Experiencing a sudden, shooting pain in your head when you cough can be unsettling. This phenomenon, known as a cough headache, is often a benign and temporary condition. However, it can occasionally signal an underlying medical issue that requires attention. Understanding the characteristics of these headaches can help determine when medical evaluation is appropriate.
Characteristics of Cough Headache
Primary cough headaches have distinct features. The pain begins suddenly, immediately after activities that increase pressure in the head, such as coughing, sneezing, laughing, or straining during a bowel movement. This sharp, stabbing, or bursting pain affects both sides of the head, often feeling most intense at the back.
The pain is brief, lasting from a few seconds to a few minutes. After the initial sharp pain, a dull ache might persist for several hours. These headaches are not accompanied by other symptoms like nausea, watery eyes, or sensitivity to light and sound.
Potential Causes
Cough headaches fall into two categories: primary and secondary. Primary cough headaches are benign, meaning the cough itself is the trigger without an identifiable underlying structural problem. The exact cause of primary cough headaches is not fully understood, but it is thought to involve a sudden increase in pressure within the head due to the force of coughing.
Secondary cough headaches are caused by an underlying medical condition and can be more serious. One common cause is a Chiari malformation type I, a structural defect where brain tissue, specifically the cerebellum, extends into the spinal canal at the base of the skull. This can cause pressure on the brainstem and disrupt cerebrospinal fluid (CSF) flow, leading to pain with coughing.
Other conditions causing secondary cough headaches include brain aneurysms (weak, bulging blood vessel spots) and brain tumors (both cancerous and non-cancerous), which increase pressure within the skull. Another cause is spontaneous intracranial hypotension, a condition of low cerebrospinal fluid (CSF) pressure due to a CSF leak. Reduced CSF volume leads to traction on pain-sensitive structures, exaggerated by coughing.
When to Seek Medical Attention
While many instances of head pain with coughing are harmless, certain signs indicate the need for medical evaluation. Any new-onset cough headache, especially in individuals over 40, warrants a doctor’s visit to rule out a more serious underlying cause. Seek medical attention if the pain is severe, prolonged, or recurs frequently.
“Red flag” symptoms that suggest a secondary cause include dizziness, unsteadiness, or problems with balance. Other concerning symptoms are changes in vision, such as blurriness or double vision, ringing in the ears, hearing loss, or numbness or weakness in the arms or face. Fainting, neck stiffness, or headaches that worsen over time or with changes in posture are reasons to consult a healthcare provider promptly.
Diagnosis and Management
Diagnosing the cause of a cough headache involves a thorough medical history and a neurological examination. Medical professionals inquire about the pain’s characteristics, its duration, and any accompanying symptoms. To identify or rule out underlying structural causes, imaging tests are performed.
Magnetic resonance imaging (MRI) of the brain and spine is used to reveal issues like Chiari malformations, tumors, or aneurysms. A computerized tomography (CT) scan also creates cross-sectional views of the brain. A lumbar puncture (spinal tap) may be recommended to analyze cerebrospinal fluid for pressure abnormalities or leaks.
Management approaches differ based on whether the cough headache is primary or secondary. For primary cough headaches, reassurance is often sufficient. Over-the-counter pain relievers can help manage discomfort. Doctors may prescribe specific medications like indomethacin, propranolol, or acetazolamide if the headaches are severe or frequent.
For secondary cough headaches, treatment focuses on addressing the identified underlying condition, which may involve medication or surgical intervention.