Spontaneous Low Cerebrospinal Fluid Pressure Syndrome Can Mimic Primary Cough Headache

Abstract

CLINICAL HISTORY This is a 66-year-old white male with occasional mild headaches in the past. He presented with a 4month history of headaches occurring one to four times per day, brought on by having a bowel movement, stooping, or getting up from a sitting position. He did not know if the headache was triggered by coughing because he had not coughed at all. The headache was a bifrontal and bitemporal sharp, aching pain with a 7/10 intensity and occasionally a 9/10 intensity with an average duration of 1 minute and a range of 30 seconds to 1 hour. About 20 of the headaches had lasted more than 1 minute, with most in a range of 1 to 2 minutes. He had tried ibuprofen and acetaminophen with questionable help. For the prior 5 days, he had increased his dose of aspirin from 81 mg per day to 325 mg per day. The headache was then different with a constant bifrontotemporal pressure with an intensity of 1/10 but he had not had the brief headaches with activity exacerbation. He had a CT scan of the sinuses on June 14, 2004 with essentially negative findings.