Sharp pain in the back of the head when coughing is a specific type of headache known as a cough headache. This sensation often appears suddenly and is typically brief, lasting from seconds to minutes, though it can sometimes extend up to two hours. Such headaches are characteristically triggered not only by coughing but also by other actions that increase pressure within the head, such as sneezing, straining during bowel movements, lifting heavy objects, laughing, or even bending over. The pain is frequently described as sharp, stabbing, or bursting, and can occur on one or both sides of the head, often localized to the back (occipital region). While often benign, understanding their nature is important because they can occasionally signal an underlying medical condition.
Understanding Cough Headaches
Cough headaches are broadly categorized into two types: primary and secondary. Primary cough headaches are not linked to underlying structural issues in the brain or skull. They are generally considered harmless and typically resolve on their own without specific treatment. The exact mechanism is not fully understood, but it is believed to involve a sudden increase in pressure inside the head during activities like coughing, which temporarily affects blood vessels and cerebrospinal fluid dynamics.
Secondary cough headaches are caused by an underlying structural problem within the brain or surrounding structures. They can be more serious and require a medical evaluation to identify the root cause. One common cause of secondary cough headache is a Chiari malformation type I, where brain tissue (cerebellar tonsils) extends into the spinal canal. This anomaly can obstruct normal cerebrospinal fluid (CSF) flow at the base of the skull, leading to an exaggerated increase in pressure during coughing.
Other conditions leading to secondary cough headaches include brain tumors, which can increase pressure within the skull by their presence or by blocking CSF pathways. Aneurysms, weakened, bulging areas in blood vessel walls in the brain, can also cause cough headaches, often due to pressure on nearby tissues. Additionally, issues with cerebrospinal fluid pressure, whether too high (idiopathic intracranial hypertension) or too low (spontaneous CSF leak), can trigger these headaches. The sudden pressure changes from coughing can exacerbate the existing CSF imbalance, leading to pain.
When to Seek Medical Attention
While many cough headaches are not serious, certain indicators suggest the need for a medical evaluation. New onset cough headaches, particularly if over age 40 or 50, warrant attention. Headaches that are persistent, severe, or progressively worsening should also prompt a visit to a healthcare professional.
Accompanying neurological symptoms require immediate medical assessment. These can include dizziness, unsteadiness, numbness, weakness in limbs, changes in vision (blurred or double), difficulty speaking, or fainting.
Headaches that do not resolve quickly or are associated with other symptoms like fever, a stiff neck, or unexplained weight loss are also concerning. Consult a doctor if there is any concern about the pain’s nature or if headaches significantly disrupt daily activities.
Diagnosis and Management
Diagnosis typically begins with a thorough medical history and physical examination, including a neurological assessment. This helps understand headache characteristics and identify associated symptoms that might point to an underlying condition.
Magnetic Resonance Imaging (MRI) of the brain, often including the cervical spine, is the primary diagnostic tool to rule out secondary causes like Chiari malformation, brain tumors, or aneurysms. A Computed Tomography (CT) scan may be an alternative. If CSF pressure issues are suspected, a lumbar puncture (spinal tap) may measure cerebrospinal fluid pressure and analyze its composition.
Management depends on the identified cause. For primary cough headaches, treatment often involves reassurance and lifestyle modifications, such as avoiding triggers. Medications like indomethacin are often prescribed to reduce the frequency and severity of these headaches, although their exact mechanism is not fully understood. Acetazolamide may also be considered.
If a secondary cough headache is diagnosed, treatment focuses on addressing the underlying condition. Surgical intervention may be necessary for conditions like Chiari malformation to relieve pressure or for brain tumor removal. Aneurysms might require procedures to seal them or divert blood flow. When CSF pressure abnormalities are the cause, management can involve medications to regulate CSF production or procedures to address CSF leaks or blockages.