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Cough Headache

A cough headache can either be primary (idiopathic) or secondary to another disease condition. In both types, individuals experience a sudden onset headache that is associated with coughing, and the Valsalva maneuver. Neuroimaging is an important tool in excluding underlying pathology.


Presentation

A cough headache (CH) is a rare diagnosis. It is described as a headache that lasts between one second and thirty minutes, as a result of coughing or other actions that cause an acute increase in intra-abdominal pressure, such as the Valsalva maneuver, straining when passing stool, lifting heavy weights and sneezing. Headaches of longer duration, up to two hours, have been reported [1]. All individuals have a 1% risk of suffering from cough headaches during their lifetime [2]. The disease prevalence in specialized headache clinics is similar [3]. In terms of distribution, men are more affected by CH than women, and the diagnosis is usually made after the fourth decade of life.

CH is classified into primary and secondary (also referred to as symptomatic CH), as described by the International Headache Society (IHS) [4]. In primary CH, there is no identifiable cause for the headache. Moreover, primary CH is benign [5]. The typical characteristics of a primary CH are sudden onset of bilateral pain in the frontotemporal or posterior regions of the head, with varying intensities, sometimes described as explosive [1]. Less common presentations include a unilateral headache and toothache [6] [7]. Features such as nausea and vomiting, as well as photophobia and phonophobia, which are commonly experienced in migraines, are not typical of CH.

Secondary CH occurs in response to an existing condition. Secondary CH is, in the majority of cases, caused by the Chiari malformation, type I. Patients with underlying pathology often exhibit a range of other symptoms, besides the headache.

It is assumed that the increase in abdominal pressure in primary CH increases venous pressure and thus intracranial pressure, culminating in CH. A similar mechanism has been proposed for secondary CH. Another hypothesis for primary CH is that there is overcrowding of the posterior cranial fossa [8]. In both classifications, the pathophysiology is not clearly understood.

It is important to note that primary CH is a diagnosis of exclusion, necessitating the investigation and exclusion of other possible causes of a headache.

Nightmare
  • “This lasted about 8 weeks altogether and this was a nightmare time for me. But it was the trigger event that made me go and seek help. I couldn’t work or sleep and it was driving me a bit crazy, so I went to see my GP.”[headacheexpert.co.uk]
Cough
  • Abstract Cough headache (CH) is a relatively rare, but an important complication of cough.[ncbi.nlm.nih.gov]
  • Abstract Benign cough headache is an uncommon primary headache disorder marked by short-lasting attacks of pain triggered by coughing. Magnetic resonance imaging of the brain is required to assure that the cough headache is truly benign.[ncbi.nlm.nih.gov]
  • BACKGROUND: The current definition of cough headache includes provocation of the symptom by Valsalva manoeuvre, and it is generally believed that all cough headache results from a sudden increase in intracranial pressure.[ncbi.nlm.nih.gov]
  • There are several possible causes of secondary cough headache. The hypothesis that cough headache may be the expression of spontaneous intracranial hypotension has been advanced only recently.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Headaches provoked by cough and sexual activity are possibly associated with venous abnormalities in a significant subgroup of affected patients.[ncbi.nlm.nih.gov]
Aspiration
  • ) The technique is simple which has an active exhalation of the breath where the aspirant is duly focused on forcefully exhaling it with the sudden contraction of the abdomen and inhaled involuntarily where the abdomen is released instantly.[mindorbs.com]
Regurgitation
  • Venogram disclosed either internal jugular or vertebral venous regurgitation in the BCH group. Acquired thoracic inlet valvular incompetence might contribute to BCH. Copyright 2005 S. Karger AG, Basel.[ncbi.nlm.nih.gov]
  • Venogram disclosed either internal jugular or vertebral venous regurgitation in the BCH group. Acquired thoracic inlet valvular incompetence might contribute to BCH. 2005 S.[karger.com]
Distractibility
  • Now close the eyes and take away the mind from the external distractions. 3. Place the right palm in the navel area of the stomach where this area is pulled towards the backbone. 4.[mindorbs.com]
Uremia
  • Headache is a common complaint of uremia patients. We conducted a clinical-radiological correlation study on 15 uremia patients with headache and central venous thrombosis.[ncbi.nlm.nih.gov]
  • […] headache. ( 16033395 ) Ferrante E. 2005 20 Primary cough headache responsive to topiramate. ( 16033389 ) Medrano V....Piqueras L. 2005 21 Primary cough headache. ( 16004844 ) Pascual J. 2005 22 Cough headache and thoracic inlet valvular competence in uremia[malacards.org]

Workup

As a result of the possibility of a causative disease, which is the case in about 50% of patients with cough headaches, radiological investigations have to be carried out in order to rule them out. Alternative causes of CH include posterior and anterior fossa tumors, Chiari malformation, acute sphenoid sinusitis, intracranial cysts, subdural hematoma, cerebral aneurysms, and brain metastatic lesions [1] [9]. Furthermore, other headache conditions exacerbated by coughing may be present. Neuroimaging is thus employed, of which the modality of choice is magnetic resonance imaging (MRI). It is required for diagnosis, and serves as a guide for further treatment plans.

