Sir Charles Symonds neurologic training began at the National Hospital, Queen Square where he was taught by Gordon Holmes and Kinnier Wilson. He later spent time studying psychiatry under Adolf Meyer at the Johns Hopkins Hospital and neurosurgery under Harvey Cushing at the Peter Bent Brigham Hospital. Under the tutelage of Cushing, Symonds was the first to document the importance of intracranial aneurysms as a cause of subarachnoid hemorrhage and paved the way for clinicians to diagnose the condition before death. His clinical interest in the physical and psychological effects of head trauma was born out of his many years of service in the military. From these experiences, he understood the necessity for psychologists and neurologists to work together in the treatment of these patients. Later, he created a Hospital for Head Injuries at Oxford University. Symonds' knowledge of such a broad number of diseases for which he proficiently wrote and made significant scientific discoveries is truly astonishing. 1).
“Cephalée d'effort” (Tinel C.E.) is provocated by any physical effort: taking up a heavy weight, but also coughing, sneezing, laughing, going to stool. Pain is usually localized, abrupt in onset and of short duration. One may distinguish: 1) C.E. secondary to intracranial lesions, cranial traumatism, tumours of posterior fossa, syringomyelobulbia, Arnold-Chiari malformation, Paget disease, etc… 2) Isolated or primary C.E.: they occur mainly in men after fifty. Recurrence is capricious. Prognosis is good. Three mechanisms are possible: acute veinous hypertension of dural sinuses; sharp C.S.F. pressure rise, dural traction. The denomination of “céphalée d'effort” given by Tinel in 1932 is preferred to this of cough headache given by Sir Charles Symonds in 1956; because of the anteriority and wider conception of causal physical efforts, including cough 3).