Ever have a patient with a chronic cough unresponsive to anti-reflux, allergic rhinitis, and asthma treatment? Sensory Neuropathy might be the problem and Amitriptyline the answer.
Sensory neuropathic cough: A common and treatable cause of chronic cough
Robert W. Bastian,MD, Abhay M. Vaidya, MD, and
Kathelijne G. Delsupehe, MD
Otolaryngology–Head and Neck Surgery (2006) 135, 17-21
12 cases – 40% reduction chronic cough with 10 mg Amitriptyline.
Comment – I try Singulair 10 mg hs. to see if the chronic cough is helped by that as it seems to help both rhinitis and asthma based cough – some patients have been pleasantly surprised.
Any tips for chronic cough?
I had a cough for 15 years that was unresponsive to any allergy asthma or reflux treatment . My cough was uncontrollable and violent triggered by singing, talking , standing up , eating and siting . I would have a choking coughing spell at least once every time i was in church . Anytime and everytime i would eat something scratchy such as chips, peanuts etc without fail the first bite taken would cause me to start coughing for at least 30 seconds . Everytime i would talk on the phone my family new that eventually that i would start coughing so hard that they would just have to call me back . They were used to it. People would suggest different things to take they said might help and i would just say you dont understand ive tried everything and nothing nothing nothing helps…..When i read about sensory neuropathic cough (nerve damage to throat ) i cried for 20 minutes because finally after 15 years there was a diagnosis for what i had , and 10 mg amitryptiline was the cure. My life has changed dramatically my cough is 90 percent better i call it my miracle pill . Two months on the medicine reversed the nerve damage in my throat after all these years. thank you doctors for your research thank you very much…
Wow – After all these years, someone is finally being helped by my blog- It such a warm feeling. Thank you.
I actually sent this comment to Dr. Bastian who wrote the original article. He wrote this reply:
Hello Dr. Montbriand,
Absolutely kind of you to send this along. At our institute, I estimate we have seen 1000 patients with this problem, from all over the place. I have a youtube video on the subject, hoping to spread the word, but have not had time to create the “treatment” side. I admire your blog, BTW.
Robert Bastian
Robert W. Bastian, M.D. Bastian Voice Institute http://www.bastianvoice.com phone: 630.724.1100
His youtube sites are:
Part I: Coughing that Won’t Go Away: Sensory Neuropathic Cough
http://www.youtube.com/watch?v=kFyRbLPilyE&feature=related
Part II: Coughing That Won’t Go Away: Sensory Neuropathic Cough
http://www.youtube.com/watch?v=v3k1WrULAhA
It appears that gabapentin is useful for this condition as well…
Thank you Dr. Bastian
admin
Donya, I want to say thank you for what you posted. I have had a chronic cough for over 12 years. I have had Allergy test, Gerd test, lungs scrapped, swallow test, asthma test and several doctors. In which, they have all tried with no success of finding a cause. I cough all day and wake up in the night sometimes. it wears on your body. The muscles in my neck have been hurting for about a year now. It is so embarassing, plus I wet myself everytime I cough. I am in the process of trying to find a doctor in the Arlington, Tx area that will treat this. I hope that I will be able to report a success like yours!
Hey Mona has the treatment helped …I just came across these comments and so excited to know I’ve helped people understand what’s going on with them (:
I have a dry cough for many many years I’m talking like 15 years and for the last three years I’ve been on gabapentin for fibromyalgia. This drug does nothing for dry cough. I hack my brains out continuesly to the point of passing out. Been on steroids etc… So I disagree with your findings on the Gabapentin helping.
Thankyou Donya so much for sharing this information. somehow somewhere I read your blog. This is life changing for me. I too have had this condition for I would say over 20 years. I have tried everything and am currently having the injections for DUSTMITES allergies which I presume will continue. It’s ironic as I recall once the cough disappearing for a while and I put it down to that I was regularly taking garlic in large doses to try and clear up my post natal drip. However I realize now that I had been taking amitriptyline to help in migraine prevention and sleeping better. When I found out that this medication was an anti depressant I stopped taking it thinking why take something like this when I wasn’t depressed!!!this was about 1o years ago, hindsight of course is a wonderful thing.