Treatment

  • The usual treatment is indomethacin, which can be highly effective although recently lumbar puncture has again been advocated.[ncbi.nlm.nih.gov]
  • In this short review, we illustrate the possible treatment strategies on the basis of information collected from a systematic analysis of the international literature.[ncbi.nlm.nih.gov]
  • Fever is a common symptom in a variety of health ailments, but treatment is indicated when fever is accompanied by additional symptoms such as headache and cough.[livestrong.com]
  • Cough Headache Treatment There is no definite treatment plan for cough headaches. Since the severe pain lasts only for several minutes at a time, it is not advisable to treat the headache with painkillers.[headachemd.net]

Prognosis

  • We have reviewed the clinical features, aetiology, differential diagnosis, management, and prognosis of benign cough headache.[ncbi.nlm.nih.gov]
  • Silbert PL, Edis RH, Stewart-Wynne EG et al (1991) Benign vascular sexual headache and exertional headache: interrelationships and long term prognosis.[link.springer.com]

Etiology

  • In contrast to cough headache, secondary cases are rare, and sentinel subarachnoid bleeding is the most frequent etiology.[ncbi.nlm.nih.gov]
  • Cough headache can be a primary benign condition or secondary to underlying etiologies. We herein describe a case of a 52-year-old woman with cough headache that presented as reversible cerebral vasoconstriction syndrome (RCVS).[ncbi.nlm.nih.gov]
  • The aim of this cross-sectional clinical study was to evaluate the frequency, characteristics and etiology of CH among the patients referred to our Outpatient Department with the complaint of cough, and to investigate the relationship between their cough[ncbi.nlm.nih.gov]
  • Overview The authors discuss the clinical manifestations, etiology, differential diagnosis, diagnostic evaluation, and management of primary cough headache.[medlink.com]

Epidemiology

  • Known variations in ocular hydrodynamics, ocular rigidity, and forced expiration rationalize epidemiology of BCH. This hypothesis can be tested by study of pupillary function and facial sweating in patients with BCH.[ncbi.nlm.nih.gov]
  • Sjaastad O, Pettersen H, Bakketeig LS (2001) The Vaga study; epidemiology of headache I: the presence of ultrashort paroxysms.[link.springer.com]
  • It is not usually necessary to proceed to cerebral angiography, a more precise but invasive investigation of the brain's blood vessels, if MRA and MRV are normal. [1] Epidemiology [ edit ] Incidence of thunderclap headache has been estimated at 43 per[en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • Background Primary cough headache (PCH) is precipitated by coughing or the Valsalva manoeuver (VM), and its underlying pathophysiology remains unclear.[ncbi.nlm.nih.gov]
  • The possible pathophysiological significance of this concurrence of both types of indomethacin-responsive pain is discussed.[ncbi.nlm.nih.gov]
  • Its pathophysiology remains a mystery.[ncbi.nlm.nih.gov]
  • In both classifications, the pathophysiology is not clearly understood. It is important to note that primary CH is a diagnosis of exclusion, necessitating the investigation and exclusion of other possible causes of a headache.[symptoma.com]
  • Heiss and their colleagues at NIH (National Institute of Health) reported on their theory in the March, 2003 issue of the Journal of Neurosurgery in a study titled, Pathophysiology of headache associated with cough in patients with Chiari I malformation[conquerchiari.org]

Prevention

  • Getting flu shots annually helps in preventing cough headaches. Avoiding bending or heavy lifting for prolonged periods of time helps in preventing cough headaches.[epainassist.com]
  • Prevention: To prevent primary cough headaches, avoid coughing. Treat lung infections, such as bronchitis, and avoid cough-inducing medications.[knowyourdisease.com]
  • Secondary cough headaches Risk factors for secondary cough headaches include: Being younger than age 40 Prevention Preventing the actions that trigger your cough headaches — whether that's coughing, sneezing or straining on the toilet — may help reduce[drugs.com]
  • The Centers for Disease Control and Prevention explains that there is a difference in bacterial versus viral meningitis. In either condition, treatment is necessary to manage symptoms and prevent severe damage to the body.[livestrong.com]

References

Article

  1. Chen PK, Fuh JL, Wang SJ. Cough headache: a study of 83 consecutive patients. Cephalalgia. 2009;29(10):1079–1085.
  2. Rasmussen BK, Olesen J. Symptomatic and nonsymptomatic headaches in a general population. Neurology. 1992;42(6):1225–1231.
  3. Pascual J. Primary cough headache. Curr Pain Headache Rep. 2005;9(4):272–276.
  4. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004;24(suppl 1):9–160.
  5. Boes CJ, Matharu MS, Goadsby PJ. Benign cough headache. Cephalalgia. 2002;22(10):772–779.
  6. Ozge C, Atis S, Ozge A, Nass Duce M, Saracoglu M, Saritas E. Cough headache: frequency, characteristics and the relationship with the characteristics of cough. Eur J Pain (London, England) 2005;9(4):383–388.
  7. Moncada E, Graff-Radford SB. Cough headache presenting as a toothache: a case report. Headache. 1993;33(5):240–243.
  8. Dodick DW. Polysomnography in Hypnic Headache Syndrome. Headache. 2000;40(9):748–752.
  9. Pascual J, Gonzalez-Mandly A, Martin R, Oterino A. Headaches precipitated by cough, prolonged exercise or sexual activity: a prospective etiological and clinical study. J Headache Pain. 2008;9(5):259–266.

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Last updated: 2018-06-22 10:58