Know Your Pain

What are Cough Headaches? An Overview

Coughing hard can sometimes lead to a headache. Although cough headache is a rare type of headache, about one in a hundred people experience this kind of a headache sometime in life.

Headaches occurring as a result of coughing, sneezing, blowing your nose, straining yourself during excretion or simply bending down are termed as cough headaches. While some of these could occur due to serious intracranial diseases, most of them are not malignant. There are two types of cough headaches - primary and secondary.

Primary cough headaches:
These are benign headaches triggered by strain like coughing and sneezing or Valsalva maneuvers, and are not associated with intracranial disorders. The cause of primary cough headaches is not known, although increased intracranial pressure is generally thought to be the primary reason.

Characteristics of primary cough headaches:
* Sudden onset
* Sharp, piercing pain for duration between one second to 30 minutes
* Dull pain thereafter, possibly lasting for hours
* Usually on both sides of the skull, sometimes at the back
* Not associated with nausea, vomiting, increased light or sound sensitivity, conjunctival injection, rhinorrhea, or lacrimation.

Primary cough headaches occur at an average age of 55 years. They usually alleviate on their own, but preventive treatment can be sought.

Preventive treatment of primary cough headaches:

* Indomethacin (anti-inflammatory)
* Acetazolamide (diuretic to decrease fluid pressure)
* Topiramate (anti-seizure)
* Spinal tap procedure (lumbar puncture through which cerebrospinal fluid is removed in a small quantity to help reduce intracranial pressure)

Spinal tap is rarely needed and doctors will most probably put you on simple daily medications that help reduce pressure in the skull.

Secondary cough headaches:

These are serious, caused by intracranial disorders like:

* Irregular shape of the skull
* Brain protruding through the base of the skull
* Chiari type 1 malformations
* Carotid or vertebrobasilar disease
* cerebral aneurysms

Characteristics of secondary cough headaches:

* Pain precipitated by head or postural changes
* Both sides of the brain
* Can occur at any age.


Diagnostic neuro-imaging can differentiate secondary cough headaches from primary ones. An MRI of the brain can determine whether malformations in the skull are behind the headache. Careful evaluation to find out the underlying cause is crucial for these uncommon types of headache.

Treatment of secondary cough headaches:

Preventive treatments are of no use in secondary cough headaches. The only option usually available to doctors is surgery.