"Laryngeal vertigo" was first described in 1876 which means loss of consciousness following cough. It is commonly termed as cough syncope now and since then several hundred cases of cough syncope have been reported in association with several medical conditions. Few of the early authors supposed this entity as a form of epilepsy, however by the mid-20^th century, general consensus revealed that post-tussive syncope was a result of markedly raised intrathoracic pressures which is induced by coughing.

A typical profile of the patient with cough syncope coming from the literature is of a middle-aged, overweight or large-framed male with obstructive airways disorders. Most probably, such an individual is more likely to produce the exceptionally high intrathoracic pressures that is associated with cough-induced fainting.

The exact mechanism of cough syncope still remains a matter of debate. Theories that are proposed include several concerns of the marked elevation of intrathoracic pressures that is induced by coughing such as reduced cardiac output causing decline in systemic blood pressure and, subsequently, cerebral hypoperfusion; increased cerebrospinal fluid (CSF) pressure that can cause increased extravascular pressure around the cranial vessels, causing reduced brain perfusion; or, a cerebral concussion-like effect from a prompt rise in CSF pressure.

Additional new mechanistic studies have suggested a neurally mediated reflex vasodepressor-bradycardia reaction to cough. As the loss of consciousness is a direct and immediate result of cough, eradication of cough will remove the resultant syncopal episodes. Therefore, the approach to the patient with cough syncope needs detailed evaluation and treatment of probable underlying causes of cough and is summarized in numerous recently published cough management guidelines.

Source: Dicpinigaitis PV, Lim L, Farmakidis C. Cough syncope. Respir Med. 2014 Feb;108(2):244-51. doi: 10.1016/j.rmed.2013.10.020. Epub 2013 Nov 5. PMID: 24238768.