Modified Valsalva test differentiates primary from secondary cough headache

The Journal of Headache and Pain

Research Article

Russell JM Lane¹  Paul TG Davies² 

[1] Charing Cross Hospital, Imperial College, London, UK;Department of Clinical Neurosciences, Charing Cross Hospital, Room 3 N12, Fulham Palace Road, W6 8RF, London, UK;John Radcliffe Hospital, University of Oxford, Oxford, UK;

关键词: Cough headache;    Valsalva;    Chiari malformation;   

DOI  :  10.1186/1129-2377-14-31

 received in 2012-12-17, accepted in 2012-12-17,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundThe 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. We sought to question that presumption and to determine whether the Valsalva test might distinguish primary from secondary cough headache.MethodsWe examined 16 consecutive cough headache patients using a modified Valsalva test (exhalation into the connecting tube of a standard anaeroid sphygmomanometer to 60 mm Hg for 10 seconds). A positive response was recorded if the manoeuvre provoked headache. All patients subsequently underwent brain MRI.ResultsNone of the patients had neurological signs. Eleven had positive modified Valsalva tests. Ten were found subsequently to have posterior fossa pathologies (secondary cough headache: 8 Chiari Type 1 malformations, 2 posterior fossa meningiomas). The cough headache was relieved following surgery in all cases. One patient with a positive Valsalva test had an apparently normal brain MRI but measurements of hindbrain and posterior fossa dimensions were consistent with ‘posterior fossa crowdedness’. The remaining 5 patients had negative (4 patients) or equivocal (1 patient) Valsalva tests and normal MRI scans (primary cough headache).ConclusionsThese 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. The modified Valsalva test can also determine whether tonsillar herniation found on brain MRI is symptomatic. 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.

【 授权许可】

CC BY   
© Lane and Davies; licensee Springer. 2013. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.