Experiencing a headache when you cough can be unsettling. This specific type of head pain, known as a cough headache, arises suddenly with activities that increase pressure in the abdomen and chest, such as coughing, sneezing, laughing, or even straining during a bowel movement. While often harmless and brief, some cough headaches can indicate an underlying medical condition.
Understanding Cough Headaches
Cough headaches are defined by head pain that occurs exclusively or predominantly after actions that cause a sudden increase in intracranial pressure. These headaches are categorized into two main types based on their cause. Primary cough headaches are considered benign, meaning they do not result from an underlying structural issue or disease. In contrast, secondary cough headaches are caused by an identifiable underlying condition affecting the brain or structures near the brain and spine. Approximately half of all individuals who experience a cough headache have the secondary type.
Potential Underlying Causes
Secondary cough headaches are often linked to structural abnormalities within the brain or skull. A common cause is Chiari malformation type I, a condition where brain tissue at the lower back of the skull extends into the spinal canal, potentially disrupting cerebrospinal fluid flow. This displacement can lead to increased pressure during coughing or straining. Other structural issues that can cause secondary cough headaches include brain tumors, which exert pressure on surrounding brain tissue, and cerebral aneurysms, which are weak, bulging spots in a blood vessel in the brain that can press on nearby structures. Conditions involving abnormal cerebrospinal fluid pressure, such as a cerebrospinal fluid leak or a buildup of excess fluid (hydrocephalus), can also lead to secondary cough headaches.
When Medical Attention is Needed
Certain symptoms accompanying a cough headache warrant prompt medical evaluation. A new onset of cough headaches, especially if they are severe or progressively worsening, should be assessed by a healthcare provider. Any associated neurological symptoms are also a cause for concern. These include changes in vision, such as blurred or double vision, issues with balance or coordination, dizziness, unsteadiness, or fainting. Other symptoms include numbness or weakness in limbs, or ringing in the ears.
Diagnostic Approaches and Treatment Options
Diagnosing the cause of cough headaches typically involves a thorough medical history and a neurological examination. To rule out underlying structural issues, doctors often recommend brain imaging tests. Magnetic Resonance Imaging (MRI) is a common imaging technique that uses magnetic fields and radio waves to create detailed cross-sectional images of the brain and surrounding structures. A Computed Tomography (CT) scan, which uses X-rays to create cross-sectional images, may also be used. In some cases, a lumbar puncture, also known as a spinal tap, may be performed to analyze the cerebrospinal fluid and measure its pressure.
Treatment for cough headaches varies depending on the underlying cause. For primary cough headaches, which are generally harmless and short-lived, treatment may not always be necessary. If they are frequent or disruptive, preventive medications such as indomethacin, an anti-inflammatory drug, or acetazolamide, a diuretic that reduces spinal fluid, may be prescribed. Other medications like propranolol, methysergide, and naproxen can also be considered. When a secondary cough headache is diagnosed, treatment focuses on addressing the specific underlying condition; for instance, surgery may be performed to correct a Chiari malformation or remove a brain tumor or aneurysm.