Neurological Sciences

, Volume 33, Issue 2, pp 429–433 | Cite as

Cough headache secondary to spontaneous intracranial hypotension complicated by cerebral venous thrombosis

  • T. Ferrante
  • L. Latte
  • G. Abrignani
  • M. Russo
  • G. C. Manzoni
  • P. Torelli
Case Report


Cough headache may be the clinical manifestation, sometimes isolated, of an intracranial disease. 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. In fact, this would represent an exception to the rule that cough headache is generally secondary to conditions leading to an increase in intracranial pressure and/or volume. We report and discuss a case of cough headache secondary to spontaneous intracranial hypotension in an otherwise healthy 59-year-old man. The condition was complicated by cerebral venous thrombosis.


Cough headache Spontaneous intracranial hypotension Cerebral venous thrombosis 


  1. 1.
    Headache Classification Subcommittee of the International Headache Society (2004) The International Classification of Headache Disorders: 2nd edn. Cephalalgia 24(suppl 1):1–160Google Scholar
  2. 2.
    Pascual J, Iglesias F, Oterino A, Vázquez-Barquero A, Berciano J (1996) Cough, exertional, and sexual headaches: an analysis of 72 benign and symptomatic cases. Neurology 46:1520–1524PubMedGoogle Scholar
  3. 3.
    Pascual J (2005) Primary cough headache. Curr Pain Headache Rep 9:272–276PubMedCrossRefGoogle Scholar
  4. 4.
    Pascual J, González-Mandly A, Martín R, Oterino A (2008) Headaches precipitated by cough, prolonged exercise or sexual activity: a prospective etiological and clinical study. J Headache Pain 9:259–266PubMedCrossRefGoogle Scholar
  5. 5.
    Rasmussen BK, Olesen J (1992) Symptomatic and non symptomatic headaches in a general population. Neurology 42:1225–1231PubMedGoogle Scholar
  6. 6.
    Chen PK, Fuh JL, Wang SJ (2009) Cough headache: a study of 83 consecutive patients. Cephalalgia 29:1079–1085PubMedCrossRefGoogle Scholar
  7. 7.
    Symonds C (1956) Cough headache. Brain 76:557–568CrossRefGoogle Scholar
  8. 8.
    Rooke ED (1968) Benign exertional headache. Med Clin North Am 52:801–802PubMedGoogle Scholar
  9. 9.
    Jacome DE, Stamm MA (2004) Malignant cough headache. Headache 44:259–261PubMedCrossRefGoogle Scholar
  10. 10.
    Eross EJ, Swanson JW, Krauss WE, Parisi JE (2002) A rare cause of cough headache in an adult. Headache 42:382PubMedCrossRefGoogle Scholar
  11. 11.
    Smith WS, Messing RO (1993) Cerebral aneurysm presenting as cough headache. Headache 33:203–204PubMedCrossRefGoogle Scholar
  12. 12.
    Britton TC, Guiloff RJ (1988) Carotid artery disease presenting as cough headache. Lancet 1:1406–1407PubMedCrossRefGoogle Scholar
  13. 13.
    Satikov IN, Mattle HP (1978) Vertebrobasilar dolichoectasia and exertional headache. J Neurol Neurosurg Psychiatry 41:930–933CrossRefGoogle Scholar
  14. 14.
    Williams B (1976) Cerebrospinal fluid pressure changes in response to coughing. Brain 99:331–346PubMedCrossRefGoogle Scholar
  15. 15.
    Williams B (1980) Cough headache due to craniospinal pressure dissociation. Arch Neurol 37:226–230PubMedCrossRefGoogle Scholar
  16. 16.
    Nightingale S, William B (1987) Hindbrain hernia headache. Lancet 1:731–734PubMedCrossRefGoogle Scholar
  17. 17.
    Sansur CA, Heiss JD, De Vroom HL, Eskioglu E, Ennis R, Oldfield EH (2003) Pathophysiology of headache associated with cough in patients with Chiari I malformation. J Neurosurg 98:453–458PubMedCrossRefGoogle Scholar
  18. 18.
    Evans RW, Boes CJ (2005) Spontaneous low cerebrospinal fluid pressure syndrome can mimic primary cough headache. Headache 45:374–377PubMedCrossRefGoogle Scholar
  19. 19.
    Nuti A, Baldacci F, Lucetti C, Dolciotti C, Cipriani G, Bonuccelli U (2010) A case of idiopathic low CSF pressure headache presenting as cough headache. Neurol Sci 31:669–672Google Scholar
  20. 20.
    Mea E, Chiapparini L, Savoiardo M, Franzini A, Bussone G, Leone M (2009) Clinical features and outcomes in spontaneous intracranial hypotension: a survey of 90 consecutive patients. Neurol Sci 30(Suppl 1):S11–S13PubMedCrossRefGoogle Scholar
  21. 21.
    Mokri B (2004) Spontaneous low cerebrospinal pressure/volume headache. Curr Neurol Neurosci rep 4:117–124PubMedCrossRefGoogle Scholar
