PDF(Pubmed)
Abstract：
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.
摘要：
原发性咳嗽头痛（PCH）是一种罕见的疾病，其特征是突然发作。双侧头痛通常持续一秒钟到两小时。头痛与Valsalva动作有关，例如咳嗽或紧张，但在没有颅内异常的情况下，与长时间的体育锻炼无关。我们报告了一名53岁女性的PCH异常表现，该女性患有持续数小时的严重突发性头痛。头痛最初是由PCH典型的咳嗽引起的，但在诱发发作的方式上是不寻常的。头痛开始发生时没有任何Valsalva动作的关联，最终没有明显的触发。患者最初来到心脏病专家的办公室，然后将她转介给神经科医生进行进一步评估。神经科医生最初开了甲基强的松龙片剂，主要是为了抑制咳嗽.磁共振成像,磁共振血管造影术(MRA),然后进行头部CT扫描以排除可能的次要原因，例如肿块，颅内出血,动脉瘤,或其他血管异常。神经科医生在诊断PCH后4天和9天开出吲哚美辛和托吡酯，分别。五天后,β受体阻滞剂酒石酸美托洛尔被处方，因为患者的血压与头痛相关显著升高。上述治疗可有效限制头痛的强度和持续时间，并在四周后缓解症状。这种情况有助于理解PCH的潜在演变，该PCH具有与Valsalva动作无关的触发器，并最终在没有已知触发器的情况下发生，并提供了持续时间异常长的PCH示例。
