Materiały źródłowe

• #1 Headache associated with cough: a review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3671207/

  Headache only triggered by coughing is a rather uncommon condition. The aim of the present review is to present an overview of the diagnosis, clinical characteristics, pathophysiology and treatment of both primary and symptomatic cough headache and discuss other relevant headache disorders affected by coughing. The diagnosis of primary cough headache is made when headache is brought on and occurs only in association with coughing, straining or a Valsalva manoeuvre and in the absence of any abnormalities on neuro-imaging. In case an underlying pathology is identified as a cause of the headache, the diagnosis of symptomatic cough headache is made. The vast majority of these patients present with a Chiari malformation type I. Other frequently reported causes include miscellaneous posterior fossa pathology, carotid or vertebrobasilar disease and cerebral aneurysms. Consequently, diagnostic neuroimaging is key in the diagnosis of cough-related headache and guides treatment.

• #2 Cough headaches – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/primary-cough-headaches/symptoms-causes/syc-20371200

  Cough headaches are a type of head pain triggered by coughing and other types of straining. This may include sneezing, blowing your nose, laughing, crying, singing, bending over or having a bowel movement. […] Cough headaches are fairly uncommon. There are two types: primary cough headaches and secondary cough headaches. Primary cough headaches are usually harmless, are caused only by coughing and get better quickly without treatment. A primary cough headache is diagnosed only when a provider has ruled out possible causes other than coughing. […] A secondary cough headache may be triggered by a cough, but it is caused by problems with the brain or structures near the brain and spine. Secondary cough headaches can be more serious and may require treatment with surgery. […] The cause of primary cough headaches is unknown.

• #3 Headache associated with cough: a review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3671207/

  Cough triggering headache is an uncommon finding. It is characterized as headache triggered by rapid increases in intra-abdominal pressure, caused by coughing, sneezing or straining. The life-time prevalence of cough headache is estimated to be 1%. The prevalence in a headache clinic varies from 0.4% to 1.2%. […] Primary cough headache, previously also called benign cough headache or Valsalva-manoeuvre headache, is currently defined by the International Headache Society (IHS) as a headache, precipitated by coughing or straining in the absence of any intracranial disorder lasting up to 30 minutes. […] The pathophysiology of primary cough headache is not well understood, but various hypotheses have been formulated. It seems likely that it is associated with an increased intracranial pressure caused by coughing, this due to an increase in the intra-thoracic and intra-abdominal pressure subsequently leading to an increase in the central venous pressure. A recent study showed a transverse or jugular vein stenosis by means of MR venography in 5 out of 7 patients with primary cough headache, although the debate continues as to whether this stenosis is a primary or secondary process related to raised intracranial pressure. […] An increase in intracranial pressure is also believed to be the underlying mechanism of symptomatic cough headache, although the exact mechanism is unknown. In patients with a Chiari malformation type I, this seems to be caused by the sagging of the cerebellar tonsils below the foramen magnum.

• #4 Headache associated with cough: a review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3671207/

  Cough triggering headache is an uncommon finding. It is characterized as headache triggered by rapid increases in intra-abdominal pressure, caused by coughing, sneezing or straining. The life-time prevalence of cough headache is estimated to be 1%. The prevalence in a headache clinic varies from 0.4% to 1.2%. […] Primary cough headache, previously also called benign cough headache or Valsalva-manoeuvre headache, is currently defined by the International Headache Society (IHS) as a headache, precipitated by coughing or straining in the absence of any intracranial disorder lasting up to 30 minutes. […] The pathophysiology of primary cough headache is not well understood, but various hypotheses have been formulated. It seems likely that it is associated with an increased intracranial pressure caused by coughing, this due to an increase in the intra-thoracic and intra-abdominal pressure subsequently leading to an increase in the central venous pressure. A recent study showed a transverse or jugular vein stenosis by means of MR venography in 5 out of 7 patients with primary cough headache, although the debate continues as to whether this stenosis is a primary or secondary process related to raised intracranial pressure. […] An increase in intracranial pressure is also believed to be the underlying mechanism of symptomatic cough headache, although the exact mechanism is unknown. In patients with a Chiari malformation type I, this seems to be caused by the sagging of the cerebellar tonsils below the foramen magnum.

• #5 Headache associated with cough: a review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3671207/

  Cough triggering headache is an uncommon finding. It is characterized as headache triggered by rapid increases in intra-abdominal pressure, caused by coughing, sneezing or straining. The life-time prevalence of cough headache is estimated to be 1%. The prevalence in a headache clinic varies from 0.4% to 1.2%. […] Primary cough headache, previously also called benign cough headache or Valsalva-manoeuvre headache, is currently defined by the International Headache Society (IHS) as a headache, precipitated by coughing or straining in the absence of any intracranial disorder lasting up to 30 minutes. […] The pathophysiology of primary cough headache is not well understood, but various hypotheses have been formulated. It seems likely that it is associated with an increased intracranial pressure caused by coughing, this due to an increase in the intra-thoracic and intra-abdominal pressure subsequently leading to an increase in the central venous pressure. A recent study showed a transverse or jugular vein stenosis by means of MR venography in 5 out of 7 patients with primary cough headache, although the debate continues as to whether this stenosis is a primary or secondary process related to raised intracranial pressure. […] An increase in intracranial pressure is also believed to be the underlying mechanism of symptomatic cough headache, although the exact mechanism is unknown. In patients with a Chiari malformation type I, this seems to be caused by the sagging of the cerebellar tonsils below the foramen magnum.

