4.6.1 External-compression headache

A 46-year-old man describes a long-distance cycling event, reporting a headache that he says is now at least the sixth time this pattern has occurred over the racing season. He explains that the pain begins each time while his aerodynamic helmet strap is cinched tightly across his forehead for hours during a race, and it is concentrated squarely under the strap rather than felt generally over the scalp. Onset occurs within roughly fifty minutes of tightening the strap for a long climb, and the pain has resolved within the hour every time once he has stopped and slackened the strap. He denied vomiting, denied any flashing lights beforehand, and denied weakness or speech disturbance. There is no family history of headache disorders.