Experiencing a headache every time you cough can be disconcerting. While often harmless, this type of head pain sometimes signals an underlying medical condition. Understanding their characteristics helps determine the cause and guide appropriate management.
Understanding Cough Headaches
A cough headache is a specific type of head pain suddenly triggered by coughing or other activities that increase pressure within the abdomen and head. These activities include sneezing, laughing, bending over, or straining during a bowel movement. The pain typically begins abruptly with the cough and subsides quickly.
Cough headaches are categorized into two main types: primary and secondary. Primary cough headaches are benign, meaning they are not caused by an underlying medical condition. Secondary cough headaches arise as a symptom of a pre-existing health issue, which can be serious. Differentiating between these types is an important step in determining the proper course of action.
Primary Cough Headaches
Primary cough headaches are characterized by their sudden onset immediately following a cough or other Valsalva maneuver, such as straining or sneezing. The pain is often described as sharp, stabbing, splitting, or bursting. This type of headache usually affects both sides of the head, though it can sometimes be unilateral, and may be more pronounced at the back of the head.
The duration of primary cough headaches is typically brief, lasting from a few seconds to a few minutes. Some individuals may experience a dull ache for up to two hours after the initial sharp pain. These headaches are not associated with symptoms like nausea, vomiting, or sensitivity to light and sound, which are common with other headache types like migraines. It is thought that the sudden increase in pressure within the chest and abdomen during coughing temporarily increases pressure inside the skull.
Secondary Cough Headaches
Secondary cough headaches are caused by an identifiable underlying medical condition affecting the brain or structures near the brain and spine. These conditions often alter intracranial pressure or brain structure, making the brain more sensitive to pressure changes induced by coughing. Such headaches can be more severe and may persist for longer durations, sometimes hours or even weeks, depending on the underlying cause.
Common underlying causes include Chiari malformation type I (where brain tissue extends into the spinal canal), brain tumors, cerebral aneurysms, spontaneous cerebrospinal fluid (CSF) leaks, hydrocephalus (an excess buildup of CSF), or structural defects in the skull.
These headaches are often accompanied by neurological symptoms, such as:
- Dizziness
- Unsteadiness
- Balance problems
- Blurred or double vision
- Facial numbness
- Fainting
When to Seek Medical Attention
Consult a healthcare provider if you experience sudden headaches after coughing, especially if they are new, frequent, or severe. Neurological signs such as changes in vision, dizziness, unsteadiness, numbness in the arms, or speech difficulties warrant immediate medical evaluation.
Seek prompt medical advice if the headache pattern changes, or if cough headaches begin in individuals over 50. Any cough headache that lasts longer than the typical brief duration or occurs with symptoms like nausea, vomiting, or confusion should also be brought to a doctor’s attention.
Diagnosis and Management
Diagnosing a cough headache typically begins with a thorough medical history and a neurological examination. The doctor will ask about the headache’s characteristics, including its duration, intensity, and any associated symptoms. Neuroimaging tests are often performed to determine if an underlying condition is present.
Magnetic Resonance Imaging (MRI) of the brain and cervical spine is a common diagnostic tool. It visualizes brain structures and rules out abnormalities such as Chiari malformations, tumors, or other structural issues. Treatment for cough headaches depends on the identified cause. For primary cough headaches, management often involves medications like indomethacin, propranolol, or acetazolamide. If a secondary cause is found, treatment focuses on addressing the underlying condition, which may involve surgical intervention for issues like Chiari malformations or brain tumors.