Pain on top of the head when coughing is a cough headache, often triggered by activities that increase pressure within the abdomen and chest, such as sneezing, laughing, or straining. While concerning, this pain is frequently benign, indicating no serious underlying condition. These headaches typically begin suddenly after a cough, lasting from a few seconds to a few minutes, though some can persist for up to two hours.
Common Explanations
A common explanation is a primary cough headache. This type of headache is directly caused by coughing or straining, and not linked to any underlying brain or health disorders. The precise mechanism is not fully understood, but it involves a sudden increase in pressure inside the chest and abdomen, elevating pressure within the head. This can result in a sharp, splitting, or bursting pain, often felt on both sides of the head.
Tension headaches, often described as a dull ache or pressure around the head, can also be exacerbated by coughing. Sudden physical exertion from a cough can increase muscle tension in the head, neck, and shoulders, intensifying an existing tension headache. Sinus pressure is another common culprit. Inflamed or congested sinuses, such as from a cold, allergies, or a sinus infection, can build pressure and cause pain in the forehead, cheeks, or behind the eyes. Coughing can further increase this pressure, leading to a sharp pain on top of the head.
Dehydration can also contribute to headaches that worsen with coughing. When dehydrated, brain tissue can temporarily shrink, pulling away from the skull and causing pain that might be more pronounced with sudden movements or pressure changes from coughing. Additionally, muscle strain in the neck and head from prolonged or forceful coughing can lead to localized pain. The repeated stress on these muscles can cause stiffness, aching, or even spasms, making coughing uncomfortable.
Underlying Serious Conditions
While less common, pain on top of the head when coughing can signal a more serious underlying condition, often referred to as secondary cough headaches. One such condition is Chiari malformation type I, a structural defect where brain tissue extends into the spinal canal. Coughing can cause an exaggerated increase in pressure within the skull and spine, leading to headache due to the obstruction of cerebrospinal fluid flow.
Brain tumors can also present with headaches that worsen with coughing or straining. This occurs because a growing tumor can increase pressure inside the skull or press on sensitive nerves or blood vessels. Such headaches might be dull and pressure-like, often worse in the morning. Cerebral aneurysms, weak, bulging spots in a brain blood vessel, can also cause cough headaches, though this is rare. The sudden increase in intracranial pressure during a cough could potentially stress a weakened vessel.
Spontaneous intracranial hypotension (SIH) is another condition where a cerebrospinal fluid (CSF) leak causes lower fluid pressure inside the skull. While typically causing headaches that improve when lying down, coughing or straining can temporarily exacerbate the pain by further altering CSF pressure dynamics. Secondary cough headaches may present with other symptoms such as dizziness, unsteadiness, or vision changes, which are not typically seen with benign cough headaches.
When to Seek Medical Attention
Seek medical attention if pain on top of the head when coughing is new, frequent, or severe. Any sudden onset of intense pain, especially if it’s a first-time headache, warrants medical evaluation. This is especially true if accompanied by other concerning symptoms.
Seek prompt medical attention if you experience any of these red flag symptoms:
- Vision changes, such as blurred or double vision.
- Weakness, numbness, or difficulty speaking.
- A fever coupled with a stiff neck.
- Pain that does not go away, worsens over time, or is accompanied by fainting or unsteadiness.
- A cough that is persistent for several weeks, or if you are coughing up blood.
Strategies for Relief
For benign cases of cough headaches, several strategies can offer relief. Staying well-hydrated is effective, as dehydration can contribute to headaches. Resting in a quiet, comfortable environment can also help reduce the intensity of the pain.
Over-the-counter pain relievers like acetaminophen (Tylenol) or NSAIDs such as ibuprofen (Advil, Motrin) or naproxen (Aleve) can alleviate headache pain. These medications block pain signals or reduce inflammation. Always follow the dosing instructions on the packaging.
Avoiding known triggers, if identifiable, can be beneficial. For instance, if certain strenuous activities or coughs consistently lead to pain, modifying these actions might help. Practicing gentle breathing techniques can promote relaxation and reduce headache severity. Deep, slow breathing, such as inhaling for four seconds and exhaling for six, can calm the nervous system and reduce tension. Applying a warm compress to the head or neck can also provide comfort by relaxing tense muscles.