Disclaimer: This article is for information only and is not medical advice. Always talk to your doctor before starting, stopping, or changing any medication.
What Is a Neurogenic Cough?
A neurogenic cough (sometimes called chronic cough or refractory cough) is a cough that lasts more than eight weeks when common causes like infection, asthma, or reflux have been ruled out.
Doctors now think it happens because the nerves in your throat become too sensitive. This makes you cough in response to things that would not normally bother you, such as:
- Cold air
- Perfume or smoke
- Talking or laughing
This constant “tickle” or urge to cough can be exhausting, affect sleep, and make social situations difficult.
Why Amitriptyline Is Prescribed
Amitriptyline is an older antidepressant medicine. In low doses (like 10 mg at night) it is sometimes used to calm a sensitive cough reflex.
It can help because it:
- Calms sensitive throat nerves.
- Reduces the brain’s reaction to the urge-to-cough signal.
- Helps with sleep, making nighttime coughing less of a problem.
Many people notice improvement within a few weeks.
The Problem With Long-Term Use
Amitriptyline is part of a group of drugs called anticholinergics. These block a brain chemical called acetylcholine, which is important for memory and concentration.
Long-term risks include:
- Memory and thinking problems
- Confusion or daytime sleepiness
- Dry mouth, constipation, or dizziness
- Higher dementia risk:
- A U.S. study found people taking strong anticholinergics daily for 3+ years had a 54% higher risk of dementia (Gray et al., 2015).
- A U.K. study confirmed a nearly 50% higher risk, especially with medicines like amitriptyline (Coupland et al., 2019).
Because of these risks, experts recommend using amitriptyline only for a short time.
How to Stop Amitriptyline Safely
Stopping suddenly can cause problems like poor sleep, irritability, or worse coughing. Doctors usually suggest a gradual taper:
- Step 1: Reduce from 10 mg to 5 mg each night for 1–2 weeks.
- Step 2: Stop after that if symptoms are under control. If cough worsens, stay on 5 mg a little longer before stopping.
Always taper under medical supervision.
Behavioural Cough Suppression Therapy (BCST): A Safer Long-Term Option
BCST is a speech-therapy-based programme that helps people manage cough without medicine. It is usually delivered in six sessions by a trained therapist.
The Six Sessions
- Education
- Learn why your cough nerves are over-sensitive.
- Keep a daily log of cough severity (0–100 points).
- Try a simple “micro-set” technique: gentle nasal inhale → swallow → pause 2–3 seconds → slow exhale (option: sip water).
- Trigger Management
- Identify your personal cough triggers.
- Practise strategies like sipping water, silent swallows, or nasal breathing to manage them.
- Automaticity (Breaking the Habit Loop)
- Learn to interrupt automatic coughing with planned “IF–THEN” strategies (e.g., If I feel an urge while talking, then I swallow and breathe slowly through my nose).
- Vocal Hygiene
- Reduce throat irritation by staying hydrated.
- Replace throat-clearing with a hard swallow or silent cough.
- Troubleshooting
- Review progress with your therapist.
- Identify barriers (e.g., strong perfume at work).
- Practise “mini-sessions” daily if urges remain strong.
- Consolidation
- Compare new scores with your baseline.
- Agree on warning signs for relapse (e.g., cough severity ↑ by 20 points).
- Plan long-term self-management.
Example Logs
Daily Symptom Log
| Date | Cough Severity (0–100) | Urge to Cough (0–100) | Trigger | Notes |
|---|---|---|---|---|
| 1 Sept | 72 | 78 | Cold air | Micro-set stopped the urge in 30 s |
| 2 Sept | 65 | 70 | Talking | Two urges, both controlled with sips |
Trigger Management Log
| Date | Trigger | Strategy Used | Urge Intensity | Outcome |
|---|---|---|---|---|
| 3 Sept | Perfume | Nasal breathing + sip | 65 | Urge passed, no cough |
| 4 Sept | Phone call | Swallow every few minutes | 58 | Only 2 suppressed urges |
Weekly Progress Log
| Week | Avg Cough Severity | Avg Urge | LCQ Score (3–21) | Notes |
|---|---|---|---|---|
| 1 | 48 | 50 | 12.8 | Practising daily |
| 4 | 35 | 38 | 14.6 | Sleep better, fewer coughs |
The Bottom Line
- Amitriptyline can help at first but is risky if used long term.