Consequently after reading your blog I viewed Dr Bastian YouTube which is wonderful that he is sharing this information. Next day straight to my Doctor with the information who has started me off on the 10 mg dose and with a script I can take up to 30mg if I notice that it works but not well enough. I’m on my third day and awaiting results which I believe will come from other previous experience. So thank you and Dr Bastian and Dr Chang for their articles. My coughing was totally taking over my life. Unble to even serve my customers without coughing with my small business. Unable to meditate and lost confidence in attending plays etc or any activity that required quiet time. Coughing during the night effecting sleep. Violent coughing where I had tears running down my face and gasping for breath.
I am sooooo looking forward to my new life. My body has taken its tole and was becoming a stressed wreck!!!!! I will be sharing this information with many. My Dr will be researching and I have told two Pharmacists already. This information needs to get out there. I’m sure there are thousands of people to be helped.Thank you again for directing me to the info and I hope to be cough free soon
regards. Julie Gilbert from Perth Western Australia
Hi I just want to say that I was on Amitriptyline for a couple years. It was AMAZING. However, my body kept getting more and more used to the drug. Earlier this year I was up to 125 mg per night on Amitriptyline and suffering from nightmares, hallucinations, blurry vision, and lots of weight gain. This drug DOES do it’s job. So, my doctor and I are now trying Neurontin to try something that has less side affects and can do the same job. I’ve just recently started it and so far I’m a little bit scared that I’ve started back at square one. I am still feeling like I’m constantly stifling a cough. My SOMETIMES saving grace is buying breath spray and spraying the back of my throat to hopefully stop the horrible itch and need to cough. I really don’t want to go back on Amitriptyline, but I may have to if Neurontin does not help me. I’m currently starting my first day of 300 mg 3x a day. I’m hoping life improves.
I have had a chronic cough for soo long I cannot remember when it started. I had an incident about 15 years ago, where I was exposed to chlorine when the pool chlorine exploded in my car while I was driving. I could not stop immediately and breathed it in for about 5 minutes if not longer. I feel that episode may have contributed to my problem. I hope to get help with my problem now that I have this valuable information. Thank you so much.
I have had this problem for many years. I have had sinus surgery do to polyps. and still have a chronic cough. I have all the symptoms mentioned. I feel this began after I was exposed to swimming pool chlorine which exploded in my car as I was driving. I hope to get some help now that I understand I am not alone with this problem. Thank you very much for sharing.
Hi again, I am now finding that the amitryptiline in low doses isnt working as effectively after 6 months? Any hints, anyone? what is a safe dosage to take. No Doctor I have been too knows anything about a sensory neuropathic cough, but when i explained etc, I got the medication as they could ‘see how it could work”
Could someone who knows where to go to now, email Julie on julzg@iinet.net.au
I was soooo happy to be rid nearly at times 100percent of the coughing, and dread its return which is happening. JULIE PS takiing 25 to 30mgs of the drug currently
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Julie:
First of all, one assumes you have ruled out other issues:
Esopahgeal reflux – no response to anti-ulcer ppi pills and raising head of mattress with pillows underneath head of bed
Allergies – Lack of response to Singulair which works for both asthma and hayfever.
A recent article goes over possible new options:
Evidence for Sensory Neuropathy and Pharmacologic Management
Scott M. Greene, C. Blake Simpson, MD*
Otolaryngol Clin N Am 43 (2010) 67–72
free article here:
http://ainotes.wikispaces.com/file/view/PVVN+Evidence+for+Sensory+Neuropathy+and+Pharmacologic+Management+-+Otolaryngology+Clinics+2011.pdf
They mention 2 newer agents:
Gabapentin :
“Patients were instructed to begin dosing at 100 mg/d and to increase dosage up to 900 mg/d in divided doses over a 4-week period.”
Pregabalin (lyrica) :
“Patients were started at 75 mg twice a day and were then raised over 4 weeks to 150 mg twice a day if needed for symptomatic relief. In one patient, 150 mg three times
a day was needed.”
Good luck.
– admin
I tried lyrica. It gave me rash and I was very very tierd all the time it helped my cough about 70% but I had to stop it
We don’t have amitriptiline in my country
I am using remaron and it is not helping much
Can I by amitriptiline on line ? And how?
Please help
——————-
Amitriptyline was originally marketed as Elavil brand.
Apparently in Saudi Arabia it is marketed as Laroxyl – see:
http://www.crazymeds.us/pmwiki/pmwiki.php/Meds/Elavil
I would like to find out if there are any Doctors in the Austin area up to Waco area that treat chronic cough based on sensory neuropathy? I have had issues over the past 6 years and need help.
