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.
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 . All individuals have a 1% risk of suffering from cough headaches during their lifetime . The disease prevalence in specialized headache clinics is similar . 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) . In primary CH, there is no identifiable cause for the headache. Moreover, primary CH is benign . 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 . Less common presentations include a unilateral headache and toothache  . 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 . 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.
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]
Jaw & Teeth
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  . 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.
The usual treatment is indomethacin, which can be highly effective although recently lumbar puncture has again been advocated. [ncbi.nlm.nih.gov]
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]
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]
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]
In contrast to cough headache, secondary cases are rare, and sentinel subarachnoid bleeding is the most frequent etiology. [ncbi.nlm.nih.gov]
Overview The authors discuss the clinical manifestations, etiology, differential diagnosis, diagnostic evaluation, and management of primary cough headache. [medlink.com]
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.  Epidemiology [ edit ] Incidence of thunderclap headache has been estimated at 43 per [en.wikipedia.org]
Background Primary cough headache (PCH) is precipitated by coughing or the Valsalva manoeuver (VM), and its underlying pathophysiology remains unclear. [ncbi.nlm.nih.gov]
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 of Cough Headache To prevent a cough headache, the actions which trigger the cough headaches should be avoided, such as coughing (of course!), sneezing or straining during bowel movements etc. [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]
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