• #6 Cough Headache: Causes, Symptoms, Treatment & Types

  https://my.clevelandclinic.org/health/diseases/21071-cough-headache

  A cough headache is head pain that occurs after coughing, sneezing, laughing or straining. A cough headache can last anywhere from a few seconds to 30 minutes, on average. Some can last up to two hours. These headaches aren’t common. Most cases are harmless, but some may have a more serious cause. […] The exact cause of a primary cough headache isn’t well understood. Experts think coughing raises the pressure inside your chest and abdomen (belly), which increases the pressure in your brain. […] Most causes of a secondary cough headache happen due to a growth abnormality in your brain. One of the most common is Chiari malformation type I. This occurs when brain tissue in the lower back part of your skull extends into your spinal canal (the base of your skull). It’s the area of your brain that regulates your balance.

• #7 Headache associated with cough: a review | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/1129-2377-14-42

  The pathophysiology of primary cough headache is not well understood, but various hypotheses have been formulated. It seems likely that it is associated with an increased intracranial pressure caused by coughing, this due to an increase in the intra-thoracic and intra-abdominal pressure subsequently leading to an increase in the central venous pressure. A recent study showed a transverse or jugular vein stenosis by means of MR venography in 5 out of 7 patients with primary cough headache, although the debate continues as to whether this stenosis is a primary or secondary process related to raised intracranial pressure. […] An increase in intracranial pressure is also believed to be the underlying mechanism of symptomatic cough headache, although the exact mechanism is unknown. In patients with a Chiari malformation type I, this seems to be caused by the sagging of the cerebellar tonsils below the foramen magnum.

• #8 Primary Cough Headache Associated with Jugular Insufficiency: Report of Two Cases

  https://ijms.info/IJMS/article/download/1619/2052?inline=1

  Insufficiency of the internal jugular valve is a scarcely found etiology in the literature for the cough headache, which can be associated with other vascular disorders. […] The two case reports help to broaden the discussion on the possible association between primary cough headache and insufficiency of the internal jugular vein system, although the correlation between those two pathologies is still being debated. […] The association of insufficiency of the internal jugular valve with PCH is rarely described. […] According to some authors, the associated jugular venous insufficiency could be a factor related to the pathogenesis of PCH, although some also have suggested that this entity could be considered a secondary headache when venous insufficiency is demonstrated. […] Headache associated with the reflux of the internal jugular vein during diastole can be justified by increased intracranial pressure; cerebral edema; venous infarction, and stimulation of trigeminocervical nociceptors located on the surface of the venous system.

• #9 Primary cough headache | MedLink Neurology

  https://www.medlink.com/articles/primary-cough-headache

  Wang and colleagues postulated that primary cough headache was due to CSF hypervolemia, leading to an increased craniospinal pressure dissociation during coughing, thus, explaining the response to acetazolamide, indomethacin, and lumbar puncture. […] The same group reported the association of primary cough headache with morphometric MRI evidence of posterior cranial fossa overcrowding. […] The authors suggested that posterior fossa overcrowding might cause a relative obstructive CSF pathway around the craniocervical region, contributing to a higher intracranial pressure during cough.

• #10 Primary cough headache | MedLink Neurology

  https://www.medlink.com/articles/primary-cough-headache

  Wang and colleagues postulated that primary cough headache was due to CSF hypervolemia, leading to an increased craniospinal pressure dissociation during coughing, thus, explaining the response to acetazolamide, indomethacin, and lumbar puncture. […] The same group reported the association of primary cough headache with morphometric MRI evidence of posterior cranial fossa overcrowding. […] The authors suggested that posterior fossa overcrowding might cause a relative obstructive CSF pathway around the craniocervical region, contributing to a higher intracranial pressure during cough.

• #11 Primary Cough Headache Associated with Jugular Insufficiency: Report of Two Cases

  https://ijms.info/IJMS/article/download/1619/2052?inline=1

  The retrograde venous flow, due to insufficiency, produces an intravenous swelling with dilation of the plexus in the pre-valvular region, a site innervated by nociceptors from the trigeminal system, commencing with pain and resulting in trigeminal stimulation. […] The VM is a controlled method for a better understanding of how the cough acts in the human body, since both produce similar physiological effects in increasing the venous pressure within the chest and abdomen. […] Due to the physiology involved in VM and its compensatory responses and the consequences of a jugular insufficiency, the occurrence of headache in both reported cases shows a possible causal association between those factors. […] Two patients are described with symptoms consistent with PCH, who also had jugular venous insufficiencies verified in Doppler sonography, which may or may not favor the occurrence of this primary headache.

• #12 Modified Valsalva test differentiates primary from secondary cough headache | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/1129-2377-14-31

  Alternatively, PCH might reflect dalgie veineuse intracranienne pain arising from intracranial venous distension, as originally proposed by Tinel. […] Our data suggest that secondary cough headache is caused by a transient increase in intracranial CSF pressure due to obstruction of normal CSF dynamics. […] By contrast, PCH is not provoked by Valsalva manoeuvre and must be due to another mechanism. This could be through orbital venous plexus congestion during effort in the presence of jugular venous incompetence and a reduced threshold for trigeminal sensory activation.

