Cough Headache: Why Does My Head Hurt When I Cough?

It’s back! The cough has returned to bother you. However, it’s not alone this time. It has brought a HEADACHE along with it.

Do you get a headache whenever you get a cough? Headache induced by cough is a rare observation. Cough headaches are thought to affect 1% of people in their lifetime.

In the winter season, cough is a common symptom and a vital lung defense mechanism. If you are struggling, not just with a cough, but also an accompanying headache, then it’s time to discover all about Cough Headache: Why does my head hurt when I cough?

What is a cough headache?

When a person coughs, sneezes, or strains, their intra-abdominal pressure quickly rises, causing a headache. This condition is known as cough headache. In a headache clinic, the prevalence of cough headache ranges from 0.4% to 1.2%.

A single or multiple coughs will cause a moderately severe generalized headache to appear quickly and last only a few minutes. Sneezing, bending, stooping, and straining may also cause headaches, prompting people to avoid these activities.

Cough headache is mostly seen in people who are not prone to headaches. It is not associated with other primary headache disorders such as migraine.

Here is an interesting history of cough headaches:

• Cough headache was first described in medical literature in 1932 by Tinel.
• Before Symonds and Rooke reported cases of benign cough headache, which is now known as primary cough headache, cough headache was thought to be an alarming symptom.
• There have been approximately 400 cases of primary cough headache reported in the literature.

Different types of cough headaches

Cough headaches are subdivided into primary or benign and secondary or symptomatic cough headaches.

Primary cough headache

Symonds was the first to recognize primary cough headache as a distinct disease in 1956.

The International Headache Society (IHS) defines primary cough headache (benign cough headache or Valsalva-manoeuvre headache) as a headache precipitated by coughing or other straining manœuvre, but not by prolonged physical exercise, in the absence of any disorders within the skull.

Primary cough headache is not associated with any obvious neurological or musculoskeletal disease. Over 80% of patients with a primary cough headache are males in contrast to symptomatic cough headache, which has no gender preference.

Primary cough headaches are usually bilateral (on both sides) and posterior (backside), primarily affecting people over 40.

Secondary Cough Headache

Coughing can trigger secondary cough headache (SCH), but it is the result of another condition.

Approximately 40% of cases have underlying conditions, most commonly Chiari type 1 malformation, posterior fossa lesions, cerebral aneurysms, obstructive hydrocephalus, and spontaneous low cerebrospinal fluid (CSF) pressure.

Although cough headaches have been reported in a wide range of patients, the majority with secondary causes are under 50 years of age. Secondary cough headaches are most associated with Arnold-Chiari type I malformations.

Why does my head hurt when I cough?

You may be experiencing a cough or a headache or you may be experiencing both a cough and headache.

Activities like coughing, sneezing, straining, bending, laughing, lifting weights, sudden postural movements, and defecating can induce a headache. The pain is sudden, short-lived, usually bilateral, and has few additional characteristics.

These activities may cause a rapid increase in abdominal pressure, which can increase the pressure in the head, thereby triggering a headache. If you are wondering why my head hurts when I laugh or cough, or why I get a headache every time I cough, now you know why.

Symptoms of Cough Headache

• Benign or primary cough headaches usually appear abruptly after coughing or performing a Valsalva maneuver (performance of forced expiration against a closed glottis).
• Primary cough headache is bilateral in distribution (but can be unilateral), with pain ranging from moderate to severe intensity and described as sharp and stabbing in quality. The headache reaches its peak intensity almost immediately and typically subsides over several seconds to a few minutes.
• Vertigo, nausea, and sleep disturbances have been discovered to be associated symptoms for up to two-thirds of patients with PCH.
• Patients with secondary or symptomatic cough headaches differ from patients with primary cough headaches in that they typically have more associated symptoms, depending on the underlying abnormality.
• Additional headache triggers, higher pain intensities, and diverse headache durations and locations are generally reported.

What causes a headache when coughing?

Although there are several theories, the underlying cause of primary cough headaches is unknown. It is likely related to elevated intracranial pressure brought on by coughing, which raises intra-thoracic and intra-abdominal pressure, which in turn raises central venous pressure.

Wang proposed that cough headache is caused by cerebrospinal fluid (CSF) hypervolemia, which raises intracranial pressure while coughing. Wolff believed that cough headaches were caused by a systemic infection that altered vascular tone in the cranial vessels.

A more packed posterior cerebral fossa was observed in patients with primary cough headache by Chen et al. When someone coughs, this could cause a relative blockage of CSF flow, which raises intracranial pressure.

The specific mechanism underlying symptomatic cough headache is uncertain, but it is thought to be related to a rise in intracranial pressure.

After Chiari type I malformation, various posterior fossa lesions are the most frequent cause of symptomatic cough headache. Spontaneous low CSF pressure and obstructive hydrocephalus are additional reasons.

How are cough headaches diagnosed?

Patients with cough headaches should undergo a neuroimaging evaluation, including a brain MRI (Magnetic Resonance Imaging) with and without contrast. A cough headache can only be considered a primary cough headache (PCH) after all other underlying causes have been eliminated.

The diagnostic criteria for PCH are described by the International Headache Society (IHS) as:

At least two sudden onset headache episodes lasting between one second and two hours; brought on “only in association with coughing, straining, and/or other Valsalva maneuverer” in the absence of any intracranial disorder.

What are the treatment options for cough headaches?

• Most primary cough headache sufferers experience a spontaneous recovery after up to four years.
• Usually, no acute therapy is required because of the short duration. For most, if not all, patients, a preventive treatment approach should be considered because symptoms can be quite impairing.

Drug therapy

• Indomethacin is the preferred treatment for PCH. Several studies have shown that taking doses of 25 mg to 150 mg daily for two to five months is a successful treatment.
• Another study has indicated that higher daily doses of up to 250 mg may be necessary.
• Indomethacin’s probable mechanism of action could be that it lowers intracranial pressure. In certain smaller case series, other therapeutic alternatives such as topiramate, propranolol, methysergide, naproxen, ergovine, intravenous dihydroergotamine, and phenelzine have been observed to be effective.

Medical therapy

Most patients receiving acetazolamide and CSF fluid drainage have reported significant improvement or complete remission of PCH symptoms because of these therapies' ability to lower intracranial pressure.

Surgery

For symptom relief, patients with intracranial pathologies can need surgical intervention. Foramen magnum expansion combined with posterior cerebral fossa decompression is the standard surgical treatment for Chiari type I malformation.

Always consider your personal health status and consult with a healthcare professional for the appropriate treatment suitable to you.

Conclusion

Cough headaches are not common. They may be caused due to coughing, sneezing, bending, stooping, or straining, or may have some underlying condition. Coughing increases the intracranial pressure leading to a headache.

Other causes of cough headaches include Chiari type I malformation, packed posterior cerebral fossa, and CSF blockage. Primary cough headaches recover spontaneously and need no acute therapy. However, to treat the primary cough headache, Indomethacin is the preferred drug.

Now you must have a fair idea about Cough Headache: Why does my head hurt when I cough? Next time you are coughing, keep a check on whether you are experiencing a headache, how long it lasts, and if it is persistent, consult a healthcare provider for a suitable treatment.