OBJECTIVE

To describe two patients with recurring unilateral brief headaches that fulfilled criteria for both primary cough headache (CH) and chronic paroxysmal hemicrania (CPH).

BACKGROUND

CH is typically a bilateral headache, specifically triggered by cough, straining, or other Valsalva maneuvers. The report of cases sharing features with other primary headache disorders, such as CPH, suggest common pathogenic mechanisms.

METHODS

Case reports.

RESULTS

Two patients (one man), aged 55 and 64, had a two-year history of daily, unilateral, side-locked headache attacks, lasting about 15 minutes, and associated with ipsilateral tearing. Headaches were triggered by cough, sneezing, laughing, or bending forward. Both patients experienced a marked and sustained improvement with indomethacin, and both relapsed when it was interrupted.

CONCLUSIONS

These cases suggest the existence of transitional phenotypes, or shared pathogenic mechanisms, between CH and CPH, two indomethacin-responsive headaches. A more comprehensive analysis of different CH subtypes is necessary to understand their relation with other primary headaches.