What is a Neurogenic Cough
A neurogenic cough is a persistent cough that happens due to problems with the nerves controlling the throat and airway, rather than from irritation like a cold or allergies, talking or laughing can easily trigger a coughing fit that lasts for several minutes. Breathing in cold air, drinking something cold or bending over can also cause someone with a neurogenic cough to start coughing. In cases where the coughing becomes constant, it may even lead to vomiting (which is something I do much to frequently). Think of it like a "glitch" in the nerve system that makes your body think it needs to cough, even though there's no real cause like mucus or an infection.
Normally, your body coughs to clear out irritants or blockages, but with a neurogenic cough, the nerves might be overly sensitive or damaged, causing the cough reflex to kick in too easily. It can last for months or even years and is often tricky to diagnose because it’s not caused by typical lung or throat issues.
Medical studies suggest that about 11% of Americans may have a neurogenic cough, also called a sensory neuropathic cough. This type of cough is linked to overly sensitive nerves in the throat and larynx, leading to persistent coughing.
Treatment for a neurogenic cough usually focuses on calming the overactive nerves with medication, physical therapy, or sometimes speech therapy to retrain the throat muscles.
What Can Cause a Neurogenic Cough
Research indicates that a neurogenic cough is often caused by:
- Upper respiratory infection: can lead to inflammation and irritation of the throat nerves, resulting in a neurogenic cough.
- Damaged nerve endings: can produce a tickling sensation that triggers a cough.
- Laryngeal sensory neuropathy: occurs when the nerves in your throat (larynx) are damaged.
- Post nasal drip: when mucus from your nose runs down your throat, tickling the nerves and causing you to cough.
Diagnosing a Neurogenic Cough
The diagnosis of a neurogenic cough can be a bit of a process because it involves ruling out other common causes of a chronic cough. Here’s how a doctor might go about it:
- Medical History and Symptoms Review: The doctor will start by asking about your cough. How long has it lasted? Is it triggered by certain things like allergens, cold air, or talking? They’ll also ask about other symptoms like runny nose, heartburn, or shortness of breath, to see if a common condition; like allergies or asthma, might be the cause.
- Physical Examination: Next, the doctor will do a physical exam, checking your throat, lungs, and nose. They’ll listen to your breathing and might look for signs of infection or irritation that could be causing the cough.
- Tests to Rule Out Other Causes:
- Chest X-rays or CT Scans: These might be done to rule out lung conditions like pneumonia, tumors, or chronic bronchitis.
- Lung Function Tests: To check for asthma or other breathing issues.
- Allergy Tests: If an allergy is suspected, they may perform tests to see if allergens are triggering your cough.
- Gastroesophageal Reflux Disease (GERD) Tests: If heartburn or acid reflux might be the issue, tests can be done to confirm it.
- Trial Treatments: If the cause isn’t clear, doctors might try treatments for common conditions like asthma; using inhalers (they had me try an inhaler, but as soon as I took a breath in, it immediately triggered a coughing fit), or GERD; with acid-blocking medications (I tried this for months, following my doctors' recommendations on the dosage and timing. Although I do have mild acid reflux, the medication had no effect on my cough). If your cough doesn’t respond to these treatments, it gives a clue that the cause may be neurogenic.
- Specialized Tests: If no other cause is found, a neurologist or ENT (ear, nose, and throat) specialist may get involved. They might perform tests that look at the sensitivity of the nerves in your throat, or try certain medications that target nerve function.
- Diagnosis of Exclusion: Once other causes have been ruled out, and if there’s a history or evidence suggesting nerve involvement, the doctor may diagnose a neurogenic cough. This diagnosis often comes after everything else has been checked and ruled out, which is why it can take some time.
Once diagnosed, treatments aim to calm the overactive nerves and reduce the cough reflex. A diagnosis of neurogenic cough explains the condition, but it doesn't always clarify the cause. Neurogenic cough is often related to vagal neuropathy, where the vagus nerve has been affected. This can happen due to factors like viral infections that damage the nerve. The vagus nerve is key in controlling the cough reflex, so when it's overly sensitive or damaged, it can cause a chronic cough.
What the Doctor May Recommend
Doctors might suggest using a combination of treatments, that may help reduce symptoms and improve quality of life, to manage a neurogenic cough, such as:
Speech & Language Therapy
Comprehensive cough management through Speech and Language Therapy (SLT) helps patients manage their cough and reduce related symptoms through a variety of techniques. These may include education to understand potential triggers and irritants, symptom management strategies to suppress the urge to cough, and vocal care to maintain healthy vocal cords. Additionally, SLT often incorporates breathing exercises, such as pursed-lip breathing, to improve breath control, along with manual therapy focused on relieving tension in the neck, head, and upper body.