- Taper slowly with your doctor’s guidance.
- Start BCST early so you have skills to manage cough during tapering.
- Use logs to track progress and spot relapses.
This combined approach gives the best chance of long-term cough control without risking brain health.
References
- Chamberlain Mitchell, S. A., Garrod, R., Clark, L., Douiri, A., Parker, S. M., Ellis, J., Morice, A. H., Ludlow, S., Fowler, S. J., & Birring, S. S. (2017). Physiotherapy, and speech and language therapy intervention for chronic cough (PSALTI): A randomised controlled trial of clinical effectiveness. Thorax, 72(2), 129–136. https://doi.org/10.1136/thoraxjnl-2016-208843
- Coupland, C. A. C., Hill, T., Dening, T., Morriss, R., Moore, M., & Hippisley-Cox, J. (2019). Anticholinergic drug exposure and the risk of dementia: A nested case–control study. JAMA Internal Medicine, 179(8), 1084–1093. https://doi.org/10.1001/jamainternmed.2019.0677
- Gray, S. L., Anderson, M. L., Dublin, S., Hanlon, J. T., Hubbard, R., Walker, R., Yu, O., & Larson, E. B. (2015). Cumulative use of strong anticholinergics and incident dementia: A prospective cohort study. JAMA Internal Medicine, 175(3), 401–407. https://doi.org/10.1001/jamainternmed.2014.7663
- Morice, A. H., Millqvist, E., Bieksiene, K., Birring, S. S., Dicpinigaitis, P. V., Ribas, C. D., Smith, J. A., Tonia, T., & McGarvey, L. (2020). ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. European Respiratory Journal, 55(1), 1901136. https://doi.org/10.1183/13993003.01136-2019
- Raj, A. A., Pavord, D. I., & Birring, S. S. (2009). Clinical cough IV: What is the minimal important difference for the Leicester Cough Questionnaire? Handbook of Experimental Pharmacology, (187), 311–320. https://doi.org/10.1007/978-3-540-79842-2_16
- Nguyen, A. M., Bacci, E. D., Vernon, M., Birring, S. S., Rosa, C., Muccino, D., & Schelfhout, J. (2021). Validation of a visual analogue scale for assessing cough severity in patients with chronic cough. Therapeutic Advances in Respiratory Disease, 15, 17534666211049743. https://doi.org/10.1177/17534666211049743
- Rhatigan, K., Hirons, B., Kesavan, H., Satia, I., Woodcock, A., & Smith, J. A. (2023). Patient global impression of severity in chronic cough: Validation and symptom severity categories. Journal of Allergy and Clinical Immunology: In Practice, 11(12), 3706–3712.e1. https://doi.org/10.1016/j.jaip.2023.09.026
- Vertigan, A. E., Theodoros, D. G., Gibson, P. G., & Winkworth, A. L. (2006). Efficacy of speech pathology management for chronic cough: A randomised placebo controlled trial of treatment efficacy. Thorax, 61(12), 1065–1069. https://doi.org/10.1136/thx.2006.064337
- Visca, D., Beghè, B., & Fabbri, L. M. (2020). Management of chronic refractory cough in adults. European Journal of Internal Medicine, 81, 15–21. https://doi.org/10.1016/j.ejim.2020.07.006
- Yi, Y., Liu, Y., Zhang, Y., & Fang, Y. (2024). Effect of behavioural therapy on refractory chronic cough: Meta-analysis of randomised clinical trials. Journal of Clinical Medicine, 13(19), 5739. https://doi.org/10.3390/jcm13195739