Cough Headache: A Study of 83 Consecutive Patients

• Published in: Cephalalgia Vol. 29; no. 10; pp. 1079 - 1085
• Main Authors: Chen, P-K, Fuh, J-L, Wang, S-J
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.10.2009; Blackwell Publishing Ltd
• Subjects: Adult; Aged; Aged, 80 and over; Brain Diseases - diagnosis; Brain Diseases - epidemiology; Chiari malformation; Comorbidity; cough headache; exertional headache; Female; Headache Disorders, Primary - diagnosis; Headache Disorders, Primary - epidemiology; Humans; Incidence; indomethacin; Male; Middle Aged; Risk Assessment - methods; Risk Factors; Taiwan - epidemiology; Young Adult; Taiwan; exertional headache; cough headache; Chiari malformation; indomethacin
• ISSN: 0333-1024; 1468-2982
• DOI: 10.1111/j.1468-2982.2009.01844.x

To delineate the differences in clinical characteristics and evaluate the outcome between primary and secondary cough headache, 83 consecutive patients (59M/ 24F, mean age 61.5 ± 17.7 years) with cough headache (1.2%) out of 7100 patients in a headache clinic were studied. All of them received brain imaging studies. Most did not have relevant brain lesions (n = 74, 89.2%, primary group) except for nine patients (10.8%, the secondary group). Most of the intracranial lesions were located in the posterior fossa (n = 6, 67%), including only two patients with Chiari malformation. The primary group had a higher response rate to indomethacin than the secondary group (72.7% vs. 37.5 %, P = 0.046). Mild to moderate headache intensity and age onset < 50 years predicted a favourable response. At a mean follow-up of 51.4 months, 83.9% of patients with primary cough headache completely remitted. Inconsistent with the proposed International Classification of Headache Disorders, 2nd edn criteria, 10.8% of patients with primary cough headache had headache duration of > 30 min. Clinical features, neurological examinations and drug response could not safely differentiate primary from secondary cough headache. Neuroimaging studies are required in each patient.