• #13 4.1 Primary cough headache – ICHD-3

  https://ichd-3.org/other-primary-headache-disorders/4-1-primary-cough-headache/

  Headache precipitated by coughing or other Valsalva (straining) manœuvre, but not by prolonged physical exercise, in the absence of any intracranial disorder. […] The syndrome of cough headache is symptomatic in about 40% of cases, and the majority of patients in whom this is so have Arnold-Chiari malformation type I. Other reported causes include spontaneous intracranial hypotension, carotid or vertebrobasilar diseases, middle cranial fossa or posterior fossa tumours, midbrain cyst, basilar impression, platybasia, subdural haematoma, cerebral aneurysms and reversible cerebral vasoconstriction syndrome. […] 4.1 Primary cough headache is usually bilateral and posterior, and predominantly affects patients older than 40 years of age. There is a significant correlation between the frequency of cough and the severity of the headache. Associated symptoms such as vertigo, nausea and sleep abnormality have been reported by up to two-thirds of patients with 4.1 Primary cough headache. […] While indomethacin (50-200 mg/day) is usually effective in treating 4.1 Primary cough headache, a few symptomatic cases have been reported to respond to this treatment.

• #14 Headache associated with cough: a review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3671207/

  Cough triggering headache is an uncommon finding. It is characterized as headache triggered by rapid increases in intra-abdominal pressure, caused by coughing, sneezing or straining. The life-time prevalence of cough headache is estimated to be 1%. The prevalence in a headache clinic varies from 0.4% to 1.2%. […] Primary cough headache, previously also called benign cough headache or Valsalva-manoeuvre headache, is currently defined by the International Headache Society (IHS) as a headache, precipitated by coughing or straining in the absence of any intracranial disorder lasting up to 30 minutes. […] The pathophysiology of primary cough headache is not well understood, but various hypotheses have been formulated. It seems likely that it is associated with an increased intracranial pressure caused by coughing, this due to an increase in the intra-thoracic and intra-abdominal pressure subsequently leading to an increase in the central venous pressure. A recent study showed a transverse or jugular vein stenosis by means of MR venography in 5 out of 7 patients with primary cough headache, although the debate continues as to whether this stenosis is a primary or secondary process related to raised intracranial pressure. […] An increase in intracranial pressure is also believed to be the underlying mechanism of symptomatic cough headache, although the exact mechanism is unknown. In patients with a Chiari malformation type I, this seems to be caused by the sagging of the cerebellar tonsils below the foramen magnum.

• #15 Cough headaches – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/primary-cough-headaches/symptoms-causes/syc-20371200

  Secondary cough headaches may be caused by: A defect in the shape of the skull. A defect in the part of the brain that controls balance (cerebellum). This can happen when part of the brain is forced through the opening at the base of the skull (foramen magnum), where only the spinal cord should be. Some of these types of defects are called Chiari malformations. A weakness in one of the blood vessels in the brain (cerebral aneurysm). A brain tumor. A spontaneous cerebrospinal fluid leak. […] Sometimes, what is first diagnosed as a cough headache may be caused by a cerebrospinal fluid (CSF) leak. Coughing or straining may trigger the headache, but the underlying cause is the cerebrospinal fluid (CSF) leak. This is one of the reasons why it’s important to see your provider for a new cough headache.

• #16 Pathophysiology of headache associated with cough in patients with Chiari I malformation – PubMed

  https://pubmed.ncbi.nlm.nih.gov/12650413/

  Object: The aim of this study was to evaluate the pathophysiology underlying headache associated with cough in patients with Chiari I tonsillar abnormality. The authors hypothesized that peak intrathecal pressure during coughing is higher in patients with headache aggravated by cough than in patients without or in healthy volunteers. […] Peak intrathecal pressures during cough and at baseline were elevated in patients with headache associated with cough compared with either patients without headache or healthy volunteers. After surgery, intrathecal pressures during cough were significantly lower than preoperative values and headache aggravated by cough was resolved partially or completely. Headache linked to coughing in patients with Chiari I malformation is associated with sudden increased intrathecal pressure caused by obstruction to the free flow of CSF in the subarachnoid space.

• #17 Pathophysiology of headache associated with cough in patients with Chiari I malformation in: Journal of Neurosurgery Volume 98 Issue 3 (2003) Journals

  https://thejns.org/view/journals/j-neurosurg/98/3/article-p453.xml

  Object. The aim of this study was to evaluate the pathophysiology underlying headache associated with cough in patients with Chiari I tonsillar abnormality. […] Peak intrathecal pressures during cough and at baseline were elevated in patients with headache associated with cough compared with either patients without headache or healthy volunteers. […] Headache linked to coughing in patients with Chiari I malformation is associated with sudden increased intrathecal pressure caused by obstruction to the free flow of CSF in the subarachnoid space.

• #18 Cough Headache – what causes this rare headache?

  https://www.severe-headache-expert.com/cough-headache/

  Cough headache is a provoked headache when coughing causes a sudden intense sharp pain. A cough headache is often in the top or back of the head, but any part of the head can be affected. […] Strictly speaking, cough headache only occurs as a result of a cough stimulus. However, it is also known that stooping, sneezing or lifting can produce the pain. Weightlifters can get this pain when lifting extreme weights. […] The mechanism of headache brought on by coughing is not known for certain. Patients with the Chiari Malformation may have a ball-valve effect at the base of the brain. A cough causes a rise in pressure inside the head. This pressure rise worsens the Chiari Malformation, by forcing the cerebellar tonsils further into the spinal canal. The pressure in the head rises very sharply, and then falls more slowly. The sudden rise in intracranial pressure (Intra = inside, cranial = head) is what causes the sudden pain.

