This same headache is also triggered by bending his head and body towards the ground, as in tying his shoelaces while seated in a chair. Tightening his lower back or abdominal muscles, as in lifting a heavy object or straining at stool, also triggers a headache. When he puts his foot on a chair to tie his shoelaces a headache does not appear, nor does one appear when he bends his knees to a full squat to pick up an object from the floor. The duration of his cough-induced headaches is similar. Soon after getting out of bed in the morning, he can bend over to tie his shoelaces without triggering a headache.
Headaches occur every day, but only after the above actions.
Repetitive physical activities, such as cutting wood, do not trigger headaches. Most of his headaches strike the left temple, but others occur in the right temple or across the back of the head. The pain feels like he has been hit in the head by a baseball bat, or like an intensly tight band on his head. It is similar to the pain he has experienced from eating a big scoop of ice cream. He had a normal MRI and physical and neurologic examinations.