Gabapentin
Gabapentin can help with a neurogenic cough because it calms down overactive nerves in your throat that are making you cough. It's like turning down the volume on nerves that are sending too many "cough" signals to your brain. This helps reduce the urge to cough.
Neuromodulators
Neuromodulators are a type of medicine that helps calm down the nerves in your throat. By doing this, they reduce the strong sensations that make you feel like you need to cough. They also interrupt the "reflex arc," which is the automatic loop in your body that triggers a cough, making it easier to control.
Superior Laryngeal Nerve Blocks
Superior laryngeal nerve (SLN) blocks are a safe and affordable treatment option for people with a neurogenic cough (a cough caused by nerve issues). This treatment works by numbing a specific nerve in your throat that triggers the cough reflex, helping to reduce or stop the coughing. It's a low-risk procedure and can be a good alternative to other treatments.
Laryngeal Botox Injections
Laryngeal Botox injections are used for people who have a stubborn cough that doesn't get better with regular medicine. The Botox helps relax the muscles in the throat to reduce the urge to cough.
Complications of a Neurogenic Cough
A neurogenic cough is more than just an annoyance - its persistent and often uncontrollable nature can lead to various physical, psychological, and social challenges.
Here’s a breakdown of the complications - most of which I’ve personally experienced:
Impact on Quality of Life
- Disrupted daily activities: The constant coughing can interfere with work, daily tasks, and social interactions.
- Social isolation: People may withdraw from social settings to avoid embarrassment caused by frequent coughing.
Psychological Distress
- Anxiety and stress: The inability to control the cough can cause frustration, stress, and anxiety.
Physical Complications
- Urinary incontinence: Severe coughing fits can put pressure on the bladder, causing unintentional leakage of urine.
- Muscle strain: Chronic coughing places continuous strain on the chest and abdominal muscles, leading to soreness or discomfort.
- Rib fractures: In extreme cases, forceful coughing can result in rib fractures.
Associated Symptoms
- Throat irritation and pain: Hypersensitivity of the throat's nerves often leads to chronic irritation and soreness.
- Globus sensation: A persistent feeling of a "lump in the throat" is a common experience.
- Dysphagia (difficulty swallowing): Chronic throat irritation and muscle strain may make swallowing more difficult.
- Vocal cord dysfunction: Repeated strain on the vocal cords can affect voice quality and lead to hoarseness.
Can a Neurogenic Cough Cause Vomiting?
A neurogenic cough, particularly in severe cases of Sensory Neuropathic Cough (SNC), can lead to vomiting as the intense, forceful coughing fits place excessive strain on the body, overstimulating the gag reflex and triggering nausea or vomiting as an involuntary response to the persistent and violent nature of the coughing episodes.
Can a Neurogenic Cough Cause Nosebleeds?
A severe neurogenic cough can sometimes cause a nosebleed due to the intense pressure from forceful coughing, which can rupture tiny blood vessels in the nasal lining. This can also occur in individuals with fragile blood vessels, nasal irritation, or a history of frequent nosebleeds, especially during strong, persistent coughing episodes.
My Journey to the Neurogenic Cough
Here's a brief synopsis of what I went through.
After my dad passed away, my husband and I returned home to help my mom. We went from a warm, humid climate back to a cold, wet one. We stayed there for a few months, and halfway through the visit, I started losing weight, vomiting after coughing, and the joints in my hands and my knees were starting to bother me.
While away, I visited a doctor who did a chest X-ray, which came back clear. They diagnosed me with acid reflux, though it wasn’t a major issue for me, and prescribed acid-blocking medications. I followed the instructions, but the medication didn’t help. Once we returned home, I went to my own doctor, had full blood work done, and discovered I had hyperthyroidism and rheumatoid arthritis. However, neither explained the cough. I was then given an inhaler, but every time I used it, it irritated my throat and caused severe coughing fits that lasted 15 minutes, often making me vomit. So, the coughing continued.
Next, I asked for a referral to an ENT specialist. At my appointment, I explained my symptoms and medical history. The doctor performed a nasal endoscopy (rhinoscopy), which involves inserting a thin, flexible tube with a camera into the nose to examine the sinuses. I was told I had post-nasal drip and a sinus infection, so I was prescribed a 10-day course of Amoxicillin and a nasal spray.
At 60-something, I had never taken Amoxicillin before, and after this experience, I’ll never take it again. I was sick for nearly two weeks, unable to leave the house, and it didn’t help the cough, nor did the nasal spray. I’m generally healthy, rarely get sick, and I prefer to avoid medications.
I went back to the ENT, and when he saw that the treatment didn’t work, he quickly diagnosed me with a Neurogenic Cough and prescribed Gabapentin. I took it for a while, but it didn’t stop the coughing, and I didn’t like the side effects, so I stopped taking it.
