Cough Syncope

Timothy C. Hain, MD • Page last modified: July 26, 2020
Cough Syncope definedIndex

Cough syncope is a syndrome in which dizziness or syncope occurs after prolonged bouts of cough. See also the syncope page, if symptoms are not particular associated with a cough or hiccup.

Cause of cough syncope:

Cough syncope patients do not exhibit more pronounced hypotension in response to cough than other fainters, but they also manifest an inappropriate cough-triggered blood pressure-heart rate relationship. These findings argue in favor of the importance of a neurally mediated reflex contribution to symptomatic hypotension in cough syncope. (Benditt, D. G., N. Samniah, et al.; 2005).

It is well known that cough syncope may occur in the Arnold-Chiari malformation (Ireland, P. D., D. Mickelsen, et al. (1996)). This is probably due to impaired autonomic regulation.

A related entity to cough syncope is hiccup syncope. This is largely associated with lesions of the medulla, and thus is similar to cough syncope. Sueyoshi et al reported a single case, and suggested it was due to stimulation of the glossopharyngeal nerve. (Sueyoshi, Shin, & Nakashima, 2013). Another case occurred after a brainstem stroke (Takazawa et al., 2014). A third case was associated with a small lesion in the brainstem (Shibazaki, Kurokawa, Murakami, & Sunada, 2006). Two cases were reported in MS, again involving the medulla (Funakawa & Terao, 1998; Sakakibara, Mori, Fukutake, Kita, & Hattori, 1997). In summary, is known about hiccups and syncope, but what little has been written suggests that it usually is from a brainstem source.

Evaluation of cough syncope:

Physical examination should include at a minimum

Routine Laboratory Testing:

According to Chao, A. C., R. T. Lin, et al. (2007). Cough syncope patients often exhibit absent BP overshoot following the relief of straining.

According to Choi, Y. S., J. J. Kim, et al. (1989). Sinus arrest may play a role as a mechanism of cough syncope in a patient with sick sinus syndrome, and 24 hour holter monitoring may be helpful in making this diagnosis.


Most effort is aimed at treating the cough with cough suppressants, and exhaling before coughing.

If the patient has an central or peripheral dysautonomia, treatment should be directed towards correcting that disorder too.