Other Primary Headaches: Symptoms, Causes and Treatments

January 26, 2024
November 12, 2021
Other Primary Headaches: Symptoms, Causes and Treatments

Most of the headaches we treat are primary headache disorders - headaches where the primary issue is the headache condition itself, like migraine and tension type headache.  There is a group of headaches that also fall into this category, although they each have their own characteristics. Here is our guide and list of the symptoms to help you identify your type of headache:

Primary Cough Headache 

One concerning trigger for headaches is if they worsen after you cough, sneeze or bear down.  There are rare neurological conditions that can cause this, specifically a problem with the bottom part of the brain called a Chiari malformation.  This is where the cerebellum sits too low and can be impacted by the base of the skull.  If you experience these triggers without an underlying malformation of the brain, your headache is considered a primary cough headache. 

Primary Exercise Headache 

Certain exercises can trigger headaches.  Weightlifting at heavy weights can sometimes trigger a more intense, sudden headache, where cardio exercises may trigger headaches at a specific heart rate.  If exercise worsens or triggers your headaches you should address this with your doctor - they will likely want to make sure your brain otherwise looks healthy enough for exercise, and they may recommend certain medications (like beta blockers or anti-inflammatories) to take before exercise that may help.  Taking longer warm ups also has been shown to help exercise-triggered headaches. 

Primary Sex Headache

Sexual activity can be a trigger of headaches - and there are two subtypes of headaches associated with sex.  One occurs at orgasm and is typically sudden and severe.  This kind of headache needs medical attention and imaging (see below - Primary Thunderclap Headache).  There is also a pre-orgasmic subtype, which is worsening pain that occurs as the sexual activity intensifies.  It usually improves if you take things slower, and it may be necessary to adjust some sexual activity if this is the case. 

Primary Thunderclap Headache

This is a rare but severe kind of headache that always requires medical attention.  A thunderclap headache is a severe, sudden attack - getting to peak intensity within seconds.  Life threatening medical conditions can cause thunderclap headaches, including aneurysms of the brain.  If you experience a sudden headache, you must seek medical attention.  A thunderclap headache can be considered a primary headache if your doctor has thoroughly evaluated your situation and determined that it is not because of any of these conditions.

Cold Stimulus Headache 

Most people have experienced this some time in their lives - as the name suggests, this is a headache that you get if you are exposed to something very cold.  Otherwise known as “brain-freeze”, the treatment for this headache is to eat your ice cream more slowly. 

External Pressure Headache 

This headache can occur if you are wearing something too tight on your head (like a hat) or if your hair is pulled too tight (like a tight ponytail or bun).  Treatment is typically to allow release of the pressure from time to time (and let down your hair - literally!).

Primary Stabbing Headache 

As the name implies, this is a headache that occurs very briefly, and presents as stabs in areas around the head.  Because the attacks are so short we typically do not consider acute treatment, but if the attacks are very frequent preventive medications may be necessary.  Indomethacin is a potent antiinflammatory medication that can be very effective for stabbing headache. 

Nummular Headache 

This is a headache that only occurs on one part of the headache, in a round or coin-shapped area.  It is typically not tender, but the pain can be continuous.  This is one of the only headache conditions other than chronic migraine that we use Botox as a preventive treatment. 

Hypnic Headache

Also known as “alarm clock headache”, this condition is notable for waking the person up at nearly the exact time every night.  It typically lasts less than one and a half hours, and is best treated with coffee before bedtime (seriously!). 


New Daily Persistent Headache 

This is a difficult-to-treat headache that starts on a specific day and becomes daily and continuously.  It can have features of migraine or tension type headache, and often your headache specialist will treat you based on the features of your headache and what it most closely resembles. This can often happen after an infection or inflammatory event, and has even been reported to occur after a serious life event or medical procedure.  Many post-Covid headaches are presenting now as New Daily Persistent Headaches.

One of the best ways to identify your type of headache is to track your symptoms regularly and talk to a certified neurologist about it. Sign up for the Neura Health membership and get a consultation from a doctor on how you can treat a specific type of headache.

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Thomas Berk, MD FAHS
Thomas Berk is Medical Director at Neura Health, where he treats Neura patients via video visit. He is a former Clinical Assistant Professor at the Department of Neurology at NYU Grossman School of Medicine.
About the Author
Thomas Berk, MD FAHS is Medical Director of Neura Health and a neurologist and headache specialist based in New York City. A former Clinical Assistant Professor at the Department of Neurology at NYU Grossman School of Medicine, he has over 12 years of clinical experience. He graduated from the NYU Grossman School of Medicine and completed his neurology residency at NYU as well. He completed a headache fellowship at the Jefferson Headache Center in Philadelphia. He is a Fellow of the American Headache Society and has been on the Super Doctors list of rising stars for the past five years.

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