———-
Dr. Bastian, who wrote the article, is a Laryngologist (voice box expert)
I found a list of laryngologists here:
http://voicedoctor.net/physicians
For Doctor in the USA, You will notice Dr. Bastian is highly rated. You can go through list and see if someone is near you, phone and see if they deal with neurogenic cough as described by Dr. Bastian.
Alternatively, you could call Dr. Bastian’s office and see if they would recommend anybody – looks like he has helped train some of them.
Robert W. Bastian, M.D.
Bastian Voice Institute
http://www.bastianvoice.com
phone: 630.724.1100
Good luck
-admin
Wow so happy to know that I was able to help some of you with this …and to know I’m not alone !!!
Thank you for this article. I’ve been coughing for close to six years. I knew I had to do something when my son took the book away from me to read a very exciting story because my continuous cough messed up the story. So I went to Mayo Clinic and took $1800 worth of tests and received no solution. Symbicort, ventolin, nexium, and another pill that starts w an S. Chest X-rays and pulminologists, allergy tests…you name it, I did it. I’ve had steroids prednisone and none of it worked. After reading Donyas response, I made an appointment and got the 10mg of amitryptiline and it worked. My body is not used to medicine other than what I listed. The amitryptiline wore me out the first day. I slept like a baby without coughing. Before this, I had long episodes of coughing throughout the night. I would go to sleep at 11:00 and by 3:00am I would have a coughing episode that would keep me up for the remainder of the night. I would talk and all of a sudden break into an uncontrollable cough. My cough would be loud and hard. Everyone would ask if I was alright. I would drive and have a cough attack. Red lights were my friend. It was crazy!!!! In three days of taking meds I have not had any spasms. I still cough a little. I cut the pill in half this third day so I would not sleep all day because it makes me groggy. I hope it works at 5mgs. How long should I take this pill? Is it a life long thing or will my hypersensitive nerve endings heal?
Shana so glad to hear that you are better from amitriptyline . You ask if you will have to stay on meds and I can tell you that I was on them for a year and quit because I thought I was better but the cough did come back . So I’m currently on 2o mg again . When I came across dr bastians videos I cried for 30 min . Couldn’t believe I found the answer after so many years of not knowing why I coughed the way I did ….so happy to hear you are having success with the meds .
I forgot to mention Dr. Bastians videos were awesome!!! My husband thought you had me as his patient. The symptoms you shared in the video were identical to mine!
It took me 10 years to figure out why I had this horrible cough. It was interfering with my life. I diagnosed this cough by searching 0nline. All of my doctors said either they had never heard of it or that I didn’t have it. I finally went online and found an ENT doctor at UCLA who has treated patients for this type of cough. I’m on 12.5mg of amitriptyline. I have only been on it for 8 days and my cough has improved by about 95% since the very first day. Just hoping it doesn’t come back. It has been a miracle. If anyone needs a recommendation in the Los Angeles area let me know.
I too have been suffering with a chronic cough for 20 years. I also have diagnosed my cough by searching online and reading books. Please could you recommend me the name and contact info for your ENT at UCLA. I live in the Los Angeles area. Thank you.
Liz, I live near UCLA and would appreciate the name of the doctor you mentioned. I have had an unexplained cough for about 8 months, and have been to every kind of specialist.
Thanks.
I too have been coughing for so many years that I can’t even remember when it started. All day everyday, when I eat, talk, sleep, breath, etc. Have been to Alergists, Pulmonologists, Gastoenterologists and have had so many invasive tests and even had things removed in hopes that would be the cure. But now it’s worse than ever. I am so glad I continued to do research and found my exact problem shared by so many others…Sensory Neuropathic Cough. I live in the Los Angeles area…would you be so kind as to provide me the name of the UCLA ENT doctor who has treated this type of cough? Many thanks!
How is your cough doing now? How long you had to take amitryptline? Or are you still taking?
Hi everyone. I help Dr. Bastian manage his website and teaching materials, including videos. It’s very encouraging to read in these comments about people who have been helped by his videos.
I wanted to let you all know that the full-length version of Dr. Bastian’s second video about sensory neuropathic cough (“Medications”) can be seen here: https://vimeo.com/78557842
Take care!
I seem to be three years late in finding this blog. I just started Amitriptyline for my chronic cough. Has anyone found a connection between the chronic cough and tinnitus? I’ve had both for years. I appreciate any feedback or suggestions.