• #19 Cough-Associated Headache in Patients with Chiari I Malformation: CSF Flow Analysis by Means of Cine Phase-Contrast MR Imaging | American Journal of Neuroradiology

  http://www.ajnr.org/content/32/4/739

  The purpose of this study was to analyze the CSF flow in patients with Chiari I to determine differences between patients with and without CAH. […] This CAH is attributed to abnormal CSF flow at the foramen magnum and is, when severe, considered an indication for decompressive surgery. […] Our results show that Cine-PC imaging can demonstrate differences in CSF flow patterns between patients with Chiari I with and without CAH. Those with this symptom had much shorter CSF systole and longer CSF diastole compared with those without it. […] CAHs are seen in 30% of patients with Chiari I malformation and are believed to be due to CSF flow impairment at the foramen magnum. […] Several theories have been proposed to explain the pathophysiology of CAH in patients with Chiari I. Most agree that tonsillar herniation produces impairment of CSF flow at the foramen magnum and results in this symptom.

• #20 Cough headaches – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/primary-cough-headaches/symptoms-causes/syc-20371200

  Secondary cough headaches may be caused by: A defect in the shape of the skull. A defect in the part of the brain that controls balance (cerebellum). This can happen when part of the brain is forced through the opening at the base of the skull (foramen magnum), where only the spinal cord should be. Some of these types of defects are called Chiari malformations. A weakness in one of the blood vessels in the brain (cerebral aneurysm). A brain tumor. A spontaneous cerebrospinal fluid leak. […] Sometimes, what is first diagnosed as a cough headache may be caused by a cerebrospinal fluid (CSF) leak. Coughing or straining may trigger the headache, but the underlying cause is the cerebrospinal fluid (CSF) leak. This is one of the reasons why it’s important to see your provider for a new cough headache.

• #21 Cough headaches | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/cough-headaches?content_id=CON-20371185

  Cough headaches are a type of head pain triggered by coughing and other types of straining. […] A secondary cough headache may be triggered by a cough, but it is caused by problems with the brain or structures near the brain and spine. […] The cause of primary cough headaches is unknown. […] Secondary cough headaches may be caused by: A defect in the shape of the skull. A defect in the part of the brain that controls balance (cerebellum). This can happen when part of the brain is forced through the opening at the base of the skull (foramen magnum), where only the spinal cord should be. Some of these types of defects are called Chiari malformations. A weakness in one of the blood vessels in the brain (cerebral aneurysm). A brain tumor. A spontaneous cerebrospinal fluid leak. […] Sometimes, what is first diagnosed as a cough headache may be caused by a cerebrospinal fluid (CSF) leak. Coughing or straining may trigger the headache, but the underlying cause is the CSF leak. This is one of the reasons why it’s important to see your provider for a new cough headache. […] Treatment differs, depending on whether you have primary or secondary cough headaches. […] If you have secondary cough headaches, surgery is often needed to fix the underlying problem.

• #22 Modified Valsalva test differentiates primary from secondary cough headache | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/1129-2377-14-31

  The current definition of cough headache includes provocation of the symptom by Valsalva manoeuvre, and it is generally believed that all cough headache results from a sudden increase in intracranial pressure. […] These findings suggest that secondary cough headache results from a transient increase in intracranial CSF pressure during exertion in the presence of obstruction to normal cerebrospinal fluid dynamics. […] Primary cough headache appears to be caused by a different mechanism, possibly through congestion of the orbital venous plexus in the presence of jugular venous incompetence and a reduced threshold for trigeminal sensory activation. […] It is generally believed that all cough headache is caused by a sudden increase in intracranial pressure resulting from exertion. […] However, this mechanism does not accord with our observation that PCH is not provoked by a maximal voluntary Valsalva manoeuvre.

• #23 Pathophysiology of headache associated with cough in patients with Chiari I malformation – PubMed

  https://pubmed.ncbi.nlm.nih.gov/12650413/

  Object: The aim of this study was to evaluate the pathophysiology underlying headache associated with cough in patients with Chiari I tonsillar abnormality. The authors hypothesized that peak intrathecal pressure during coughing is higher in patients with headache aggravated by cough than in patients without or in healthy volunteers. […] Peak intrathecal pressures during cough and at baseline were elevated in patients with headache associated with cough compared with either patients without headache or healthy volunteers. After surgery, intrathecal pressures during cough were significantly lower than preoperative values and headache aggravated by cough was resolved partially or completely. Headache linked to coughing in patients with Chiari I malformation is associated with sudden increased intrathecal pressure caused by obstruction to the free flow of CSF in the subarachnoid space.

