Pain on the left side of your head when coughing, often called a “cough headache,” is a recognized phenomenon. Understanding these headaches and their origins can help guide appropriate action.
The Nature of Cough Headaches
Cough headaches are a distinct type of head pain triggered by actions that increase pressure within the abdomen and chest, such as coughing, sneezing, straining, laughing, singing, or bending over. This pain typically comes on suddenly and can be described as sharp, stabbing, splitting, or bursting. Most commonly, these headaches are short-lived, lasting from a few seconds to a few minutes, though some can persist for up to two hours.
These headaches do not typically involve symptoms like nausea, watery eyes, or sensitivity to light or sound, which are common with other headache types. When a cough headache occurs without an underlying structural problem in the brain, it is classified as a “primary cough headache.” These primary headaches are generally considered harmless and often resolve on their own without specific medical intervention.
Underlying Reasons for Pain When Coughing
While primary cough headaches are usually benign, pain triggered by coughing, especially if localized to one side, can indicate a “secondary cough headache.” These secondary headaches require evaluation.
One common underlying cause is a Chiari malformation type I, a condition where brain tissue extends into the spinal canal due to a skull abnormality. When you cough, the sudden increase in pressure within the spinal fluid can be exaggerated in individuals with Chiari malformation, leading to head pain. This pressure increase is thought to stretch the dura, the covering of the brain and spinal cord, which contains pain-sensitive nerve endings.
Brain tumors can also cause headaches that worsen with coughing or straining. A growing tumor can increase pressure inside the skull, or it can block the normal flow of cerebrospinal fluid, both of which lead to increased intracranial pressure. The brain itself lacks pain receptors, but the stretching of the dura or pressure on pain-sensitive blood vessels and nerves can cause discomfort, which may be localized to one side depending on the tumor’s location. Similarly, a cerebral aneurysm, a weakened and bulging blood vessel in the brain, can cause pain exacerbated by pressure changes, and its specific location could lead to unilateral symptoms.
Beyond structural issues, other factors can contribute to head pain when coughing. Severe sinus pressure or infection can cause localized pain that intensifies with coughing due to increased pressure within the sinus cavities.
Dehydration can also make headaches more sensitive to pressure changes. When dehydrated, the brain can slightly shrink, pulling away from the skull and putting pressure on surrounding nerves, which can be exacerbated by coughing. Muscle strain in the neck or head from prolonged or forceful coughing can also lead to localized pain aggravated by subsequent coughing episodes. While primary cough headaches often affect both sides, some conditions, like a unilateral aneurysm or localized sinus issue, might present with more intense pain on a specific side, such as the left.
When to Consult a Healthcare Professional
Consult a healthcare professional if you experience new onset cough headaches, especially if you are over 50 years old. Persistent or worsening headaches, or pain that does not resolve quickly after coughing, also require medical attention.
Seek prompt evaluation if your cough headache is accompanied by other neurological symptoms, including:
- Changes in vision (such as blurred or double vision)
- Weakness, numbness, or difficulty speaking
- Problems with balance, dizziness, or fainting
- Fever or a stiff neck
- Unexplained weight loss
- Headaches that wake you from sleep
These symptoms can indicate a secondary cause requiring medical diagnosis.
Medical Evaluation and Treatment Options
A healthcare provider will typically begin with a thorough medical history and physical examination, including a neurological assessment. This helps them understand your headache characteristics and identify any associated symptoms. Imaging studies are often recommended to determine the underlying cause.
A magnetic resonance imaging (MRI) scan of the brain, sometimes with contrast, is commonly used to visualize brain structures and rule out conditions like Chiari malformations, brain tumors, or aneurysms. In some cases, a computed tomography (CT) scan might also be used.
If a primary cough headache is diagnosed, meaning no underlying structural cause is found, treatment might involve observation, as these headaches often resolve on their own. For frequent or bothersome primary cough headaches, medications such as indomethacin, a type of anti-inflammatory drug, or other preventive medications like propranolol or acetazolamide, may be prescribed.
For secondary cough headaches, treatment depends on the identified underlying condition. For example, a Chiari malformation might require surgery to relieve pressure. Brain tumors are treated based on their type, which could involve surgery, radiation, or chemotherapy. If a sinus infection is the cause, antibiotics or other sinus treatments are administered. Addressing dehydration involves increasing fluid intake. The goal of medical management for secondary cough headaches is to resolve the root problem.