Last Saturday, a 57 year-old man came for consult because of ‘cough headache’ for 2 months. He was apparently seen by a neurologist already and an almost complete work-up, i.e. Cranial CT Scan, Cranial MRI, duplex scan, blood chemistry, etc., has been done. However, no definite diagnosis has yet been made and the medications given did not relieve the condition. It was his first ENT consult.
I could not think of an impression that the neurologist might not have considered. With the diagnostics done, I am sure he/she has thought of all the possible causes of this cough induced headache. All I could come up as a working diagnosis then was nonspecific neuralgia versus a vasculitis, to consider temporal arteritis.
Here’s what Mayo Clinic say about this condition.
Cough headaches are an unusual type of headache triggered by coughing and other types of straining — such as sneezing, blowing your nose, laughing, crying, singing or bending over, and straining when having a bowel movement.
Doctors divide cough headaches into two categories. Primary cough headaches are usually harmless. Secondary cough headaches are more serious, as they are caused by structural problems within the brain.
One in 100 people may experience a cough headache sometime during his or her life, but very few people have these headaches often enough that they seek medical attention.
Primary cough headaches tend to occur in limited episodes and eventually improve on their own, often within two months to two years. Secondary cough headaches sometimes require surgery to correct the underlying problem.
Signs and symptoms include:
- Strike suddenly with and just after coughing or other types of straining
- Typically last a few seconds to a few minutes — some can last up to 30 minutes
- Cause sharp, stabbing or splitting pain
- Usually affect both sides of your head and the back of your skull
- Can be followed by a dull, aching pain for several hours
What causes primary cough headaches isn't known. Some researchers suspect that increased pressure in the head (intracranial pressure) during coughing or other types of straining may play a role.
Secondary cough headaches can almost always be traced to problems at the base of the skull, where the brain and spinal cord connect. Defects in the shape of the skull or the configuration of the cerebellum can result in a portion of the brain being forced through an opening at the base of the skull (foramen magnum), where only the spinal cord should go.
Some of these types of defects are called Chiari malformations. Many people who have Chiari malformations also experience secondary cough headaches.
Primary cough headaches rarely, if ever, occur before the age of 40. They also predominantly affect men. In fact, as many as 80 percent of the people who have primary cough headaches are men.
Secondary cough headaches usually begin before the age of 40 and occur fairly equally between men and women.
Work-up will include an MRI of the brain to determine if there are any structural problems that may be causing the cough headaches.
Treatment differs, depending on whether you have primary or secondary cough headaches.
If you have a history of primary cough headaches, your doctor may recommend that you take daily medication to help prevent or reduce the pain.
These preventive medications may include:
- Indomethacin, an anti-inflammatory drug
- Acetazolamide, a diuretic that reduces the production of spinal fluid
- Topiramate, an anti-seizure drug
Rarely, a spinal tap (lumbar puncture) may be recommended. With this procedure, the doctor will remove a small amount of the fluid that surrounds your brain and spinal cord. This may help reduce the pressure inside your skull that may be causing the headaches.
Preventive medications usually don't help people who have secondary cough headaches. Instead, surgery is often needed to correct the underlying problem.
Preventing the actions that trigger your cough headaches — whether that is coughing, sneezing or straining on the toilet — may help reduce the number of headaches you experience. Some preventive measures may include:
- Treating lung infections, such as bronchitis
- Using cough suppressants as needed
- Getting an annual flu shot
- Using stool softeners to avoid constipation
By Mayo Clinic Staff
Feb 27, 2008
Feb 27, 2008
© 1998-2008 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved.
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