Overview of Cough Headaches

Ever notice that if you cough a little too hard, your head hurts for a bit? That’s a cough headache. It can also happen when you laugh, sing, sneeze, poop, bend over, blow your nose, or otherwise strain yourself. It’s often harmless and goes away quite quickly on its own, but it’s a good idea to tell your doctor because there could be a more serious cause.

Causes of Cough Headache

There are two types of cough headache. Each has a different cause:

Primary cough headache: Doctors know that the strain from a cough, sneeze, or laugh causes the headache. But they aren’t sure why it hurts.

Secondary cough headache: There’s an illness or condition to blame. The most common one is a defect called Chiari type 1 in which the shape of your skull forces the lower, rear part of your brain (it’s called the cerebellum) down and into your spinal canal. Other causes include:

  • Other defects in the shape of the skull
  • A weak blood vessel that balloons out to push on tissue around the brain (cerebral aneurysm)
  • A leak or blockage of cerebrospinal fluid that builds pressure around the brain
  • A brain tumor

Secondary cough headaches make up nearly half of these types of headaches. That’s why it’s important to talk to your doctor about your symptoms.

Cough Headache Symptoms

A primary cough headache:

  • Typically lasts a few seconds or minutes (rarely up to 2 hours)
  • Causes sharp, stabbing pain
  • Usually causes pain on both sides of your head.
  • Starts suddenly, just after you cough, sneeze, or otherwise strain
  • Doesn’t cause nausea, watery eyes, runny nose, or sensitivity to light and sound, the way some headaches do

This type of headache is more common after 40 and affects men more than women.

A secondary cough headache:

  • Will have symptoms that vary, depending on the cause
  • Typically has more -- and more serious -- symptoms
  • May last for hours or weeks instead of just seconds
  • Will hurt at the lower, back part of the skull if cause by a Chiari formation
  • May cause dizziness, facial numbness, blurry vision, balance problems, and fainting if it comes from a Chiari formation

Secondary cough headaches are more common before you turn 40.

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Diagnosis

The doctor will ask about your symptoms. They’ll want to know what your headaches feel like and how long they last. A stabbing pain on both sides of your head that goes away in a few seconds could mean a primary headache. A dull ache on one side of the head that lasts for several days might suggest a secondary type.

They may also take special pictures of your brain and skull with a computerized tomography (CT) scan or magnetic resonance imaging (MRI) machine. These can show problems in the shape of your skull, brain, or other parts of your head that could cause head pain when you cough. Only after your doctor rules out secondary causes can you be sure that your cough headaches are the more harmless primary type.

Treatment

Primary cough headache: Once they’ve ruled out secondary causes, your doctor may prescribe medication to ease inflammation linked to primary cough headache pain. The drug of choice is indomethacin. Doctors don’t know exactly why it works, but it may relieve pressure around your brain and skull.

Your doctor might prescribe medications made to treat other illness off-label for a primary cough headache. These include acetazolamide, propranolol, methysergide, naproxen, ergonovine, and others.

In rare cases, your doctor might do a procedure called a spinal tap to remove some spinal fluid and ease the pressure that could be causing your headache.

Secondary cough headache: Treatment depends in large part on the cause:

  • Chiari formation: Medication like indomethacin can ease your pain. Your doctor might suggest surgery to change the shape and relieve pressure.
  • Cerebral aneurysm: You might have a procedure to seal off the aneurysm, or a flow diverter to deprive it of blood.
  • Brain tumors: Treatment is usually surgery, radiation, and chemotherapy.

That’s why it’s so important for your doctor to figure out the cause of your cough headache before starting treatment.

WebMD Medical Reference Reviewed by Jennifer Robinson, MD on August 16, 2019

Sources

SOURCES:

Mayo Clinic: “Chiari malformation,” “Cough headaches.”

UpToDate: “Primary cough headache.”

MedLink Neurology: “Primary cough headache.”

The Journal of Headache and Pain: “Headache associated with cough: a review.”

UCSF Health: “Brain Tumor Treatment.”

Migraine Trust: “Diagnosis.”

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