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Cough neuropathy is nerve damage causing cough; tinnitus is nerve damage in ear causing ringing
-admin
I have this same cough – for about 25 years now. Started with my one and only pregnancy. It started with a cold. The cold went away, but the cough did not. Lasted the entire last half of the pregnancy. Coughed so much and so hard, I thought my baby would think that coughing was the only sound in the universe. It stopped the day she was born, but then returned a few years later and never left. I’ve been treated for asthma, but I knew in my heart I never had asthma, because I have never had difficulty breathing. I just read a very helpful book called THE CHRONIC COUGH ENIGMA by Dr. Jamie Koufman. Have made an appointment with an otolaryngologist to get started on amitriptyline or desipramine. That’s my story. It might help someone. I pray the drug works for me.
_____________
Thanks for sharing – Best of luck!
-admin
I have had a chronic cough for one year. My ENT Dr. recommends amitiptyline and my Pulmonary Dr recommends Gabapentin. Really would like your opinion.
Hey Jill just wanted to say I have never tried the gabapentin I always heard amitriptyline was better and that is what I take . They usually prescribe amitriptyline first and if you can’t tolerate it or have bad side effects from it then they will switch you to gabapentin .
Thank you so much for posting your blog. I’ve been throat clearing and coughing for 11-12 years I can recall the episode that started it. I used to perform in amateur theatre. During rehearsals for a show I developed a respiratory infection and laryngitis. I continued to try and sing (against the suggestion of a fellow cast member and doctor). When the respiratory infection had cleared up I noticed that my voice continued to sound lower and ‘flu like’. It never went back to normal. I’ve had the throat clearing and cough ever since. A year ago I had my thyroid disabled with radioactive iodine due to Graves Disease and developed radioactive thyroiditis. I also have GERD, IBS and Barrett’s Syndrome. I have coughed violently since then. I can’t work as the cough is so debilitating. I’m currently taking 50mg of Amiltryptaline at night to treat chronic insomnia and general anxiety. The cough is alleviated to a certain extent at night. I feel sick and tired constantly. You have shed some well needed light at the end of a very dark tunnel. I have a Dr appointment tomorrow to start the next series of testing. I won’t stop now until I get some relief from this nightmare. My thoughts are with everyone who suffers this horrid ailment.
I went to mg doctor armed with this information. He prescribed Amitriptyline 10mg morning and noon, 50mg at night. 2 days in to treatment and my cough is 70% better. Thank you so very much for your blog.
What’s up, yeah this article is really good and I have learned lot of things from
it concerning blogging. thanks.
Been coughing for 20 years. Just a silly little tickle in my throat that has ruined my life. I’d had been treated for all the usual cough causes – asthma, GERD etc etc. No improvement. A couple of years ago I discovered this thing about SNC. I took my online research to my doctor who gave me Tramadol. Tramadol (a nerve pain killer) worked brilliantly. Cough was gone 100%. However after a year I developed a tolerance and needed to increase the dose for it to still work. So now I’m wondering if I try another drug like amitriptyline whether it will work as the Tramadol used to. And then of course – what happens when I develop a tolerance for amitriptyline? I’m wondering if a ‘break’ of perhaps a year from the ‘tramadol’ (using amitriptyline instead) would make the tramadol work again at a later date.
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Julie,
lots new out since I wrote that article:
Recent good article available free reviews options:
Bastian, Zachary J., and Robert W. Bastian.
The use of neuralgia medications to treat sensory neuropathic cough: our experience in a retrospective cohort of thirty-two patients.
PeerJ 3 (2015): e816.
https://peerj.com/articles/816/
Interestingly, they found that amitriptyline worked in 14/78 and desipramine, another old antidepressant that is less sedating, worked in 11/73
– gabapentin might help too though number needed to treat was 3.52 to get one success
Ryan NM, Birring SS, and Gibson PG:
Gabapentin for refractory chronic cough: a randomised, double-blind, placebo-controlled trial.
Lancet 2012; 380: pp. 1583-1589
http://www.researchgate.net/profile/Nicole_Ryan/publication/230803783_Gabapentin_for_refractory_chronic_cough_a_randomised_double-blind_placebo-controlled_trial/links/0fcfd50bfce0db8112000000.pdf
recent review on gabapentin suggests it is well tolerated:
Ryan, Nicole M.
A review on the efficacy and safety of gabapentin in the treatment of chronic cough.
Expert opinion on pharmacotherapy 16.1 (2015): 135-145.
http://informahealthcare.com/doi/abs/10.1517/14656566.2015.981524
-?B12
http://www.thelancet.com/journals/lanres/article/PIIS2213-2600%2813%2970043-2/abstract
article mentions that B12 deficiency could aggravate so should have levels done – wonder if near daily shots, found to help pain, could help cough too.
