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Table of Contents
Year : 2022  |  Volume : 6  |  Issue : 4  |  Page : 117-118

Cough, cough-induced, and primary cough headache

Department of Medicine, Federal University of Santa Maria, Santa Maria, Brazil

Date of Submission10-Feb-2022
Date of Acceptance26-May-2022
Date of Web Publication06-Oct-2022

Correspondence Address:
Dr. Jamir Pitton Rissardo
Av. Roraima, 1000 - Camobi, Santa Maria, RS 97105-900
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mtsm.mtsm_6_22

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How to cite this article:
Rissardo JP, Fornari Caprara AL. Cough, cough-induced, and primary cough headache. Matrix Sci Med 2022;6:117-8

How to cite this URL:
Rissardo JP, Fornari Caprara AL. Cough, cough-induced, and primary cough headache. Matrix Sci Med [serial online] 2022 [cited 2023 Feb 1];6:117-8. Available from: https://www.matrixscimed.org/text.asp?2022/6/4/117/358004

Dear Editor,

We read the article entitled “Magnetic Resonance Imaging of Leptomeningeal Cyst with Atypical Presentation: Cough-Induced Headache” on the esteemed “Matrix Science Medica” with great interest. Dar et al. presented two adult patients with posttraumatic leptomeningeal cysts presenting as cough-induced headache. The headache worsened on forceful coughing in both individuals. In this context, the presence of growing skull fractures with headache and cough highlights the possible association between this type of headache and cerebrospinal fluid dynamic.[1]

Headache associated with coughing is characterized by headaches triggered by a rapid increase in intra-abdominal pressure caused by coughing, sneezing, or straining. It is an uncommon finding with a lifetime prevalence of <1%. Interestingly, the syndrome of cough headache is symptomatic in about 40% of cases, and the majority of these patients have Arnold– Chiari malformation More Details Type I.[2]

Herein, we would like to discuss recent studies about this rare condition. Four main mechanisms could explain headaches triggered by cough, which are jugular vein stenosis, cerebrospinal fluid hypervolemia, infection altering vascular tone, and crowdedness of the posterior cranial fossa [Figure 1]. We believe that these mechanisms combined lead to the development of headaches, instead of being separated pathways.
Figure 1: Pathophysiological mechanisms related to headache associated with cough. There are four main pathways that are jugular vein stenosis, cerebrospinal fluid hypervolemia, infection alters vascular tone, and crowdedness of posterior cranial fossa. The third version of the diagnostic criteria for primary cough headache of the international classification of headache disorders

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Takizawa et al. reported a case of an individual presenting with both primary cough headache and headache attributed to temporomandibular disorder. Their report was interesting because headaches associated with referred pain exhibit secondary central nervous system effects that can easily confound clinicians. It is worthy of mentioning that involuntary nonfunctional tooth contact is believed to be an important cause of both types of headaches.[2]

Primary cough headaches are mainly observed in adult patients, but cough-induced headaches are potentially symptomatic in the pediatric population. Omata et al. described a 7-year-old boy presenting with powerful cough-induced headaches. Echo examination confirmed right internal jugular vein dilatation during a Valsalva maneuver, and the individual was diagnosed with primary cough headache with internal jugular phlebectasia. Their report brings a new idea about the pathophysiology of this type of headache, which may be associated with the morphology and function of the internal jugular vein.[3]

Moreno-Ajona et al. reported a 53-year-old male diagnosed with primary cough headache using indomethacin, which was stopped due to gastroesophageal reflux disease. He was started on noninvasive vagal nerve stimulation (nVNS) using the gammaCore™ device. The individual showed improvement in his symptoms with nVNS, in particular, the parasympathetic reflex arc. This approach has advantages when compared to indomethacin such as good tolerability and safety of neuromodulation.[4]

In a recent Chinese respiratory clinic, it was assessed the prevalence, predictive factors, and clinical characteristics of cough headache in 679 patients. The prevalence of cough headache was 18.0% in these coughing patients. The main risk factor for the development of cough headache was age between 31 and 50 years (odds ratio 2.0). Furthermore, cough headache was associated with cough severity. It is noteworthy that headache severity had a positive correlation with cough severity, age, and headache duration.[5]

In sum, primary cough headaches are related to a mixture of pathological mechanisms. They are probably more common than we first believed. Moreover, when present in the pediatric population, further evaluation is needed.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Dar MA, Ashraf O, Rafiq S, Wani IA. Magnetic resonance imaging of leptomeningeal cyst with atypical presentation: Cough-induced headache. Matrix Sci Med 2021;5:50-2.  Back to cited text no. 1
  [Full text]  
Takizawa K, Urata K, Tanaka R, Ozasa K, Young A, Noma N. Headache attributed to temporomandibular disorder and primary cough headache. Neurol Int 2022;14:158-63.  Back to cited text no. 2
Omata Y, Takahashi Y, Nakazawa T, Omata T. Paediatric primary cough headache with internal jugular phlebectasia. BMJ Case Rep 2021;14:e242590.  Back to cited text no. 3
Moreno-Ajona D, Villar-Martínez MD, Goadsby PJ, Hoffmann J. Primary cough headache treated with non-invasive vagal nerve stimulation. Neurology 2020;95:593-4.  Back to cited text no. 4
Zhang Y, Zhao X, Wang Y, Dong Z, Yu S. Prevalence and characteristics of cough headache in a Chinese respiratory clinic. Cephalalgia 2021;41:366-74.  Back to cited text no. 5


  [Figure 1]


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