Skip to main content
Erschienen in: The Journal of Headache and Pain 1/2015

Open Access 01.12.2015 | Poster presentation

P040. Primary Valsalva maneuver headache without primary cough headache

verfasst von: Enrico Ferrante

Erschienen in: The Journal of Headache and Pain | Sonderheft 1/2015

download
DOWNLOAD
print
DRUCKEN
insite
SUCHEN

Background

The uncommon headache related to a Valsalva maneuver (VM) is coded within the International Headache Society Classification (ICHD-3beta) among “Other primary headaches”, 4.1 “Primary cough headache” (PCH). This chapter deals with headaches precipitated by coughing or straining in the absence of any systemic or intracranial disorder. The clinical features of the pain are characterized by sudden onset, lasting from 1 s to 2 hours, and brought on by and occurring only in association with coughing, straining, and/or a VM. Neuroimaging plays an important role in differentiating secondary forms.

Case report

A 71-year-old woman with obesity, high blood pressure, type 2 diabetes, hypothyroidism and glaucoma was admitted because for the past 18 months she had headache attacks with stabbing severe pain (NVR 10/10), on the right fronto-temporal side with parietal-occipital diffusion. The pain lasted from 30 to 360 minutes with and without intake of analgesic, respectively. For the first 6 months, the headache was triggered only when bending over. Subsequently, also other activities that required the execution of a Valsalva maneuver (coughing, sneezing, laughing) caused the same headache attacks. Neurological examination and hematologic work up were normal. MRI of the brain, angiography and CSF circulation study were normal. The patient was treated with indomethacin 50 mg daily for 4 days and then 50 mg twice a day for two months. The headache gradually disappeared after 5 days of therapy. After 12 months of follow-up the patient is in good health.

Discussion and conclusions

The pathophysiology of headache triggered by VM is unknown. The most reasonable hypothesis is a sudden increase in intracranial pressure secondary to high venous pressure, such as during coughing; other reported contributing factors are transient post-infective hypersensibility of pressure receptors localized in venous vessels, reduction of the posterior fossa volume with consequent crowding of its structures, incompetence of the valves of the internal jugular veins, venous stenosis, and intermittent intraocular pressure elevation. The initial history of our case and some cases reported in the literature suggest that the headache caused by maneuvers related to increased intrathoracic pressure (Valsalva's maneuver like stimuli) may not be triggered by coughing. In these cases, when structural lesions are excluded by MRI or similar tests, we propose the eponym, “primary Valsalva maneuver headache” (which is more appropriate than the equivalent [“PCH”]). In these patients it is possible that the Valsalva maneuver provoked by the cough did not reach the pain threshold to cause headache.
Written informed consent to publication was obtained from the patient(s).
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://​creativecommons.​org/​licenses/​by/​4.​0), which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
download
DOWNLOAD
print
DRUCKEN
Metadaten
Titel
P040. Primary Valsalva maneuver headache without primary cough headache
verfasst von
Enrico Ferrante
Publikationsdatum
01.12.2015
Verlag
Springer Milan
Erschienen in
The Journal of Headache and Pain / Ausgabe Sonderheft 1/2015
Print ISSN: 1129-2369
Elektronische ISSN: 1129-2377
DOI
https://doi.org/10.1186/1129-2377-16-S1-A130

Weitere Artikel der Sonderheft 1/2015

The Journal of Headache and Pain 1/2015 Zur Ausgabe

Invited speaker presentation

Biological substrates of migraine

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 Appendizitis Nachrichten

Schmerzen im Unterbauch, aber sonst nicht viel, was auf eine Appendizitis hindeutete: Ein junger Mann hatte Glück, dass trotzdem eine Laparoskopie mit Appendektomie durchgeführt und der Wurmfortsatz histologisch untersucht wurde.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

23.04.2024 Operationsvorbereitung Nachrichten

Derzeit wird empfohlen, eine Therapie mit GLP-1-Rezeptoragonisten präoperativ zu unterbrechen. Eine neue Studie nährt jedoch Zweifel an der Notwendigkeit der Maßnahme.

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.