Cough headaches

Date Updated: 05/05/2020

Overview

Cough headaches are an unusual type of headache triggered by coughing and other types of straining — such as from sneezing, blowing your nose, laughing, crying, singing, bending over or having a bowel movement.

Doctors divide cough headaches into two categories. Primary cough headaches are usually harmless, occur in limited episodes and eventually improve on their own. Secondary cough headaches, also called symptomatic cough headaches, are more serious, as they can be caused by problems within the brain. Treatment of secondary cough headaches may require surgery.

Symptoms

Primary cough headaches

Begin suddenly with and just after coughing or other types of straining
Typically last a few seconds to a few minutes — some can last up to two hours
Cause sharp, stabbing or splitting pain
Are usually felt in the front of the head
Affect both sides of your head
May be followed by a dull, aching pain that lasts for hours

Secondary cough headaches

Secondary cough headaches often have symptoms similar to those of primary cough headaches, though you may experience:

Longer lasting headaches
Dizziness
Unsteadiness
Fainting
Numbness in the face or arms

When to see a doctor

Consult your doctor if you experience sudden headaches after coughing — especially if the headaches are frequent or severe or you have any other troubling signs or symptoms, such as imbalance or blurred or double vision.

Causes

Primary cough headaches

The cause of primary cough headaches is unknown.

Symptoms

Secondary cough headaches

Secondary cough headaches may be caused by:

A defect in the shape of the skull.
A defect in the cerebellum, the part of the brain that controls balance. This can occur when a portion of the brain is forced through the opening at the base of the skull (foramen magnum), where only the spinal cord is supposed to be.

Some of these types of defects are called Chiari malformations.
A weakness in one of the blood vessels in the brain (cerebral aneurysm).
A brain tumor.
A spontaneous cerebrospinal fluid leak.

Risk factors

Primary cough headaches

Risk factors for primary cough headaches include:

Age. Primary cough headaches most often affect people older than age 40.
Sex. Men are more prone to getting primary cough headaches.

Secondary cough headaches

Risk factors for secondary cough headaches include:

Being younger than age 40

Prevention

Preventing the actions that trigger your cough headaches — whether that's coughing, sneezing or straining on the toilet — may help reduce the number of headaches you experience. Some preventive measures may include:

Treating lung infections, such as bronchitis
Avoiding medications that cause coughing as a side effect
Getting an annual flu shot
Using stool softeners to avoid constipation
Minimizing heavy lifting or bending for long periods

Diagnosis

Your doctor may recommend brain-imaging tests, such as MRI or CT scans, to rule out other possible causes for your headaches.

Magnetic resonance imaging (MRI). During an MRI, a magnetic field and radio waves are used to create cross-sectional images of the structures within your head to determine whether any problems are causing your cough headache.
Computerized tomography (CT) scan. These scans use a computer to create cross-sectional images of your brain and head by combining images from an X-ray unit that rotates around your body.

Treatment

Treatment differs, depending on whether you have primary or secondary cough headaches.

Primary cough headache

If you have a history of primary cough headaches, your doctor may recommend that you take daily medication to help prevent or reduce the pain.

These preventive medications may include:

Indomethacin (Indocin, Tivorbex), an anti-inflammatory drug
Propranolol (Inderal, Innopran XL, others), a medication that relaxes blood vessels and reduces blood pressure
Acetazolamide, a diuretic that reduces the amount of spinal fluid, which can reduce the pressure inside the skull

Other medications used to treat primary cough headache include naproxen (Naprelan, Naprosyn, others), ergonovine (Methergine), intravenous dihydroergotamine (D.H.E. 45) and phenelzine (Nardil).

Rarely, a spinal tap (lumbar puncture) may be recommended. With this procedure, the doctor removes some of the fluid that surrounds your brain and spinal cord. It's not clearly understood why this helps cough headaches, but the procedure may reduce the pressure inside your skull that may be causing the headaches.

Secondary cough headache

If you have secondary cough headaches, surgery is often needed to fix the underlying problem. Preventive medications usually don't help people who have secondary cough headaches. However, responding to medication doesn't necessarily mean that you have a primary cough headache.

Preparing for an appointment

You're likely to start by seeing your family doctor. However, in some cases when you call to set up an appointment, you may be referred immediately to a neurologist.

Because appointments can be brief, and because there's often a lot of information to discuss, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment and know what to expect from your doctor.

What you can do

Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
Write down key personal information, including past illnesses and operations, major stresses or recent life changes, and any medical problems that run in your family.
Make a list of all medications, vitamins and supplements that you're taking.
Take a family member or friend along, if possible. Sometimes it can be difficult to remember all of the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. For cough headaches, some basic questions to ask your doctor include:

What's the most likely cause of my headaches?
Are there any other possible causes?
What kinds of tests do I need?
When will these headaches go away?
What treatments are available?
Are there any alternatives to the primary approach that you're suggesting?
I have other health conditions. How can I best manage these conditions together?
Should I see a specialist?
Is there a generic alternative to the medicine you're prescribing me?
Are there any brochures or other printed material that I can take home with me? What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

When did you first begin experiencing cough headaches?
Have your cough headaches been continuous or occasional?
Have you had a similar problem in the past?
Have you had other kinds of headache? If so, what were they like?
Has anyone in your immediate family experienced migraines or cough headaches?
What, if anything, seems to improve your headaches?
What, if anything, makes your headaches worse?