What is cough headache?

A cough headache is a type of headache that originates from severe coughing fits or other physiological situations that cause strain, such as sneezing, intense laughter, blowing your nose, bending over, or having a bowel movement.

These headaches are categorized into two types:

• Primary: These are temporary, have no consequences, and generally do not require treatment.
• Secondary: These are more serious and can be a symptom of underlying brain abnormalities.

The causes of primary cough headaches are not associated with any serious structural or neurological disease. While they are a rare condition, they are also benign. Predisposing factors such as age, a history of migraines or tension headaches, transient intracranial hypertension induced by coughing, or a greater sensitivity of the nervous system may increase the risk of developing them.

On the other hand, secondary causes are a more worrisome situation, as they are due to an underlying structural or medical condition. The most common cause is a Chiari malformation type I, but it can also be due to brain tumors, hydrocephalus, cerebrospinal fluid obstruction, aneurysms, vascular malformations, or idiopathic intracranial hypertension.

A primary cough headache is usually intense but brief. It occurs suddenly and typically at the exact moment of coughing, sneezing, or laughing. It also disappears quickly without leaving any residual symptoms. There are no neurological effects or warning signs, and the patient is considered healthy outside of these episodes.

The characteristics of a primary cough headache include a sudden onset with exertion, a sharp or stabbing pain, a short duration, and it’s generally located at the back of the head or on both sides. This pain can recur with each coughing episode but does not progressively worsen.

Conversely, when the headache is secondary, it is often a sign of a more serious condition. The warning signs include persistent pain that worsens over time, a longer duration, and can cause dizziness, vertigo, or a sense of instability when walking or moving, double or blurred vision, and ringing in the ears. The person may also experience weakness, numbness, or a strange sensation in their face, arms, or legs. The pain may worsen when lying down or wake the patient up from sleep.

If you experience one or more of these symptoms, it’s essential to see a doctor to get a diagnosis.

Diagnosing a cough headache begins with a detailed clinical evaluation. The doctor will investigate the context of the pain, such as when it occurs, its duration and intensity, whether it is exclusively associated with coughing or other physical efforts, and if there are any other accompanying neurological symptoms.

In a diagnosis, it is crucial to distinguish between a benign primary headache and a potentially serious secondary headache. The doctor will also inquire about personal history and perform a complete neurological examination to detect any possible warning signs.

Furthermore, although it is usually performed in all cases, it is especially important if this cough is new or if there are other suspicious signs. The doctor will recommend brain imaging studies, such as a contrast-enhanced MRI, which will rule out any structural causes.

A CT scan or cerebrospinal fluid studies may also be ordered.

Only after ruling out a secondary cause with these studies can a diagnosis of primary cough headache be confirmed.

How to Get Rid of a Cough Headache

The treatment for a cough headache will depend on the cause, whether it is primary or secondary. For cases of primary headaches, the pain is usually self-limiting, but if the episodes are frequent or intense, preventive medications may be prescribed to reduce the inflammation causing it.

In some patients, simply avoiding triggers like intense exertion or controlling the cough with medication can help reduce the number of episodes.

For secondary cases, treatment is focused directly on correcting the underlying problem.

In cases of Chiari malformation type I, a decompressive surgery may be required to relieve the pressure at the base of the skull. For tumors, hydrocephalus, or other lesions, specific treatments will also be required.

In secondary cases, headache control generally improves once the underlying neurological cause is resolved.

At the Neurological Center at ABC Medical Center, we can provide you with specialized care. Contact us!