Hemicranial Cough-Induced Headache as a First Symptom of a Carotid-Cavernous Fistula-Case Report

Cough, Exertional, and Sex Headaches

In this article, the authors review the most common presentations of cough and exertional headaches and headaches associated with sexual activity. The authors elaborate on the most commonly described etiologies and identify those which are most critical to treat. The authors outline the recommendations for further evaluation and discuss effective treatment modalities for each headache type.

Hemicranial postural headache as a first symptom of a spontaneous carotid cavernous fistula: A case report

RATIONALE

Spontaneous carotid cavernous fistula (CCF) is rare, and the expression of headache caused by it can be variable.

PATIENT CONCERNS

A case of a man hospitalized for high-intensity hemicranial headache which was aggravated by lying down and relieved when standing or sitting. The pain was of a pulsating character, localized on the right, behind the eye, followed by nausea and vomiting. He gradually appeared with ophthalmoplegia, decreased visual acuity and epistaxis.

DIAGNOSIS

Digital subtraction angiogram (DSA) showed a pseudoaneurysm arising from the internal carotid artery (ICA) that projected anteriorly and medially into the sphenoid sinus with occluded fistula.

INTERVENTIONS

The pseudoaneurysm was successfully treated with covered stent.

OUTCOMES

The patient was then followed up clinically at the outpatient and seen in the outpatient clinic with no further episodes of nasal bleeding or new neurologic deficit. The vision loss and ophthalmoparesis were unchanged.

LESSONS

Hemicranial postural headache may be the first and characteristic sign of spontaneous CCF.