Abstract
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.
Similar content being viewed by others
References and Recommended Reading
Silbert PL, Edis RH, Stewart-Wynne EG, Gubbay SS: Benign vascular sexual headache and exertional headache: interrelationships and long term prognosis. J Neurol Neurosurg Psychiatry 1991, 54:417–421.
Tinel J: La céphalée a l’effort. Syndrome de distension douloureuse des veines intracraniennes. Médecine (Paris) 1932, 13:113–118.
Symonds C: Cough headache. Brain 1956, 79:557–568.
Rooke ED: Benign exertional headache. Med Clin North Am 1968, 52:801–808.
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.
Sjaastad O, Bakketeig LS: Exertional headache. I: Vaga study of headache epidemiology. Cephalalgia 2002, 22:784–790.
Sjaastad O, Bakketteig LS: Prolonged benign exertional headache: the Vaga Study of headache epidemiology. Headache 2003, 43:611–615.
Rasmussen BK, Olesen J: Symptomatic and nonsymptomatic headaches in a general population. Neurology 1992, 42:1225–1231.
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.
Sands GH, Newman L, Lipton R: Cough, exertional, and other miscellaneous headaches. Med Clin North Am 1991, 75:733–747.
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.
Boes CJ, Matharu MS, Goadsby PJ: Benign cough headache. Cephalalgia 2002, 22:772–779.
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.
Diamond S: Prolonged benign exertional headache: its clinical characteristics and response to indomethacin. Headache 1982, 22:96–98.
Pascual J, Oterino A, Berciano J: Headache in type-I Chiari malformation. Neurology 1992, 42:1519–1521.
Pascual J, Oterino A, Iglesias F, et al.: Cough headache. Headache Quart 1996, 7:201–206.
Frese A, Eikerman A, Frese K, et al.: Headache associated with sexual activity: demography, clinical features, and comorbidity. Neurology 2003, 61:796–780.
Smith WS, Messing RO: Cerebral aneurysm presenting as cough headache. Headache 1993, 33:203–204.
Britton TC, Guiloff RJ: Carotid artery disease presenting as cough headache. Lancet 1988, 1:1406–1407.
Rivera M, del Real MA, Teruel JL, et al.: Carotid artery disease presenting as cough headache in a patient with haemodialysis. Postgrad Med J 1991, 67:702.
Satikov IN, Mattle HP: Vertebrobasilar dolicoectasia and exertional headache. J Neurol Neurosurg Psychiatry 1978, 41:930–933.
Williams B: Cerebrospinal fluid pressure changes in response to coughing. Brain 1976, 99:331–346.
Williams B: Cough headache due to craniospinal pressure dissociation. Arch Neurol 1980, 37:226–230.
Nightingale S, Williams B: Hindbrain hernia headache. Lancet 1987, 1:731–734.
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.
Pujol J, Roig C, Capdevilla A, et al.: Motion of the cerebellar tonsils in Chiari type I malformation studied by cine-phase contrast MRI. Neurology 1995, 45:1746–1753.
Quigley MF, Iskandar B, Quigley ME, et al.: Cerebrospinal fluid flow in foramen magnum: temporal and spatial pattern at MR imaging in volunteers and in patients with Chiari type I malformation. Radiology 2004, 232:229–236.
Wang SJ, Fuh JL, Lu SR: Benign cough headache is responsive to acetazolamide. Neurology 2000, 55:149–150.
Raskin NH: Short-lived head pains. Neurol Clin 1997, 15:143–152.
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.
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.
Diamond S, Medina JL: Benign exertional headache: successful treatment with indomethacin. Headache 1979, 19:249.
Mathew NT: Indomethacin-responsive headache syndromes. Headache 1981, 21:147–150.
Slavik RS, Rhoney DH: Indomethacin: a review of its cerebral blood flow effects and potential use for controlling intracranial pressure in traumatic brain injury patients. Neurol Res 1999, 21:491–499.
Raskin NH: The cough headache syndrome: treatment. Neurology 1995, 45:1784.
Chalaupka FD: Therapeutic effectiveness of acetazolamide in hindbrain hernia headache. Neurol Sci 2000, 21:117–119.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Pascual, J. Primary cough headache. Current Science Inc 9, 272–276 (2005). https://doi.org/10.1007/s11916-005-0036-1
Issue Date:
DOI: https://doi.org/10.1007/s11916-005-0036-1