Experiencing pain in the back of the head when coughing can be a concerning symptom. While often a benign and temporary phenomenon, this sensation can also signal a more serious underlying condition. This article explores why coughing might lead to head pain, covering both common explanations and when medical attention is warranted.
What is a Cough Headache
A cough headache, also known as primary cough headache, is head pain triggered by coughing or other activities that increase pressure in the head. These activities include sneezing, blowing the nose, laughing, crying, or straining during a bowel movement. The pain is typically a sudden, sharp, or stabbing sensation, often felt on both sides of the head, and can be particularly noticeable in the back of the head.
The immediate physiological mechanism involves a rapid increase in pressure within the skull. Coughing elevates intra-abdominal and intrathoracic pressure, which translates to increased pressure inside the brain. This sudden change briefly stretches pain-sensitive structures, causing the characteristic short-lived pain. Primary cough headaches are usually brief, lasting seconds to minutes, though some can persist for up to two hours. They are generally considered harmless and often resolve on their own, not usually indicating a serious underlying condition.
Underlying Conditions
While many cough headaches are benign, pain in the back of the head when coughing can signal a more serious underlying condition, known as a secondary cough headache. These headaches arise from structural issues within the brain or surrounding areas, unlike primary forms which are not caused by an identifiable problem.
One common underlying condition is Chiari malformation type I, a structural defect where the lower part of the brain extends into the spinal canal. This displacement can obstruct the normal flow of cerebrospinal fluid (CSF) at the base of the skull, leading to an exaggerated increase in intracranial pressure when coughing. Brain tumors can also cause secondary cough headaches by occupying space within the skull, increasing overall pressure, or by blocking CSF flow. The headache associated with a tumor may worsen with coughing or straining due to the additional pressure exerted.
Cerebral aneurysms, which are weak, bulging spots in a blood vessel in the brain, represent another potential cause. While less common, an aneurysm can make the brain more susceptible to pain from sudden pressure fluctuations. Other structural abnormalities, such as defects in the skull’s shape, fluid buildup in the brain (hydrocephalus), or spontaneous cerebrospinal fluid leaks, can also lead to secondary cough headaches. These conditions disrupt the normal pressure dynamics within the skull, making the brain and its surrounding structures more vulnerable to pain when subjected to the rapid pressure changes induced by coughing.
When to Consult a Doctor
While many instances of head pain with coughing are temporary, certain “red flag” symptoms warrant medical evaluation. Any new cough headache, especially if it occurs after age 50, should be assessed by a healthcare professional. Persistent pain, or pain that progressively worsens over time, also suggests a need for medical attention.
Additional symptoms accompanying a cough headache that indicate a potential underlying issue include neurological changes. These can encompass:
Vision changes, such as blurred or double vision
Weakness, numbness, or difficulty speaking
Problems with balance or unsteadiness
Dizziness or fainting spells
Systemic symptoms like fever or unexplained weight loss
A headache that differs significantly from any previous headaches experienced
If any of these accompany a cough headache, seeking medical advice is advisable.
Medical Evaluation and Management
When consulting a doctor for head pain with coughing, evaluation typically begins with a detailed medical history. The doctor will ask about the pain’s characteristics, duration, frequency, and any associated symptoms. A thorough neurological examination will also be performed to check for neurological deficits.
To determine if a serious underlying condition is present, imaging tests are often necessary. Magnetic Resonance Imaging (MRI) of the brain and neck is the preferred method, as it visualizes structural abnormalities like Chiari malformations, brain tumors, or other contributing issues. A Computed Tomography (CT) scan may also be used. In rare instances, a lumbar puncture (spinal tap) may be recommended to assess cerebrospinal fluid pressure or analyze the fluid.
Management depends on the diagnosis. If a primary cough headache is confirmed with no underlying cause, treatment might involve observation or pain relief medications. Anti-inflammatory drugs like indomethacin are often prescribed, and other medications that reduce intracranial pressure, such as acetazolamide, may be considered. If a secondary cough headache is diagnosed, the focus shifts to addressing the underlying condition. This could involve surgical intervention to correct structural problems like Chiari malformation or to remove a brain tumor. Effective management requires a professional diagnosis and personalized treatment.