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To the Editor: Raskin1 recently reported his experience in the diagnosis, management, and treatment of the so-called “cough headache syndrome.” He presents interesting anecdotal data regarding the efficacy of indomethacin and LP with CSF drainage for treatment of this infrequently encountered headache syndrome, and suggests pathophysiologic explanations. Dr. Raskin implies that thoracic pressure is directly transmitted to the intracranial venous system via the jugular veins “since these venous channels are valveless” and quotes work by Williams.2 Williams actually states, “the origin of the pressure pulse (after coughing) is almost certainly a surge of blood into the epidural venous plexus from the abdominal and thoracic cavities which squeezes the dura.”2 There is …
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