• #24 4.1 Primary cough headache – ICHD-3

  https://ichd-3.org/other-primary-headache-disorders/4-1-primary-cough-headache/

  Headache precipitated by coughing or other Valsalva (straining) manœuvre, but not by prolonged physical exercise, in the absence of any intracranial disorder. […] The syndrome of cough headache is symptomatic in about 40% of cases, and the majority of patients in whom this is so have Arnold-Chiari malformation type I. Other reported causes include spontaneous intracranial hypotension, carotid or vertebrobasilar diseases, middle cranial fossa or posterior fossa tumours, midbrain cyst, basilar impression, platybasia, subdural haematoma, cerebral aneurysms and reversible cerebral vasoconstriction syndrome. […] 4.1 Primary cough headache is usually bilateral and posterior, and predominantly affects patients older than 40 years of age. There is a significant correlation between the frequency of cough and the severity of the headache. Associated symptoms such as vertigo, nausea and sleep abnormality have been reported by up to two-thirds of patients with 4.1 Primary cough headache. […] While indomethacin (50-200 mg/day) is usually effective in treating 4.1 Primary cough headache, a few symptomatic cases have been reported to respond to this treatment.

• #25 Paediatric primary cough headache with internal jugular phlebectasia | BMJ Case Reports

  https://casereports.bmj.com/content/14/6/e242590

  Primary cough headaches (PCHs) are mainly observed in people aged 40 years, but cough-induced headaches are potentially symptomatic in children. […] PCHs and internal jugular vein abnormalities may be related. Thus, tests assessing internal jugular vein morphology and function should be considered for PCH cases. […] Headaches caused by coughing are rare, occurring in approximately 1% of patients presented during consultations due to headache in a big neurological department and are mainly observed in people aged 40 years. […] PCH is defined as a sudden-onset headache induced by cough, strain or a Valsalva manoeuvre, lasting for 1 s to 2 hours, and not caused by any other disorders. […] A significant correlation between coughing frequency and headache severity has been hypothesised, and acute treatment for PCH is generally not required because PCH durations are short.

• #26 Head hurts when I cough: Causes, symptoms, and remedies

  https://www.medicalnewstoday.com/articles/head-hurts-when-i-cough

  A primary cough headache can happen when straining causes sudden pressure when coughing. […] A primary cough headache is potentially due to sudden pressure in the abdomen, which coughing can cause. This may increase pressure in the head, causing a headache. […] A secondary cough headache is due to an underlying condition, such as a brain disorder. […] A condition called Chiari type I malformation is the most common cause of secondary cough headaches. […] A secondary cough headache can last anywhere between a few seconds to several weeks. […] A secondary headache can also have other triggers besides coughing. […] A secondary cough headache is more serious and due to a disorder with the brain, such as a tumor or skull defect.

• #27 Cough as a neurological sign: What a clinician should know

  https://www.wjgnet.com/2220-3141/full/v11/i3/115.htm

  Cough reflex testing is a quick, easy, and cheap test performed during the cranial nerve examination. In this article, we reviewed the role of cough in various neurological disorders that increase or decrease cough sensitivity. […] The cough reflex is under the voluntary control of the higher neurologic centers, such as the cerebral cortex, which has a vital role in initiating and inhibiting cough. […] Various neurological diseases could associate with increased cough reflex sensitivity, including cerebral and cerebellar disorders, neuromyelitis optica spectrum disorder (NMOSD), and vagal neuropathy. […] The cough is caused by autonomic dysregulation secondary to loss of parasympathetic innervation, which originates predominantly in the nucleus ambiguous of the medulla oblongata. […] The neurons in the ventrolateral medulla that create cough and respiratory patterns interact with neural networks in the cerebellum-rostral interposed nucleus, rostral fastigial nucleus, and infra-cerebellar nucleus.

• #28 Cough as a neurological sign: What a clinician should know

  https://www.wjgnet.com/2220-3141/full/v11/i3/115.htm

  Cough reflex testing is a quick, easy, and cheap test performed during the cranial nerve examination. In this article, we reviewed the role of cough in various neurological disorders that increase or decrease cough sensitivity. […] The cough reflex is under the voluntary control of the higher neurologic centers, such as the cerebral cortex, which has a vital role in initiating and inhibiting cough. […] Various neurological diseases could associate with increased cough reflex sensitivity, including cerebral and cerebellar disorders, neuromyelitis optica spectrum disorder (NMOSD), and vagal neuropathy. […] The cough is caused by autonomic dysregulation secondary to loss of parasympathetic innervation, which originates predominantly in the nucleus ambiguous of the medulla oblongata. […] The neurons in the ventrolateral medulla that create cough and respiratory patterns interact with neural networks in the cerebellum-rostral interposed nucleus, rostral fastigial nucleus, and infra-cerebellar nucleus.

• #29 Cough as a neurological sign: What a clinician should know

  https://www.wjgnet.com/2220-3141/full/v11/i3/115.htm

  Cough reflex testing is a quick, easy, and cheap test performed during the cranial nerve examination. In this article, we reviewed the role of cough in various neurological disorders that increase or decrease cough sensitivity. […] The cough reflex is under the voluntary control of the higher neurologic centers, such as the cerebral cortex, which has a vital role in initiating and inhibiting cough. […] Various neurological diseases could associate with increased cough reflex sensitivity, including cerebral and cerebellar disorders, neuromyelitis optica spectrum disorder (NMOSD), and vagal neuropathy. […] The cough is caused by autonomic dysregulation secondary to loss of parasympathetic innervation, which originates predominantly in the nucleus ambiguous of the medulla oblongata. […] The neurons in the ventrolateral medulla that create cough and respiratory patterns interact with neural networks in the cerebellum-rostral interposed nucleus, rostral fastigial nucleus, and infra-cerebellar nucleus.

