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Diagnostic criteria:

A. headache fulfilling criteria B,C,D

B. brutal, lasting 1sec to 30 minutes

C. caused by coughing and/or Valsalva (blocked forced expiration),

D. not attributed to another condition.

Before being called primary, we must look for:
– An Arnold-Chiari malformation (cerebral malformation leading to an increase in cerebrospinal fluid pressure).
– Carotid or vertebro-basilar pathology.
– A cerebral aneurysm.

Description :

– Headache generally bilateral. the pain is intense, generally occipital.
– Subjects over 40 years old, 2/3 of whom are men,
– overlaps with exercise headache,
– Would be due to hyperpressure of the cerebrospinal fluid without real intracranial hypertension.

Treatment :

Preventative: treatment of nasopharyngeal or pulmonary conditions
Symptomatics: indomethacin between 25 and 150 mg, acetazolamide between 500 and 1500 mg, subtractive PL.