  22. 22.
    Schievink WI, Louy C (2007) Precipitating factors of spontaneous spinal CSF leaks and intracranial hypotension. Neurology 69:700–702PubMedCrossRefGoogle Scholar
  23. 23.
    Schievink WI, Gordon OK, Tourje J (2004) Connective tissue disorders with spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension: a prospective study. Neurosurgery 54:65–69PubMedCrossRefGoogle Scholar
  24. 24.
    Messori A, Savolini U (2001) Post-lumbar puncture intracranial hypotension. Neurol Sci 22:411–412PubMedCrossRefGoogle Scholar
  25. 25.
    Spelle L, Boulin A, Tainturier C et al (2001) Neuroimaging features of spontaneous intracranial hypotension. Neuroradiology 43:622–627PubMedCrossRefGoogle Scholar
  26. 26.
    Atkinson JL, Weinshenker BG, Miller GM, Piepgras DG, Mokri B (1988) Acquired Chiari I malformation secondary to spontaneous spinal cerebrospinal fluid leakage and chronic intracranial hypotension syndrome in seven cases. J Neurosurg 88:237–242Google Scholar
  27. 27.
    Mokri B (2003) Headache caused by decreased intracranial pressure: diagnosis and management. Curr Opin Neurol 16:319–326PubMedCrossRefGoogle Scholar
  28. 28.
    Alvarez-Linera J, Escribano J, Benito-Leun J, Porta-Etessam J, Rovina A (2000) Pituitary enlargement in patients with intracranial hypotension syndrome. Neurology 55:1895–1897PubMedGoogle Scholar
  29. 29.
    Roll JD, Larson TC, Soriano R (2003) Cerebral angiographic findings in spontaneous intracranial hypotension. Am J Neuroradiol 24:707–708PubMedGoogle Scholar
  30. 30.
    Thomas DL, Menda Y, Graham MM (2009) Radionuclide cisternography in detecting cerebrospinal fluid leak in spontaneous intracranial hypotension. Clin Nucl Med 34:410–416PubMedCrossRefGoogle Scholar
  31. 31.
    Mokri B (2000) Cerebrospinal fluid depletion and its emerging clinical/imaging syndromes. Neurosurgery focus 9:e6Google Scholar
  32. 32.
    Fay T (1937) Mechanism of headache. Arch Neurol Psychiatry 37:471–474Google Scholar
  33. 33.
    Schievink WI, Maya MM (2008) Cerebral venous thrombosis in spontaneous intracranial hypotension. Headache 48:1511–1519PubMedCrossRefGoogle Scholar
  34. 34.
    Albayram S, Kara B, Ipek H, Ozbayrak M, Kantarci F (2009) Isolated cortical thrombosis associated with intracranial hypotension syndrome. Headache 49:916–919PubMedCrossRefGoogle Scholar
  35. 35.
    Nardone R, Caleri F, Golaszewski S, Ladurner G, Tezzon F, Bailey A, Trinka E, Zuccoli G (2010) Subdural hematoma in a patient with spontaneous intracranial hypotension and cerebral venous thrombosis. Neurol Sci 31:789–791Google Scholar
  36. 36.
    Porta-Etessam J, Di Capua D, Jorquera M, Cuadrado ML, Marcos A (2011) Orthostatic headache and bilateral abducens palsy secondary to spontaneous intracranial hypotension. J Headache Pain 12:109–111PubMedCrossRefGoogle Scholar
  37. 37.
    Ozisik P, Berker M, Onal B (2010) A case of intracranial hypotension complicated with hydrocephalus. Turk Neurosurg 20:550–556PubMedGoogle Scholar
  38. 38.
    Bousser MG, Ferro JM (2007) Cerebral venous thrombosis: an update. Lancet Neurology 6:162–170PubMedCrossRefGoogle Scholar
  39. 39.
    Ferrante E, Savino A, Sances G, Nappi G (2004) Spontaneous intracranial hypotension syndrome: report of twelve cases. Headache 44:615–622PubMedCrossRefGoogle Scholar
  40. 40.
    Gentile S, Lo Giudice R, De Martino P, Rainero I, Pinessi L (2004) Headache attributed to spontaneous low CSF pressure: report of three cases responsive to corticosteroids. Eur J Neurol 11:849–851PubMedCrossRefGoogle Scholar
  41. 41.
    Ferrante E, Arpino I, Citterio A, Wetzl R, Savino A (2010) Epidural blood patch in Trendelenburg position pre-medicated with acetazolamide to treat spontaneous intracranial hypotension. Eur J Neurol 17:715–719PubMedCrossRefGoogle Scholar
  42. 42.
    Kantor D, Silberstein SD (2005) Cervical epidural blood patch for low CSF pressure headaches. Neurology 65:1138PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • T. Ferrante
    • 1
  • L. Latte
    • 1
  • G. Abrignani
    • 1
  • M. Russo
    • 1
  • G. C. Manzoni
    • 1
  • P. Torelli
    • 1
  1. 1.Department of Neuroscience, Headache CentreUniversity of ParmaParmaItaly

Personalised recommendations