• #30 Cough as a neurological sign: What a clinician should know

  https://www.wjgnet.com/2220-3141/full/v11/i3/115.htm

  Cough reflex testing is a quick, easy, and cheap test performed during the cranial nerve examination. In this article, we reviewed the role of cough in various neurological disorders that increase or decrease cough sensitivity. […] The cough reflex is under the voluntary control of the higher neurologic centers, such as the cerebral cortex, which has a vital role in initiating and inhibiting cough. […] Various neurological diseases could associate with increased cough reflex sensitivity, including cerebral and cerebellar disorders, neuromyelitis optica spectrum disorder (NMOSD), and vagal neuropathy. […] The cough is caused by autonomic dysregulation secondary to loss of parasympathetic innervation, which originates predominantly in the nucleus ambiguous of the medulla oblongata. […] The neurons in the ventrolateral medulla that create cough and respiratory patterns interact with neural networks in the cerebellum-rostral interposed nucleus, rostral fastigial nucleus, and infra-cerebellar nucleus.

• #31 Cough Headaches: Possible Causes & What To Do

  https://www.webmd.com/migraines-headaches/cough-headaches-overview

  There are two types of cough headaches. Each has a different cause: […] Primary cough headache: Doctors know that the strain from a cough, sneeze, or laugh causes the headache. But they aren’t sure why it hurts. […] Secondary cough headache: There’s an illness or condition to blame. The most common one is a defect called Chiari type 1 in which the shape of your skull forces the lower, rear part of your brain (it’s called the cerebellum) down and into your spinal canal. […] Secondary cough headaches make up nearly half of these types of headaches. That’s why it’s important to talk to your doctor about your symptoms. […] A dull ache on one side of the head that lasts for several days might suggest a secondary type. […] Only after your doctor rules out secondary causes can you be sure that your cough headaches are the more harmless primary type.

• #32 Head Hurts When I Cough: Causes, Home Remedies, and More

  https://www.healthline.com/health/head-hurts-when-i-cough

  In some people, the pressure caused by coughing can lead to a painful headache. Often, a cough headache will resolve on its own and is nothing to worry about. Other times, it may represent a more serious condition. […] Both primary and secondary cough headaches are thought to be triggered by sudden pressure within the abdomen and chest. This pressure, and the subsequent headache, can also occur when: sneezing, laughing, straining during bowel movements, bending over. […] Primary headaches come on suddenly and are not usually serious. They are most common in men and in people over 40. Their root cause is unknown. […] Secondary cough headaches may initially feel the same as primary cough headaches, but you may also have additional symptoms. These include: a longer lasting headache, feelings of unsteadiness or difficulty with balance, dizziness, fainting.

• #33 Cough Headaches in EDS/HSD: Types, Causes, and Management | ActifyPT

  https://www.actifypt.com/post/cough-headaches-eds-hsd

  Cough headaches are a type of headache caused by coughing and other types of muscular straining, such as sneezing, laughing, crying, singing, or even bending over. […] For those with EDS/HSD, it has been observed that secondary coughing headaches are often caused by upper cervical instability (instability in the neck) and lower cervical instability (instability in the lower neck/upper back). […] For those with joint instability, it has been found that almost half of cough headaches are secondary to Chiari I Malformation, especially when present in young people and the pain is located near the base of the skull. […] In addition, changes in cerebrospinal fluid circulation can also contribute to cough headaches, which is also associated with dizziness, headache, vision problems such as sensitivity to light, tinnitus, and tremors.

• #34 Paediatric primary cough headache with internal jugular phlebectasia | BMJ Case Reports

  https://casereports.bmj.com/content/14/6/e242590

  Comorbid internal jugular vein dilatation in our patient suggests that internal jugular vein abnormalities may be related to the onset of PCHs in children; this comorbidity has also never been reported. […] PCH cases where the patient had obvious internal jugular vein valve dysfunction have been reported. […] According to these reports, if there is internal jugular vein valve dysfunction, then coughing and Valsalva manoeuvres (among other symptoms) raise intrathoracic and intra-abdominal pressure, causing transient backflow of venous blood. […] This case of PCH in a child may be due to right internal jugular vein valve dysfunction with right IJP, which would cause a backflow of venous blood, giving rise to a headache. […] In PCH cases, an examination of the morphology and function of the internal jugular vein should be considered.

• #35 Head Hurts When I Cough: Causes, Treatment, and Prevention

  https://www.volusiamedicalcenter.net/post/head-hurts-when-i-cough-causes-treatment-and-prevention

  If you are prone to tension headaches or migraines, coughing or other physical exertion can act as a trigger, making your existing headache worse or even causing a new headache. […] If your sinuses are blocked or inflamed, this can cause increased pressure in the head, leading to pain that worsens when you cough or bend over.

• #36 Head Hurts When I Cough: Causes, Treatment, and Prevention

  https://www.volusiamedicalcenter.net/post/head-hurts-when-i-cough-causes-treatment-and-prevention

  If you are prone to tension headaches or migraines, coughing or other physical exertion can act as a trigger, making your existing headache worse or even causing a new headache. […] If your sinuses are blocked or inflamed, this can cause increased pressure in the head, leading to pain that worsens when you cough or bend over.

