Cough Headache
Cough-triggered headache is an uncommon finding, with a lifetime
prevalence of 1%. Headache can be triggered by rapid increase in the
intra-abdominal, intra-thoracic, and intracranial pressure, caused by
coughing, sneezing, or straining in patients with low pain threshold
(58). It is either primary or symptomatic. Primary cough headache
(previously known as benign cough headache or Valsalva-manoeuvre
headache) is currently defined as a headache with sudden onset,
occurring only in association with coughing, straining and/or Valsalva
manoeuvre. It lasts from one second to 30 minutes and is not related to
other disorder (59). It is more common in men over 40 years, and usually
bilateral, but sometimes unilateral. Pain is of moderate-to-severe
intensity and is usually located in the frontotemporal regions, but
sometimes presents with different patterns as toothache. The pain can be
triggered by Valsalva manoeuvrers, but never by physical exercise.
Nausea, vomiting, photo- and phonophobia are uncommon (60).
Underlying disorders can be detected in 40% of cases with symptomatic
cough headache. These lesions may involve but not limited to Chiari type
I malformation, obstructive hydrocephalus, posterior fossa structural
lesions (as arachnoid cysts, dermoid tumours, meningiomas, or
osodontoideum), spontaneous low CSF pressure or leak, subdural hematoma,
multiple brain metastases, acute sphenoid sinusitis, pneumocephalus,
pneumococcal meningitis, or non-ruptured cerebral aneurysm (61).
Symptoms are more common than observed with primary type, depending on
the underlying abnormality. The headache is more intense with variable
durations and locations. The pain may be pressing, explosive, bursting,
stabbing, dull, electrical, lancinating, or having a mixed nature.
Headache duration ranges from seconds to several weeks (58). Headache
can be triggered by a cough as well as other triggering factors as
laughing, exertion, weightlifting, defecation, or acute body or head
postural changes. Posterior fossa symptoms like dizziness, unsteadiness,
facial and upper limb numbness, vertigo, and syncope are common. The
mechanism of headache is mostly due to the increase in intracranial
pressure, supported by the fact that the headache disappears after the
surgical correction of the lesion (62).