– Bizarre as it may be, low-dose itraconazole (an antifungal) was found to help 3/5 chronic idiopathic cough subjects:
Ogawa, Haruhiko, et al.
Clinical experience with low-dose itraconazole in chronic idiopathic cough.
Cough 9.1 (2013): 1.
http://www.biomedcentral.com/content/pdf/1745-9974-9-1.pdf
-pregabalin and baclofen were recently mentioned:
Cohen, Seth M., and Stephanie Misono.
Use of Specific Neuromodulators in the Treatment of Chronic, Idiopathic Cough A Systematic Review.
Otolaryngology–Head and Neck Surgery 148.3 (2013): 374-382.
http://oto.sagepub.com/content/148/3/374.abstract
Experimental drug AF-219 can reduce daytime cough 75% as per:
Song, Woo-Jung, Yoon-Seok Chang, and Alyn H. Morice.
Changing the paradigm for cough: does’ cough hypersensitivity’aid our understanding?.
Asia Pacific Allergy 4.1 (2014): 3.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3921869/
and
Abdulqawi, Rayid, et al.
P2X3 receptor antagonist (AF-219) in refractory chronic cough: a randomised, double-blind, placebo-controlled phase 2 study.
The Lancet 385.9974 (2015): 1198-1205.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961255-1/abstract
Mention was made of using:
– citalopram – an antidepresant found helpful in esophageal hypersensitivity
http://painmuse.org/?p=1321
– oxcarbazepine – a tegretol like drug used in trigeminal neuralgia
– last resort was use of Capsaicin (pepper)spray mentioned in
Bastian, Zachary J., and Robert W. Bastian.
The use of neuralgia medications to treat sensory neuropathic cough: our experience in a retrospective cohort of thirty-two patients.
PeerJ 3 (2015): e816.
https://peerj.com/articles/816/
good luck
admin
ladies after coughing for 20 years exactly the same as all the symptoms above ..and all the tests ..I was beside my self thinking well this is it ..I will never get rid of .
a friend told me about amitripyline. .just been yo the doctors and he gave script for it Please God it works
I had the same cough from last almost 8 years. I went to so many doctors and did all kind of tests. Asthma test allergy test reflux test all came normal. Tried all kinds of medicines for allergy reflux and asthma but all failed to work. Then finally my ent doctor robert jess prescribed me elavil 25 mg before bed. After taking this medicine from the very first day i start feeling almost 70% improvement in my symptoms that was theoat clearing and coughing. Finally feeling relief from this kind of symptoms after 8 straight years.
Thanks for the comments and replies. I’m living in Swaziland.once diagnosed with rhinitis (chronic) in 2007. Seen so many doctors in different private hospitals,taken different antihistamines. The major problem was the cold weather and strong smells,like methylated spirit. Had a challenge with opening windows in a car while it was moving because of the dry air that was coming in,which resulted to nasal blockage and itchy / dry eyes. During the winter season,I felt like I was breathing through the center of my head (as if there was a huge hole with ice cubes,at the center of my head,on top). Then one Doctor prescribed amitryptiline for me. I started with 20 mg for 6 months and there after with 10 mg.I felt so bad because I thought that it was solely prescribed for depression. Amazingly,after taking it,immediately the nasal passage unblocks and no longer felt the cold sensation in my head. No matter how the cold is or strong the smell is I feel comfortable. I take the 10 mg once at night and I feel comfortable the whole of the next day. It’s 3 years now,still on amitryptiline. No more frequent visits to hospital. Every winter I had to take 2 months sick leave. Now it’s history.AMITRYPTILINE worked for me.
Thanks to DR Otto Nel in Newcastle (South Africa)
Hi, I have had my cough for about 2 yrs after a terrible upper respiratory infection. I have tried several doctors and none have helped. Barely getting through the days… Dr. Bastian’s videos explain exactly what I feel, so glad I’m not alone. Every Dr. here in AZ has had any idea of SNC- which is hard to believe. Liz mentioned a dr. at UCLA, I’d be very willing to go see him in CA if he can help me too?
What is the dr.’s name please??
I was diagnosed by Dr. Bastian 5 years ago and took 900 mg of gabapentin 4 times a day. Wanting to start a family and tired of the side effects, I found a chiropractor neurologist who really helped me. Dr. Scott Hoppe’s info is here: http://www.integrativechiroperformance.com/ While I still cough, I cough less than I did when I was on all of that medication.