After the neurogenic cough diagnosis, I researched it and realized the process I went through is the standard approach doctors take to reach that conclusion. I feel he may have known the end result would be a neurogenic cough, but to adhere to the standard medical protocol, he had to rule out other possible causes first.
I'm still coughing and trying to figure it out.
Are There Natural Remedies you Can Try?
Yes, there are some natural remedies you can try for a neurogenic cough. While these will not cure the condition, they might help manage symptoms by soothing the throat and calming the nerves involved.
Honey and Warm Liquid
Honey has natural anti-inflammatory and soothing properties that can coat the throat, while warm liquids like tea or broth help reduce irritation. Mix a teaspoon of honey into warm water, herbal tea, or lemon water. Sip it slowly, especially when you're about to talk or after coughing fits.
Honey Therapy
Take a spoonful of honey and allow it to slowly drizzle down your throat, don't swallow until you must. Honey acts as a natural demulcent, which means it forms a protective coating over the mucous membranes in the throat, reducing irritation and soothing the cough reflex. This is commonly used for conditions like sore throats, coughs, or throat irritation. I get my honey from the farmers market.
Herbal Teas
Certain herbs, such as chamomile, ginger, or licorice root, have calming, anti-inflammatory, and anti-spasmodic properties that may ease coughing and reduce throat irritation. Drink herbal teas made with these ingredients 2 to 3 times a day. Ginger tea with a touch of honey is particularly soothing.
Drink Plenty of Cool Water
Staying hydrated helps keep the mucous membranes in your throat and airways moist. This moisture can soothe irritation and reduce the urge to cough. Proper hydration is essential for maintaining respiratory health and can play a significant role in alleviating symptoms. Since cold can irritate the cough, drink cool to warm water.
Blow Your Nose
Have you noticed that your nose often gets congested when you cough? Blowing your nose can help relieve that congestion and may temporarily ease your cough as well.
Saltwater Gargle
Gargling with saltwater can reduce inflammation in the throat and may help clear out irritants. Mix 1/2 teaspoon of salt into a glass of warm water and gargle for 30 seconds, several times a day.
Throat Lozenges or Natural Pastilles
Lozenges containing ingredients like slippery elm, licorice root, or marshmallow root can coat the throat and reduce coughing reflex. Suck on these lozenges throughout the day, particularly during episodes of coughing or throat irritation.
Breathing Exercises
Breathing techniques can help reduce throat tension and overactivity in the cough reflex. They also promote relaxation, which is important since stress can worsen neurogenic cough. Practice slow, deep breathing exercises, focusing on breathing through your nose and exhaling through your mouth. This can calm the nerves and prevent coughing fits.
Avoid Triggers
Common triggers like cold air, strong odors, or allergens can worsen a neurogenic cough. If you have heat vents on the ceiling try air deflectors to move the air away from you. Keep your environment free of irritants. Use a humidifier to keep the air moist, and avoid exposure to cold, dry air or strong chemicals.
Fire Cider
Fire cider may help alleviate a chronic cough due to its combination of ingredients, which are believed to have various health benefits. You can take fire cider by the tablespoon, diluted in warm water, or as a shot, depending on your preference. I just made some fire cider (there is a recipe under Home Remedies) and I love it. I take it plain and have been trying it before bed - we'll see how this goes.
Acupuncture
Some studies suggest that acupuncture might help reduce nerve sensitivity and manage chronic coughs by stimulating certain points in the body. Consult a licensed acupuncturist for treatment sessions, which may help reduce coughing by balancing the body's energy and calming the nervous system.
Avoid Smoke
Both smoking and exposure to secondhand smoke can irritate your lungs and exacerbate coughing. If you smoke, consider discussing cessation programs with your doctor.
Prop Yourself Up With Pillows
Propping yourself up in bed can help stop or reduce coughing, especially at night, because it prevents mucus from pooling in the throat and airway. When you lie flat, mucus can accumulate, leading to irritation and triggering the cough reflex. By elevating your head and upper body, gravity helps keep the airways clearer, reduces postnasal drip, and minimizes acid reflux, both of which can contribute to coughing.
Lift Your Knees While Lying on Your Back
I’m not sure if this is a known technique, but when I slide down from my propped-up pillows to a nearly flat position and wake up coughing, I don’t feel like propping myself back up, so I stay on my back, bend my knees up, and it seems to help the coughing stop, maybe because bending my knees relieves pressure on my diaphragm and opens up my airways.
These natural remedies may help ease symptoms, but it’s always important to consult your doctor to ensure they won’t interfere with any ongoing treatments or medications.
A Neurogenic Cough Summary
In summary, a neurogenic cough is a complex condition, leading to a persistent cough. Understanding the underlying cause requires a thorough investigation of potential triggers, such as viral infections, acid reflux, environmental factors, or nerve damage. Proper diagnosis and treatment depend on addressing these root causes, so working closely with a healthcare provider is essential for effective management and relief.
