Experiencing a sudden, sharp pain at the back of the head when coughing, sneezing, or straining can be a startling sensation. This type of headache typically appears abruptly and often subsides within seconds or a few minutes. While frequently benign and fleeting, it can sometimes signal an underlying health concern that warrants attention.
Understanding Cough Headaches
Headaches triggered by coughing, known as cough headaches, are generally categorized into two main types. Primary cough headaches are typically considered benign, meaning they are not caused by an underlying structural problem in the brain or skull. These headaches are often short-lived, lasting from a few seconds to a few minutes, and can be felt on both sides of the head.
In contrast, secondary cough headaches arise from an identifiable structural abnormality within the brain or surrounding structures. These types of headaches are a greater concern because they indicate an underlying medical condition that requires investigation.
Common Causes of This Pain
Primary cough headaches have no identified structural cause and are generally harmless. The pain associated with these headaches is thought to be related to the sudden increase in pressure within the skull that occurs during a forceful cough or strain. This temporary pressure fluctuation can momentarily stretch pain-sensitive structures inside the head, resulting in the characteristic sharp pain.
Secondary cough headaches, however, stem from specific underlying conditions. The most recognized cause is Chiari Malformation Type I, a structural defect where the lower part of the cerebellum, known as the cerebellar tonsils, extends downward into the spinal canal. This abnormal positioning can obstruct the normal flow of cerebrospinal fluid (CSF), which cushions the brain and spinal cord. When a person coughs, the sudden pressure change within the skull can further compress these structures or exacerbate the CSF flow disruption, leading to pain.
Other less common but serious causes of secondary cough headaches include brain tumors, which can occupy space and increase intracranial pressure, or an aneurysm, a weakened and bulging blood vessel in the brain that might be sensitive to pressure changes. Structural abnormalities of the skull or spine can also contribute to these headaches by altering the normal anatomy and fluid dynamics within the head. Cerebrospinal fluid (CSF) leaks, where CSF escapes from its normal confines, can also cause headaches that are sometimes exacerbated by coughing due to changes in fluid pressure.
When to Seek Medical Advice
It is important to consult a healthcare professional if you experience new onset cough headaches, particularly if you are over 50. Seek medical evaluation for headaches that persist or worsen, or are not exclusively triggered by coughing or straining. Any accompanying neurological symptoms like dizziness, balance problems, vision changes, numbness, limb weakness, or difficulty swallowing require immediate medical attention.
Severe, prolonged, or unusual pain also warrants a doctor’s visit. These “red flag” symptoms suggest a possible underlying secondary cause requiring proper diagnosis and early intervention.
How Doctors Diagnose and Treat
Doctors diagnose cough headaches by taking a thorough patient history, including pain nature, triggers, and associated symptoms. A neurological examination assesses reflexes, balance, coordination, and sensory function. MRI of the brain and cervical spine is the preferred imaging method, effectively identifying structural issues like Chiari Malformation, tumors, or aneurysms.
Treatment varies based on the type. Primary cough headaches are managed with symptomatic relief, often using over-the-counter pain relievers or prescribed medications for severe cases. Secondary cough headaches require addressing the underlying cause. This may involve surgical intervention for Chiari Malformation to relieve pressure and restore CSF flow, tumor removal, or procedures to repair CSF leaks and restore fluid dynamics.