• #37 Why Does My Head Hurt When I Cough?

  https://www.megawecare.com/good-health-by-yourself/cough-and-cold/cough-headache-why-does-my-head-hurt-when-i-cough

  Cough headaches are uncommon and affect 1% of people in their lifetime. […] Primary cough headaches are not dangerous and subside after a few minutes. Secondary headaches usually have underlying causes and can be dangerous if not treated in time. […] Primary cough headaches are usually posterior and affect the backside of the head. […] Primary cough headaches are usually short-lived and harmless thus they were previously called benign cough headaches. […] Primary cough headaches typically last from a second up to two hours, whereas secondary cough headaches have been found to last from 10 seconds up to 30 minutes. […] Coughing in general, may lead to a cough headache. […] Anxiety and depression are psycho-morbidities and may trigger a cough. Coughing may further lead to a cough headache.

• #38 Research Summary: Headache associated… | American Headache Society

  https://americanheadachesociety.org/research/library/research-summary-headache-associated-with-covid-19-epidemiology-characteristics-pathophysiology-and-management

  Headache triggered by coughing was observed at a frequency of 2-16%. […] Possible mechanisms include direct viral injury or vascular injury, local inflammatory process, hypoxemia, dehydration, and possibly a systemic inflammatory response to infection.

• #39

  https://journals.lww.com/mtsm/fulltext/2022/06040/cough,_cough_induced,_and_primary_cough_headache.6.aspx

  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 ArnoldChiari malformation Type I. […] 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. We believe that these mechanisms combined lead to the development of headaches, instead of being separated pathways. […] Primary cough headaches are mainly observed in adult patients, but cough-induced headaches are potentially symptomatic in the pediatric population. […] 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.

• #40 Cough Headaches in EDS/HSD: Types, Causes, and Management | ActifyPT

  https://www.actifypt.com/post/cough-headaches-eds-hsd

  Cough headaches are a type of headache caused by coughing and other types of muscular straining, such as sneezing, laughing, crying, singing, or even bending over. […] For those with EDS/HSD, it has been observed that secondary coughing headaches are often caused by upper cervical instability (instability in the neck) and lower cervical instability (instability in the lower neck/upper back). […] For those with joint instability, it has been found that almost half of cough headaches are secondary to Chiari I Malformation, especially when present in young people and the pain is located near the base of the skull. […] In addition, changes in cerebrospinal fluid circulation can also contribute to cough headaches, which is also associated with dizziness, headache, vision problems such as sensitivity to light, tinnitus, and tremors.

• #41 Primary cough headache | MedLink Neurology

  https://www.medlink.com/articles/primary-cough-headache

  The authors discuss the clinical manifestations, etiology, differential diagnosis, diagnostic evaluation, and management of primary cough headache. […] Morphometric MRI studies that have shed new light on the etiology of primary cough headache are summarized, and evidence that CSF leaks may present as cough headache without an orthostatic component is presented. […] Primary cough headache is typically bilateral, of sudden onset, lasts less than 1 minute, and is precipitated rather than aggravated by coughing. […] Every patient presenting with cough headache should have an MRI of the brain to rule out a posterior fossa lesion. […] The intracranial venous dilatation is presumably obtained at the expense of cerebral capillaries and expulsion from the cranial cavity of such a proportion of the cerebrospinal fluid as can be accommodated by the spinal subarachnoid space.

• #42 Paediatric primary cough headache with internal jugular phlebectasia | BMJ Case Reports

  https://casereports.bmj.com/content/14/6/e242590

  Comorbid internal jugular vein dilatation in our patient suggests that internal jugular vein abnormalities may be related to the onset of PCHs in children; this comorbidity has also never been reported. […] PCH cases where the patient had obvious internal jugular vein valve dysfunction have been reported. […] According to these reports, if there is internal jugular vein valve dysfunction, then coughing and Valsalva manoeuvres (among other symptoms) raise intrathoracic and intra-abdominal pressure, causing transient backflow of venous blood. […] This case of PCH in a child may be due to right internal jugular vein valve dysfunction with right IJP, which would cause a backflow of venous blood, giving rise to a headache. […] In PCH cases, an examination of the morphology and function of the internal jugular vein should be considered.

• #43 Cough-Associated Headache in Patients with Chiari I Malformation: CSF Flow Analysis by Means of Cine Phase-Contrast MR Imaging | American Journal of Neuroradiology

  http://www.ajnr.org/content/32/4/739

  The purpose of this study was to analyze the CSF flow in patients with Chiari I to determine differences between patients with and without CAH. […] This CAH is attributed to abnormal CSF flow at the foramen magnum and is, when severe, considered an indication for decompressive surgery. […] Our results show that Cine-PC imaging can demonstrate differences in CSF flow patterns between patients with Chiari I with and without CAH. Those with this symptom had much shorter CSF systole and longer CSF diastole compared with those without it. […] CAHs are seen in 30% of patients with Chiari I malformation and are believed to be due to CSF flow impairment at the foramen magnum. […] Several theories have been proposed to explain the pathophysiology of CAH in patients with Chiari I. Most agree that tonsillar herniation produces impairment of CSF flow at the foramen magnum and results in this symptom.

