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Abstract Details

Cerebral Venous Sinus Pressure and Head Pain: A Case of Cough Headache Secondary to Superior Sagittal Sinus Stenosis
Headache
P3 - Poster Session 3 (5:30 PM-6:30 PM)
2-009
Headache triggered by cough is an uncommon disorder that can be primary or secondary in etiology. While the pathophysiology of cough headache is poorly described, there are several theories that suggest that an interplay of elevated intracranial pressure (ICP) and increased central venous pressure results in nociceptor activation with cough. We present a case of secondary cough headache resulting from sagittal sinus stenosis.
A 31-year old female with a history of migraine presented with a new headache described as 2-5 minute spikes of severe head pain triggered by cough or Valsalva. MRI brain imaging showed a 1.5 cm left para-falcine extra-axial mass involving the lateral wall of the sagittal sinus, most consistent with a meningioma. This finding was initially thought to be unrelated to her head pain. The patient’s head pain remained refractory to typical migraine treatments; however, it responded well to indomethacin and acetazolamide. Due to intolerable side effects, acetazolamide was tapered off and cough-induced head pain recurred. Venous manometry revealed a significant pressure gradient across the sagittal sinus stenosis. Her symptoms significantly improved with meningioma resection and superior sagittal venous stenting.
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This a rare presentation of cough headache secondary to superior sinus stenosis, which significantly improved on correction of increased venous pressure. This case highlights the role of pressure dynamics within the cerebral venous sinus system not only in the etiology of primary and secondary cough and other Valsalva-induced headaches, but also as a potential etiology in patients with idiopathic interracial hypertension with venous sinus stenosis.  This case also suggests that venous stenting can be an alternative to acetazolamide. Prompt recognition of secondary causes of cough headache is essential for early intervention.
Authors/Disclosures
Taylor Haddad, MD
PRESENTER 		Ms. Haddad has nothing to disclose.
Victor Wang, MD (Thomas Jefferson University Hospital) Dr. Wang has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Pfizer. Dr. Wang has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Abbvie.
Simy K. Parikh, MD Dr. Parikh has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Pfizer. Dr. Parikh has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Current Pain and Headache Reports. Dr. Parikh has received personal compensation in the range of $500-$4,999 for serving as a Author with Medlink. Dr. Parikh has received personal compensation in the range of $500-$4,999 for serving as a Faculty with Touch Independent Medical 好色先生 (touchIME) . Dr. Parikh has a non-compensated relationship as a Medical Advisory Board Member with Spinal CSF Leak Foundation that is relevant to AAN interests or activities.