A sudden, sharp, or throbbing head pain can accompany a cough. While often alarming, this specific type of headache can be a temporary discomfort or a sign of an underlying health issue. Understanding these headaches helps determine when medical attention is necessary.
What Causes Headaches When You Cough
Headaches triggered by coughing fall into two main types: primary and secondary. Primary cough headaches are generally harmless and not linked to an underlying medical condition. They result from the rapid increase in head pressure during a cough, similar to straining activities like sneezing or bending over. These headaches typically cause a sharp, splitting, or bursting pain affecting both sides of the head, often worse at the back. They usually last seconds to minutes, though a dull ache may persist for up to two hours.
Secondary cough headaches, however, indicate an underlying medical condition. These headaches are caused by structural problems in the brain or surrounding areas. One of the most frequent causes is a Chiari malformation, a condition where brain tissue extends into the spinal canal, putting pressure on the brainstem. Brain aneurysms, weakened spots in brain blood vessels, can also lead to secondary cough headaches.
Abnormal growths like brain tumors can cause these headaches by increasing pressure within the skull or pressing on sensitive nerves and blood vessels. Tumor-related headaches are often worse in the morning and aggravated by coughing or straining. Cerebrospinal fluid (CSF) leaks are another cause, occurring when the fluid cushioning the brain and spinal cord escapes. This reduced CSF pressure can cause the brain to sag, stretching pain-sensitive structures.
Other factors include sinus issues, allergies, or dehydration. Sinus inflammation can increase head pressure, making coughing more painful. The general discomfort and pressure changes associated with allergies or dehydration can also exacerbate head pain during a cough.
Recognizing Serious Symptoms
Recognizing “red flag” symptoms is important, as they indicate a secondary cough headache requiring immediate medical evaluation. Headaches that are new, unusually severe, or progressively worsening warrant prompt attention. Any cough headache accompanied by neurological symptoms signals a need for urgent care.
Neurological signs include changes in vision (blurriness, double vision, loss of sight), dizziness, unsteadiness, or balance problems. Difficulty speaking, numbness, limb weakness, or coordination problems are also concerning.
Other red flags include:
Headaches occurring without coughing
Headaches that wake an individual from sleep
Headaches accompanied by fever
Neck stiffness
Unexplained weight loss
Individuals over 50 experiencing a cough headache for the first time should seek medical advice, as this demographic has a higher risk for serious underlying causes.
How Doctors Diagnose and Treat
The diagnostic process for cough headaches begins with a thorough medical history and a comprehensive neurological examination. Doctors inquire about headache characteristics, including its duration, intensity, and location, and whether other symptoms are present. This initial assessment helps distinguish between primary and secondary types.
To rule out underlying conditions, imaging tests are commonly performed. Magnetic Resonance Imaging (MRI) of the brain and sometimes the spine is used to visualize the brain and spinal cord, identifying structural abnormalities like Chiari malformations, tumors, or aneurysms. Computed Tomography (CT) scans also provide cross-sectional images of the brain and skull. In specific cases, a lumbar puncture (spinal tap) might measure cerebrospinal fluid pressure or detect a CSF leak.
Treatment approaches vary significantly by diagnosis. For primary cough headaches, conservative management is often recommended, focusing on avoiding triggers like strenuous coughing. Medications such as indomethacin, an anti-inflammatory drug, are often effective in preventing or reducing pain. Other medications, including beta-blockers or acetazolamide, may also be prescribed to manage symptoms.
When a secondary cough headache is diagnosed, treatment primarily targets the underlying cause. Surgical intervention may be necessary for conditions like Chiari malformations or brain tumors to relieve pressure on brain structures. If a CSF leak is identified, procedures to repair it may be performed. Managing the root cause often leads to an improvement or resolution of the cough headaches.