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).