Cough Headache: Why Does Coughing Cause Headache?

Cough headaches, as the name itself suggests, are a type of headache which are triggered or brought on by coughing and other types of straining, such as blowing the nose, sneezing, laughing, singing, crying, having a bowel movement or bending over. Cough headaches are divided into two categories: Primary Cough Headaches and Secondary Cough Headaches. Primary cough headaches are often harmless and occur in limited episodes and treatment is usually not required for them, as they gradually improve on their own. Whereas, secondary cough headaches are more severe, as they occur as a result of some problems in the brain. Surgery may be needed for treatment of secondary cough headaches.

Cause of Primary Cough Headaches: The exact cause of Primary Cough Headache is not known.

Cause of Secondary Cough Headaches: There are many causes of secondary cough headaches including:

• A defect or problem in the shape of the skull.
• A defect or a problem in the cerebellum, which is the part of the brain responsible for controlling balance. This defect occurs when a part of the brain is pushed through the foramen magnum, which is an opening at the bottom of the skull and it is the region where the spinal cord is normally located. These types of defects are also known as Chiari malformations.
• A brain tumor can also cause secondary cough headaches.
• Cerebral aneurysm, which is a type of weakness in one of the brain blood vessels, can also cause secondary cough headaches.
• A spontaneous leak of the cerebrospinal fluid can also cause secondary cough headaches.

• Risk Factors for Primary Cough Headaches: Individuals who are older than 40 are more prone to primary cough headaches. Men are at an increased risk than women for having primary cough headaches.
• Risk Factors for Secondary Cough Headaches: Individuals who are below the age of 40 are at a higher risk for developing secondary cough headaches.

• These headaches begin abruptly and are brought on by coughing or just after coughing or other types of straining.
• The headache symptom experienced on coughing is stabbing, sharp or splitting in nature.
• The primary cough headache usually lasts for a few seconds to a few minutes. However, sometimes they can persist for two hours also.
• Primary cough headaches occur typically on both the sides of the head and tend to be worse on the posterior side of the head.
• Primary cough headaches can be followed by an achy, dull pain for some hours.

The symptoms of secondary cough headaches are similar to primary cough headaches, though they are more severe and include other symptoms such as:

• Secondary cough headaches are longer in duration than primary cough headaches.
• Patient also has dizziness with a secondary cough headache.
• Patient can also experience unsteadiness with a secondary cough headache.
• There may be loss of consciousness also.
• Serious symptoms, which require immediate medical attention include: sudden, severe, persistent headaches after coughing, frequent headaches after coughing accompanied by symptoms such as imbalance, double or blurred vision.

Different types of investigations are done to diagnose cough headache and to exclude other possible causes for the headache.

• Computerized tomography or CT scan uses a computer, which generates cross-sectional images of the head and brain by combining x-ray images to help diagnose a cough headache.
• Magnetic resonance imaging (MRI) is a test, which uses radio waves and magnetic fields to generate cross-sectional images of the structures present within the head to detect the cause of the cough headache.

Treatment of a cough headache depends on whether the patient has primary cough headache or secondary cough headache.

If the patient has a history of primary cough headaches, then daily medications are prescribed to reduce or prevent cough headache. In rare cases, lumbar puncture (spinal tap) may be needed to remove some of the fluid which surrounds the spinal cord and brain. This also helps in reducing the pressure within the skull that can be the cause of the headaches.

Medications used for preventing and treating a primary cough headache include:

• Propranolol is a medication, which helps in relaxing blood vessels and reducing the blood pressure.
• Indomethacin is an anti-inflammatory medicine, which helps in reducing pain from cough headache.
• Acetazolamide is a diuretic, which helps in decreasing the quantity of spinal fluid, which in turn helps in reducing the pressure within the skull.
• Some of the other medications, which are prescribed for treating primary cough headache, include naproxen, methysergide, ergonovine, phenelzine and intravenous dihydroergotamine.

If the patient has secondary cough headaches, then surgery is usually needed to treat the underlying causative problem. Preventive medications often are of no use in treating or preventing secondary cough headaches. If the patient, however, is responding to medications, it does not always mean that he/she has a primary cough headache.

To prevent a cough headache, the actions which trigger the cough headaches should be avoided, such as coughing (of course!), sneezing or straining during bowel movements etc. Avoiding these things help in reducing the number of headaches, which the patient is experiencing. Some of the preventive measures include:

• Avoiding those medications, which produce cough as a side effect.
• Treating infections of the lung, such as bronchitis, which can cause coughing.
• Getting flu shots annually helps in preventing cough headaches.
• Avoiding bending or heavy lifting for prolonged periods of time helps in preventing cough headaches.
• Stool softeners should be used to avoid constipation and straining during bowel movements.