• #44 Head Hurts When I Cough: Causes, Home Remedies, and More

  https://www.healthline.com/health/head-hurts-when-i-cough

  Secondary headaches can indicate a more serious, underlying condition. These include: Chiari malformation, brain tumor, cerebral (brain) aneurysm, changes in the pressure in the cerebrospinal fluid. […] Treatment for secondary cough headache is based upon diagnosis. […] Secondary cough headaches may respond temporarily to at-home treatments, but their root cause must be addressed in order to eliminate the problem. […] In some cases, they may indicate an underlying medical condition. That’s why it’s important to talk to your doctor if you frequently experience headaches brought on by coughing, especially if they last for two or more hours, or are extremely painful.

• #45 Indomethacin-responsive headache syndromes | MedLink Neurology

  https://www.medlink.com/articles/indomethacin-responsive-headache-syndromes

  Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) whose mechanism of action in certain types of headache disorders remains elusive (02). Indomethacin-responsive headaches consist of a heterogeneous group of primary headache disorders distinguished by their response to indomethacin (40). Absolute responsiveness is seen in a subset of trigeminal autonomic cephalalgias (paroxysmal hemicrania and hemicrania continua) in which the response is so great that the elimination of symptoms provides the hallmark for diagnosis (14). […] Relative responsiveness to indomethacin is observed in other primary headache disorders, including cough (Valsalva maneuver) headache, exercise headache, headache associated with sexual activity, and primary stabbing headache (38). […] The pathophysiology surrounding indomethacin-sensitive headaches has yet to be fully elucidated (41; 13; 17). Paroxysmal hemicrania and hemicrania continua show an absolute responsiveness to indomethacin and belong to a larger subgroup of headaches termed trigeminal autonomic cephalalgias (12). Trigeminal autonomic cephalalgias are marked by brief episodes of head pain alongside heightened cranial parasympathetic autonomic reflex activation to nociceptive input in the ophthalmic division of the trigeminal nerve, although the other trigeminal autonomic cephalalgias are not indomethacin responsive (12; 41).

• #46 Cough Headache Responsive to Occipital Nerve Blockade | Canadian Journal of Neurological Sciences | Cambridge Core

  https://www.cambridge.org/core/product/4EDECC25D5062F4D23AC21CEA5857416

  The pathophysiology of primary cough headache is not well understood. It has been hypothesised that there is an increase in intracranial pressure caused by coughing (increase in intrathoracic and intra-abdominal pressure). A more crowded posterior cranial fossa may be seen in patients with primary cough headache, supporting the hypothesis of a relative obstruction of cerebrospinal fluid flow during coughing. […] In this case, nerve block to the occipital nerves was suggested based on examination findings, and the response was dramatic. It could be hypothesised that rapid changes in head and neck position during coughing may have triggered transient compression and/or local perineural inflammation of the occipital nerves, which originate from the C2C3 spinal nerves. […] The response to nerve block raised a possible alternative presentation of primary cough headache: it may present similarly to occipital neuralgia as pain is caused by transient compression of occipital nerves during coughing or sneezing, rather than transient high intracranial pressure. This observation suggests that primary cough headaches, especially those with shorter attack duration (lasting for seconds), may be occipital neuralgia-like.

• #47 Cough headaches | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/cough-headaches?content_id=CON-20371185

  Cough headaches are a type of head pain triggered by coughing and other types of straining. […] A secondary cough headache may be triggered by a cough, but it is caused by problems with the brain or structures near the brain and spine. […] The cause of primary cough headaches is unknown. […] Secondary cough headaches may be caused by: A defect in the shape of the skull. A defect in the part of the brain that controls balance (cerebellum). This can happen when part of the brain is forced through the opening at the base of the skull (foramen magnum), where only the spinal cord should be. Some of these types of defects are called Chiari malformations. A weakness in one of the blood vessels in the brain (cerebral aneurysm). A brain tumor. A spontaneous cerebrospinal fluid leak. […] Sometimes, what is first diagnosed as a cough headache may be caused by a cerebrospinal fluid (CSF) leak. Coughing or straining may trigger the headache, but the underlying cause is the CSF leak. This is one of the reasons why it’s important to see your provider for a new cough headache. […] Treatment differs, depending on whether you have primary or secondary cough headaches. […] If you have secondary cough headaches, surgery is often needed to fix the underlying problem.

• #48

  https://www.kuh.ku.edu.tr/mayo-clinic-care-network/mayo-clinic-health-information-library/diseases-conditions/cough-headaches

  Secondary cough headaches may be caused by: A defect in the shape of the skull. A defect in the part of the brain that controls balance (cerebellum). This can happen when part of the brain is forced through the opening at the base of the skull (foramen magnum), where only the spinal cord should be. Some of these types of defects are called Chiari malformations. A weakness in one of the blood vessels in the brain (cerebral aneurysm). A brain tumor. A spontaneous cerebrospinal fluid leak. […] Sometimes, what is first diagnosed as a cough headache may be caused by a cerebrospinal fluid (CSF) leak. Coughing or straining may trigger the headache, but the underlying cause is the CSF leak. This is one of the reasons why it’s important to see your provider for a new cough headache. […] Treatment differs, depending on whether you have primary or secondary cough headaches. […] If you have secondary cough headaches, surgery is often needed to fix the underlying problem. Preventive medications usually don’t help people who have secondary cough headaches. However, responding to medication doesn’t necessarily mean that you have a primary cough headache.

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