Why Does my Head Hurt When I Cough?

Headaches are such a familiar feeling, whether due to occasional sickness, lack of sleep or a late night out with friends, that most people don’t typically associate it with coughing or sneezing. There are more than 150 different types of headaches, with one falling under the category of cough headaches. While cough headaches are uncommon, they can still pose problems and even be a sign of more severe health conditions. This blog will explain what cough headaches are, how to spot them and how you can treat them.

Headaches from coughing

Occasional coughing is a normal occurrence for humans, as it helps keep the throat and airways clear. The act of coughing involves a sudden release of air at speeds of about 100 miles per hour, fast enough to free up your airways of foreign objects or irritants.

The force needed to cough comes from thoracic, abdominal and pelvic muscles and can create pressure that radiates to your head. In some people, this pressure can cause a cough headache. Straining these muscles may also occur during the following activities:

• Bending over
• Blowing your nose
• Crying
• Having a bowel movement
• Singing
• Sneezing

Cough headaches are uncommon and occur in about 1 percent of people. To be classified as a cough headache, the pain must occur after coughing or another type of action that leads to increased strain or pressure, not if you’ve already had a headache before the cough.

Types of cough headaches

There are two types of cough headaches; primary cough headaches and secondary headaches. In general, primary cough headaches are temporary, harmless and don’t require treatment, while secondary cough headaches indicate a more severe underlying cause and can last longer.

Primary cough headaches

As the name suggests, primary cough headaches occur when a cough, sneeze or other type of straining serves as the primary source. In other words, the buildup of pressure originates from these causes and not another medical condition. People over the age of 40 are usually most affected by this type of cough.

Your doctor can diagnose you with primary cough headaches after at least two episodes that last anywhere from a second to two hours. The symptoms usually resolve on their own without treatment.

While they are an annoyance and can cause discomfort, no lasting damage occurs from primary cough headaches. Still, you should schedule a visit with your doctor after experiencing cough headaches to rule out any underlying condition that may be the culprit.

Secondary cough headaches

Secondary cough headaches occur when a cough triggers a headache but is not the reason for the problem. Instead, underlying health problems such as structural problems in the brain or spine are what causes the headache.

The following health problems can cause secondary cough headaches:

• Brain aneurysm
• Brain tumor
• Cerebrospinal fluid leak
• Cervical subluxation
• Chiari type 1 malformation (brain tissue extends into the spinal canal)
• Head shape abnormalities (positional plagiocephaly, craniosynostosis, Syndromic craniosynostosis)
• Hydrocephalus (abnormal fluid buildup in the brain)

Chiari type I malformation, a condition in which the cerebellum bulges through the opening at the base of the skull, accounts for roughly half of secondary cough headaches.

Unlike primary cough headaches, secondary cough headaches should prompt a visit to a neurologist, neurosurgeon or headache specialist for further examination. Oftentimes, the cause of the problem may be difficult to notice on your own. In other cases, there may be noticeable signs. For example, people may have neck pain or problems moving their neck may notice how they get headaches after coughing or sneezing.

What does a cough headache feel like?

The feeling associated with a cough headache can vary from sharp and stabbing to the sensation that your head is going to explode. The pain can be either unilateral (one side of the head) or bilateral (both sides of the head). In most cases, the pain is limited to the front or sides of the head. Pain at the back of the skull is indicative of a more serious problem.

Cough headaches can linger for several hours with dull pain, although primary cough headaches usually produce a sharp or stabbing pain for up to a few minutes. The pain can also change depending on your positioning (standing, sitting or lying down).

By comparison, secondary cough headaches last longer and can be associated with feelings of dizziness or imbalance. You may also faint or experience a tremor. People with secondary cough headaches have also cited hearing and vision issues such as blurry vision, double vision and hearing loss.

Can you treat this pain?

Treatment for cough headaches ultimately depends on the source and if it’s primary or secondary.

In the case of primary headaches, symptoms go away on their own and don’t need to be treated. However, people with recurrent episodes can turn to preventative medications. 

Here are some common medications:

• Indomethacin: This anti-inflammatory drug is the most common drug prescribed for cough headaches. 
• Propranolol: This drug is a beta blocker used primarily for heart conditions to relax blood vessels. 
• Acetazolamide: This drug falls under the class of carbonic anhydrase inhibitors, which restrict the activity of carbonic anhydrase, a type of enzyme that produces fluid in your body. By limiting this enzyme, spinal fluid is reduced, therefore decreasing pressure inside the skull.
• Topiramate: This drug is an anticonvulsant and primarily used to treat seizures. It works by reducing electrical activity in the brain.
• Methysergide: This drug is an ergot alkaloid, which helps narrow the blood vessels that bring blood to your head.

Contact your doctor if you experience a headache after coughing or any other type of straining movement. While most instances of cough headaches are benign, there is always a chance of a more serious cause that requires medical treatment.