Pain on the side of the head when coughing is often described as a sudden, sharp, or bursting discomfort. This pain is typically triggered by activities that increase pressure within the head, such as coughing, sneezing, laughing, bending over, or straining during a bowel movement. While unsettling, this symptom is common, and its causes range from benign to those requiring medical attention.
What Are Cough Headaches?
Cough headaches are a specific category of head pain directly provoked by coughing or similar straining actions. They are classified into two main types: primary and secondary. Primary cough headaches are benign, meaning they are not caused by an underlying structural problem in the brain or skull. They typically manifest as sudden, sharp, or splitting pain that lasts from a few seconds to a few minutes, though some can persist for up to two hours. Secondary cough headaches are triggered by coughing but result from an identifiable underlying structural issue affecting the brain or its surrounding structures. These can be more serious and may necessitate surgical intervention. Secondary cough headaches may also present with longer-lasting pain or additional symptoms such as dizziness or unsteadiness.
Underlying Causes of Pain
Cough headaches relate to pressure changes within the skull. For primary cough headaches, the exact cause is not fully understood, but a sudden increase in pressure inside the brain during coughing is believed to be the direct trigger.
Secondary cough headaches stem from specific underlying conditions that become symptomatic with pressure changes. The most common cause is Chiari malformation type I, a structural defect where brain tissue extends into the spinal canal, leading to crowding at the base of the skull. Other causes include brain tumors, which can increase pressure or block cerebrospinal fluid flow, and cerebral aneurysms, which are weakened, bulging blood vessels in the brain. Abnormalities in cerebrospinal fluid pressure, such as a spontaneous cerebrospinal fluid leak or hydrocephalus (excess fluid buildup), can also lead to cough headaches. These conditions can alter the normal dynamics of fluid within the skull, making the brain more sensitive to pressure fluctuations caused by coughing.
When to Consult a Doctor
While many instances of head pain with coughing are harmless, certain signs indicate the need for medical evaluation. Consult a doctor if the headaches are new, frequent, or severe, or if they persist beyond a few minutes. A medical consultation is particularly important if the cough headaches begin after age 50. Additional concerning symptoms, often referred to as “red flags,” include dizziness, unsteadiness, blurred or double vision, or fainting. Persistent pain not solely associated with coughing, numbness in the arms, or a headache that progressively worsens are also reasons to seek prompt medical attention. These accompanying symptoms may suggest a more serious underlying condition, such as those that cause secondary cough headaches, necessitating a thorough diagnostic workup.
Managing Discomfort
Management strategies for cough headaches depend on the underlying cause. For primary cough headaches, which are generally benign, over-the-counter pain relievers such as ibuprofen or acetaminophen can help alleviate discomfort. If these headaches are frequent or disruptive, a doctor might prescribe preventive medications. These include indomethacin, an anti-inflammatory drug, or other medications like propranolol or acetazolamide, which can help reduce pressure or relax blood vessels.
In cases of secondary cough headaches, addressing the underlying condition is the primary focus. Surgical intervention is often necessary to correct structural issues like Chiari malformation, aiming to create more space for brain tissue and alleviate pressure. Brain tumors or aneurysms also require specific treatments, which may involve surgery, radiation, or chemotherapy. Avoiding known triggers, such as strenuous activities, and maintaining good hydration can also contribute to managing symptoms.