What are the other Names for this Condition? (Also known as/Synonyms)

• Benign Cough Headache
• Valsalva-Maneuver Headache
• Valsalva-Manoeuvre Headache

What is Primary Cough Headache? (Definition/Background Information)

• Primary Cough Headache may be described as an uncommon form of primary headache disorder with a sudden onset that occurs from coughing or straining from activities, such as crying, sneezing, or blowing one’s nose, but not from prolonged physical activities such as exercise or running
• Primary Cough Headache is also noted in association with Valsalva-maneuver, which is a breathing technique involving forceful exhalation that can help in unclogging ears, testing cardiac function, or evaluating autonomic nervous system health
• In order to be termed Primary Cough Headache, there should be no physical health condition involving the brain such as a tumor/cyst, blood clot, neurological condition, or mental health disorder
• The mild-to-moderate intensity headaches in Primary Cough Headache commence immediately following the cough/straining activity and may last for a few seconds to even a couple of hours. Severe shooting pain may be felt soon after onset of the headache, which then gradually subsides
• Usually both sides of the head are affected; the backside of the head may also be involved. In individuals where the condition is cough-induced, the severity of the headache is directly dependent on the frequency of coughing
• Individuals of any age group, gender, race, or ethnicity may be at risk for Primary Cough Headache. However, the condition is generally rare below age 40
• Primary Cough Headaches may be accompanied by dizziness, loss of balance, nausea, and sleep disturbances (that are observed in over 65% of the cases). The condition generally responds well on treatment with indomethacin, a nonsteroidal anti-inflammatory drug (NSAID)

The criteria for diagnosis of Primary Cough Headache as outlined by the International Headache Society (IHS) is given below:

• At least two headache episodes fulfilling the criteria below
• Brought on by and occurring only in association with coughing, straining, and/or other Valsalva maneuver
• Sudden onset
• Lasting between 1 second and 2 hours
• Not better accounted for by another ICHD-3 diagnosis

(Source: International Headache Society Classification ICHD-3, London, United Kingdom)

Differential diagnosis to exclude the following conditions is important prior to arriving at a diagnosis of Primary Cough Headache:

• Arnold-Chiari malformation type I
• Basilar impression 
• Brain tumors
• Carotid or vertebrobasilar diseases
• Cerebral aneurysm
• Midbrain cysts
• Platybasia
• Reversible cerebral vasoconstriction syndrome (RCVS)
• Spontaneous intracranial hypotension
• Subdural hematoma

Note: When the signs and symptoms does not fulfill all the diagnostic criteria outlined for Primary Cough Headache as recognized by the International Classification of Headache Disorders (ICHD), it is defined as Probable Primary Cough Headache.