From the Research
Neurogenic cough is best evaluated and treated through a comprehensive approach that includes ruling out other causes before treatment, and first-line medications include neuromodulators like gabapentin or pregabalin, as supported by the most recent study 1. The evaluation of neurogenic cough should include a thorough history, physical examination, laryngoscopy, and possibly imaging studies to exclude structural, inflammatory, or infectious causes.
- Key points to consider in the evaluation include:
- Treatment typically begins with behavioral therapy such as speech therapy focusing on cough suppression techniques.
- First-line medications include:
- Gabapentin, starting at 300mg daily, gradually increasing to 300mg three times daily over 1-2 weeks, with treatment duration of 2-3 months
- Pregabalin, starting at 75mg twice daily, increasing as needed up to 300mg daily
- Amitriptyline, 10mg at bedtime, increasing to 25-50mg if needed, as supported by older studies 2, 4
- For patients who don't respond to these medications, other options include tramadol, baclofen (10-20mg three times daily), or low-dose morphine sulfate.
- Refractory cases might benefit from superior laryngeal nerve blocks with lidocaine or botulinum toxin injections into the vocal folds, as shown in a study from 2018 5. These treatments work by targeting neural hypersensitivity and disrupting the cough reflex pathway.
- Patients should be counseled about potential side effects including sedation, dizziness, and dry mouth, and medication should be tapered gradually when discontinuing to prevent withdrawal symptoms. The most recent guidelines from the European Respiratory Society Chronic Cough Task Force, published in 2020 1, support a stepwise approach to the management of chronic cough, including the use of neuromodulatory agents for patients with refractory chronic cough.