: in other words, the person doesn't have a headache until they exert themselves. The headache is actually triggered by some form of exertion.
They can, in certain cases, be a sign of abnormalities in the brain or other diseases. Activities that can precipitate these headaches include running, coughing, sneezing, sexual intercourse, and straining with bowel movements. Anyone who develops a severe headache following these kinds of activities requires prompt evaluation to rule out any underlying organic cause. Tests may include a MRI of the brain and MRA (magnetic resonance angiogram, an MRI in which a special contrast material or dye is injected via IV into the bloodstream to identify any abnormality in the brain vasculature) of the blood vessels in the brain, MRA of the blood vessels in the brain, and at times, a spinal tap. A common cause is known as the Arnold-Chiari malformation, where the cerebellum, located at the back of the brain, appears to be forced downward through the opening at the bottom of the skull.
Fortunately, most exertional headaches are benign in nature. The more benign causes of exertional headache include primary cough headache, primary exertional headache and primary headache associated with sexual activity. These can only be diagnosed if the more worrisome causes are first ruled out. Although these may occur in isolation, they are most frequently encountered in patients who have a genetic predilection for migraine.
Primary cough headache occurs precipitously during coughing or a sudden physical strain. It usually occurs within seconds of coughing, sneezing or straining. The pain is usually described as “sharp”, “stabbing” or “splitting” and can be quite severe in some cases. It usually involves both sides of the head and is felt most intensely in the back of the head, top of the head or forehead, although it can also involve both temples at the same time. These headaches tend to last up to about half an hour, some may actually last for hours after the inciting event. These headaches are not associated with any other neurological symptoms and there is no nausea or vomiting.
Cough headache are much more prevalent in people above the age of 40, so if it occurs in younger people, they especially need to be evaluated for other causes. Conditions which imitate primary cough headache include masses in the back of the brain, such as tumors or the Chiari malformation. In approximately 50% of all cough headache cases, an abnormality is detected, so proper testing is crucial.
Benign exertional headaches respond to usual headache therapy. Some are particularly responsive to indomethacin, an anti-inflammatory agent taken before the exertional activity or to others such as Rofecoxib and even aspirin.
Preventive measures such as quitting smoking are invaluable. Most people do not require treatment unless they're having frequent bouts of coughing. Prolonged coughing, needless to say, needs to be evaluated by a physician.
Another variant of exertional headaches is primary exertional headache, precipitated by physical exercise or strain. It typically starts as a throbbing pain on both sides of the head. Exertion may take the form of prolonged exercise, strenuous exercise such as lifting weights and other activities which might cause a red face. About 10% of the general population may experience exertional headache. They may occur more readily in high temperature, high humidity, high altitude or after drinking caffeine or alcohol.
These headaches can begin suddenly, and usually are bilateral. Some people experience these headaches straight after upon exertion, others will have to run a few blocks or do a few repetitions of exercise before they strike. These headaches can last from 5 minutes to 24 hours. Medications such as propranolol and indomethacin before exercise can help prevent these attacks, although propranolol can reduce your exercise tolerance. Again, it is essential to rule out disorders such as arterial disease or brain masses, especially if the headaches are one sided.
Your symptoms could also be manifestations of migraine headache, classically a throbbing/pounding/pulsating headache that typically affects one side of the head, is accompanied by photophobia (severe eye irritation from light) and phonophobia (intolerance of loud noises), that is why patients with migraine seek a dark quiet room, in addition to nausea/vomiting, and Is usually preceded by an aura (auras are visual illusions, like zigzags of light, that warn the patient of an upcoming migraine attack).
Although it is very common for migraine headache to become worse with exertion, you must keep in mind that headaches will worsen in people with increased intracranial pressure (increased pressure inside the head), in which case more serious entities such as brain tumors or blood vessel abnormalities, including cerebral aneurysms or arterio-venous malformations, should be ruled out.
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