Pathology Theories about the pathophysiology of exertional headache are numerous. Angiographic evidence has identified arterial dilatation or spasm as a possible factor. 11 Venous sinus dilatation or spasm can be contributory, a recent study suggests. The valsalva maneuver apparently increases arterial pressure in the central nervous system and diminishes venous blood return, leading to dilatation of the venous sinuses and veins at the base of the brain. Treatment Plan Reassure patients with BEH that no life-threatening pathology exists and educate them about proper symptom management.
Behavioral interventions are primary.
Counsel patients to avoid the trigger activity if possible. Avoiding caffeine and warming up before participating in the trigger activity are helpful adjuncts. 6 Pharmacologic interventions can be useful. Most BEH headaches resolve over time, but in some cases they persist for years. When the drug was discontinued 6 to 12 months later, all subjects had recurrence of the symptoms.