Primary Cough Headache Disorder Responds to Low Volume Therapeutic Lumbar Puncture: A Case Report With a Side Note on Therapeutics and Cranio-Spinal Dissociation

Primary cough headache disorder (PCHD) is a unique disorder with an underlying dynamic cause. Having ruled out an underlying specific etiology, it is ipso facto a diagnosis of exclusion. It has been empirically treated with cerebrospinal fluid (CSF) pressure-lowering modalities; such as indomethacin, acetazolamide and high volume CSF drainage by lumbar puncture. We describe the case of a 66-year-old man with at least a 20-year history of PCHD, who dramatically responded to low volume CSF drainage, totaling three lumbar punctures over the course of twenty years, with rapid and effective relief of headache. We review the therapy of PCHD and discuss the CSF dynamics as it pertains to lumbar and cisterna magna CSF pressures. We also propose potential mechanisms for the effectiveness of CSF lowering measures.