Cough headache responsive to methysergide

Cough headache is a very distinct syndrome of headache precipitated by coughing, lifting, bending, sneezing, laughing, or straining. The pain can be severe and, if precipitation is difficult to avoid, certainly distressing. The usual treatment is indomethacin, which can be highly effective although recently lumbar puncture has again been advocated. We encountered a patient in whom indomethacin use was relatively contraindicated and who had an apparent response to methysergide.