Tussive (Valsalva) headache

What it is

A tussive headache is a headache triggered by coughing ("tussive" means relating to coughing) or by other Valsalva maneuvers such as sneezing, straining, or bearing down. This is the characteristic headache pattern of Chiari malformation.

Understanding Tussive (Valsalva) headache

A Valsalva maneuver — coughing, sneezing, straining, bending, laughing, or bearing down — transiently raises pressure that is normally equalized smoothly between the head and spine. In Chiari malformation, the obstruction at the foramen magnum prevents this smooth equalization, so the maneuver produces a sudden, brief headache, usually at the back of the head. The tussive (cough-induced) headache is so characteristic of Chiari that its presence strongly suggests the diagnosis is relevant, although a "primary cough headache" can occur without Chiari, so evaluation is still needed. The brief, exertion-triggered nature distinguishes it from many other headaches. Understanding the tussive headache clarifies why this specific trigger pattern is a hallmark of Chiari and how it relates to the underlying flow obstruction.

Why it matters

Understanding the tussive headache helps families recognize that cough- or strain-triggered headaches are the hallmark Chiari pattern, reflecting the underlying CSF flow obstruction — an important clue in evaluation.