Primary Cough Headache: A Case Report

Primary cough headache (PCH) is an uncommon condition characterized by episodes of sudden onset, bilateral headaches typically lasting from a second to two hours. Headaches are notably associated with Valsalva maneuvers such as coughing or straining but not a prolonged physical exercise in the absence of intracranial abnormalities. We report an unusual presentation of PCH in a 53-year-old female suffering from episodes of severe sudden-onset headaches that lasted several hours. The headaches were initially precipitated by coughing as is typical with PCH but were unusual in the way the triggers for the episodes evolved. Headaches began occurring without any association of Valsalva maneuvers and ultimately occurred with no discernible trigger. The patient initially came to the cardiologist's office who then referred her to a neurologist for further evaluation. The neurologist initially prescribed methylprednisolone tablets, primarily to suppress the cough. Magnetic resonance imaging, magnetic resonance angiography (MRA) of the brain, and a head CT scan were then performed to rule out possible secondary causes such as a mass, intracranial bleed, aneurysms, or other vascular anomalies. The neurologist prescribed indomethacin and topiramate four and nine days after diagnosis of PCH, respectively. After five days, the beta blocker metoprolol tartrate was prescribed as the patient's blood pressure was rising significantly in correlation to the headaches. The above treatment was effective in limiting the intensity and duration of the headaches and the symptoms resolved after four weeks. This case contributes towards the understanding of the potential evolution of PCH presenting with triggers unassociated with Valsalva maneuvers and ultimately occurring with no known trigger as well as providing an example of PCH with an unusually long duration.