Though headaches themselves are common, what’s not common are headaches caused by coughs.

There are two types of cough headaches: primary and secondary. Primary cough headaches do not have a separate underlying cause, and generally stem from the tension and straining that can come with coughing.  Other types of straining — such as blowing your nose, bending over, or having a bowel movement — can all also cause similar head pain. Secondary headaches are a symptom of another health condition, rather than being an issue in and of themselves. 

This guide from HealthTap provides an overview of the two different types of cough headaches, what causes them, and common treatment options. 

What is a cough headache?

A cough headache is an uncommon condition with a lifetime prevalence of about 1%. 

For most people, cough headaches occur just once or twice in their lifetime after excessive straining. However, for a small portion of people, cough headaches are a sign of an underlying health problem. 

A cough headache can be triggered by coughing, sneezing, or any type of strain that puts tension on the muscles that connect to the head and neck.  

Symptoms of a cough headache can include: 

• Headache pain that comes on suddenly after straining.

• Headache pain that lasts anywhere from a couple of seconds to several hours (depending on the cause).

• Sharp or stabbing pain.

• Pain that is located in the front or side of your head. 

• Pain that is moderate to severe.

Other symptoms that can accompany headache disorders — like nausea, vomiting, and sensitivity to light and sound — are not typical symptoms of cough headaches. Those side effects may relate to migraine headaches or inflammation of the sinuses, which can occur alongside a secondary cough headache depending on the cause.

Primary vs. secondary cough headache 

The cause of secondary cough headaches (also known as symptomatic cough headaches) is an underlying health problem, while a primary cough headache is a condition in and of itself. 

Primary cough headache 

This type of headache was previously known as a “benign cough headache” because it is not associated with any underlying health problems and is generally considered harmless. 

The International Headache Society (IHS) defines this condition as a headache triggered by any type of straining that is not caused by a brain disorder. 

To be diagnosed with a primary cough headache, a patient has to have the following symptoms: 

• The headache begins suddenly without any warning symptoms, such as nausea, light or sound sensitivity, or visual changes.

• The headache begins almost immediately after coughing, straining, or performing the Valsalva maneuver (which is a type of breathing technique that forces air out, which usually occurs during a bowel movement or other increase in abdominal pressure).

• The headache reaches its peak within one minute and subsides shortly after, though it may momentarily leave behind a dull ache.

• The headache is not attributed to another disorder.

While its name may suggest that it’s primarily caused by coughing, a cough headache can be triggered by anything that increases pressure in the brain. It is very common for patients to experience a cough headache after bending over, engaging in intense physical activity, or even doing forceful breathing exercises. 

The pain from a primary cough headache is usually moderate to severe, and is felt on both sides of the head (although it’s possible to feel pain only on one side). 

The pain can last for as little as one second to 30 minutes. In rare cases, the pain can be felt for as long as two hours. The pain typically goes away on its own without any treatment. 

Unlike many primary headache disorders (like migraines), this type of headache mostly affects men over the age of 40. 

Because primary cough headaches are not caused by another health condition, headache pain tends to be the only symptom. They are also not accompanied by any pre-headache changes, such as the changes in vision that are sometimes seen with migraines. 

Secondary cough headache 

A secondary cough headache is associated with an underlying health problem. For this reason, patients with secondary headaches tend to experience various other symptoms, such as dizziness, vertigo, unsteadiness and loss of balance, sore throat, muscle weakness, and even fainting. 

One of the main causes (although relatively uncommon) of secondary cough headache is Chiari type I malformation. This happens when the skull is too small for the brain tissue. In a Chiari malformation, the cerebellum presses down toward the hole in the bottom of the skull. 

Other potential causes include brain tumors in the bottom of the skull, blockage of cerebrospinal fluid (which keeps the brain cushioned in the skull), and low levels of cerebrospinal fluid. 

Unlike patients with a primary cough headache, those with a secondary cough headache feel pain in the back of the head, usually on one side. The pain can be described as stabbing, dull, or piercing — it mainly depends on the underlying condition that caused it. 

Secondary cough headaches also usually last much longer than primary cough headaches. Some patients may feel pain for only several seconds, but many others can have a headache that seems to last consistently for several weeks. 

What causes cough headaches? 

Researchers can’t quite agree on what causes cough headaches. There are many hypotheses to explain this condition.

It’s thought that primary cough headaches are caused by an increase in pressure in the abdomen and chest, triggered by straining. This can lead to an increase in blood pressure in the venae cavae, which are the main veins located right next to the heart. This temporary increase in blood pressure then leads to an increase in pressure within the skull, which can lead to headache pain.

Some patients with primary cough headaches even experience a temporary increase in cerebrospinal fluid (CSF). Though CSF cushions the brain in the skull, having too much of it can cause pressure and pain.

Secondary cough headaches are caused by an underlying medical condition. Almost half of all patients with secondary cough headaches have a Chiari I malformation. Other patients may suffer from a brain tumor, spinal cord or spinal fluid issues, or any condition that causes a build-up of CSF in the skull. 

Although there are various conditions that can lead to a secondary cough headache, all of these conditions have one thing in common: they increase pressure in the skull. Coughing or any type of straining further increases this pressure, which can lead to headache pain. 

How are cough headaches treated?

Although more long-term studies are needed to confirm this, research shows that many cough headaches resolve on their own. The longest the condition has been known to last is approximately four years, though this is fairly uncommon. For those with certain brain conditions, symptoms may last until the underlying cause is addressed. 

For those without an underlying health condition, a cough headache will typically last up to 30 minutes and go away on its own. This makes home remedies and over-the-counter treatments like ibuprofen fairly unnecessary for primary cough headaches. 

For frequently-returning cough headaches, treatment options might include acetazolamide, which can help reduce the frequency of headaches, or indomethacin, which is a type of non-steroidal anti-inflammatory drug (NSAIDs).

NSAIDs work by relieving inflammation, which can reduce some of the pressure in the skull. Indomethacin has a high response rate, with some studies showing that it’s effective in as many as three-fourths of patients. The prescribing doctor can decide on the right dose, which usually ranges from 25 to 150 mg to be effective.

For secondary cough headaches, the underlying cause has to be addressed for symptom relief. This is often enough to get rid of the headache pain.

How to prevent cough headaches 

It’s important to prevent cough headaches from happening in the first place because of the intense pain they cause. 

The following are some effective prevention strategies to consider:

• Getting a regular physical
  Seeing a primary care provider for regular check-ups can be helpful in identifying conditions that may be causing cough headaches.

• Avoiding excessive straining
  In some cases, it’s difficult to predict who may get a cough headache from straining. As a rule of thumb, if someone is prone to cough headaches, they should avoid excessive straining whenever possible — this may include avoiding scenarios where someone is bending over for long periods of time, pushing and straining due to constipation, or even lifting heavy weights. 

Takeaways

Cough headaches are often short and temporary, and typically go away on their own. But, in some cases, they can be a sign of an underlying health condition.

If you experience a cough headache that lasts longer than two hours, or if it becomes a severe headache with intense pain and other accompanying issues like dizziness or lightheadedness, it’s important to meet with a healthcare provider to get to the root cause of the issue. 

HealthTap can connect you with a low-cost doctor to discuss your symptoms and get to the bottom of what’s going on. Through our virtual platform, you can meet with a doctor without ever leaving your home.

Talk to a doctor online today.