Primary cough headache is defined as head pain brought on by coughing or other Valsalva maneuvers, but not by prolonged physical exercise, in the absence of any intracranial disorder. Primary cough headache is considered to be a rare condition, accounting for 0.4% of all headaches consulting our Neurology Department. Its pathophysiology remains a mystery. Primary cough headache is a sudden-onset headache that usually lasts from 1 second to 30 minutes, tends to be bilateral and posterior, does not begin earlier than the fifth decade of life, is more frequent in men, is not accompanied by other neurologic manifestations, and responds to indomethacin. These clinical characteristics allow its differential diagnosis from other entities, even though a craniocervical magnetic resonance imaging study is mandatory to rule out posterior fossa lesions, especially Chiari type-I malformation.
Unable to display preview. Download preview PDF.
References and Recommended Reading
- 2.Tinel J: La céphalée a l’effort. Syndrome de distension douloureuse des veines intracraniennes. Médecine (Paris) 1932, 13:113–118.Google Scholar
- 5.Headache Classification Subcommittee of the International Headache Society: The International Classification of Headache Disorders, edn 2. Cephalalgia 2004, 24 (suppl 1):1–160. The new IHS Classification in which activity-related headaches are clearly separated in terms of diagnostic clinical criteria.Google Scholar
- 9.Pascual J, Combarros O, Leno C, et al.: Distribución por diagnósticos del dolor de cabeza como motivo de consulta neurológica. Med Clin (Barc) 1995, 104:161–164.Google Scholar
- 11.Pascual J, Iglesias F, Oterino A, et al.: Cough, exertional, and sexual headaches: an analysis of 72 benign and symptomatic cases. Neurology 1996, 46:1520–1524. The largest series on activity-related headaches in the modern neuroradiologic era, giving clinical clues for the differential diagnosis between primary and secondary cough headache.PubMedGoogle Scholar
- 13.Pascual J: Activity-related headache. In MedLink Neurology. Edited by Gilman S. San Diego: MedLink Corporation. Available at www.medlink.com. Accessed January 3, 2005.Google Scholar
- 16.Pascual J, Oterino A, Iglesias F, et al.: Cough headache. Headache Quart 1996, 7:201–206.Google Scholar
- 21.Satikov IN, Mattle HP: Vertebrobasilar dolicoectasia and exertional headache. J Neurol Neurosurg Psychiatry 1978, 41:930–933.Google Scholar
- 25.Sansur CA, Heiss JD, DeVroom HL, et al.: Pathophysiology of headache associated with cough in patients with Chiari I malformation. J Neurosurg 2003, 98:453–458. This paper confirms Williams’ data showing that headache linked to Chiari type I is associated with sudden increased intrathecal pressure caused by obstruction to the free CSF flow.PubMedCrossRefGoogle Scholar
- 30.Wolff HG: Pain-sensitive structures within the cranial cavity. In Headache and Other Head Pain, edn 2. New York: Oxford University Press; 1963:53–95.Google Scholar
- 31.Chen YY, Lirng JF, Fuh JL, et al.: Primary cough headache is associated with posterior fossa crowdedness: a morphometric MRI study. Cephalalgia 2004b, 24:694–699. Using MRI, these authors studied 14 cases with primary cough headache showing a crowded posterior cranial fossa, which may be a contributing factor to the pathogenesis of this headache syndrome.PubMedCrossRefGoogle Scholar
- 32.Diamond S, Medina JL: Benign exertional headache: successful treatment with indomethacin. Headache 1979, 19:249.Google Scholar