This exercise encompasses physical effort, exertion, trauma and cervicogenic factors. The exertional trigger can range from weight lifting to water skiing to gardening. The most common BEH patients are men in their 20s. Generally, the headache comes on suddenly with an activity that produces a valsalva maneuver. Repeating the activity triggers the same response, and not participating in the triggering activity results in absence of the headache.
Associated symptoms can include nausea, vomiting and photophobia.
Assessment of the patient's current medication use is important because headache is a common side effect of pharmacologic therapy. 6 Patients with BEH may have a family history of migraine. Social and occupational histories may provide insight about environmental exposure to chemicals that could potentially trigger headache. 7 Because BEH can be associated with benign sexual headaches, take a sensitive sexual history to ascertain whether the patient has similar headaches with orgasm. 5 Also ask about any orofacial pain.