Primary cough headache is associated with posterior fossa crowdedness: a morphometric MRI study

Area of Science:

• Neurology
• Neurosurgery
• Radiology

Background:

• Primary cough headache (PCH) is a rare headache disorder with an unknown cause.
• Understanding the anatomical factors contributing to PCH is crucial for diagnosis and treatment.

Purpose of the Study:

• To investigate the morphometric characteristics of the posterior cranial fossa (PCF) in patients with PCH using magnetic resonance (MR) imaging.
• To determine if PCF dimensions are associated with the pathogenesis of PCH.

Main Methods:

• Retrospective analysis of MR images from 18 PCH patients and 18 age- and sex-matched controls.
• Measurement of PCF morphometric parameters, including hindbrain tissue area, PCF volume, and hindbrain/PCF ratio.
• Assessment of cerebellar tonsillar position, clivus length, and other relevant craniovertebral junction measurements.

Main Results:

• Patients with PCH exhibited a significantly smaller PCF area compared to controls, resulting in a higher hindbrain/PCF ratio (0.78 vs. 0.73, P=0.005).
• PCH patients showed a lower cerebellar tonsillar tip position, shorter clivus length, and reduced distances from the clivus to the mid-pons and basion to the medulla.
• These findings indicate a more crowded posterior cranial fossa in individuals with primary cough headache.

Conclusions:

• A crowded posterior cranial fossa is a significant finding in patients with primary cough headache.
• These anatomical variations may predispose individuals to PCH and contribute to its pathogenesis.
• Further research is warranted to elucidate the precise mechanisms linking PCF crowding to cough headache.