Cough Headaches

Coughing and other forms of straining can cause headaches known as coughs. For example, you could sneeze, blow your nose, laugh, weep, sing, hunch down, or have a bowel movement.

Headaches caused by coughing are not frequent. Primary cough headaches and secondary cough headaches are the two forms. Primary cough headaches are often not harmful, are only brought on by coughing, and resolve rapidly on their own. Only until any potential reasons other than coughing have been ruled out can a doctor identify a primary cough headache.

A cough may induce a secondary cough headache, but the problem is with the brain or structures close to the brain and spine. Secondary cough headaches can be more severe and could need to be surgically treated. Everyone who experiences a cough headache for the first time should consult a doctor. The medical professional can evaluate if a cough or another factor caused the pain.

Cough Headaches: Causes

The probable causes of cough headaches may include −

  • Initial headaches from coughing

  • Primary cough headaches have no identified etiology.

  • Secondary headaches from cough

Headaches brought on by coughing secondary to −

  • A problem with the skull's contours

  • A balance-controlling portion of the brain defect (cerebellum). This can occur when a portion of the brain is driven through the foramen magnum, which is supposed to house only the spinal cord. These kinds of deformities are known as Chiari malformations in some cases.

  • Weakening in one of the brain's blood vessels (cerebral aneurysm)

  • An astrocytoma

  • Sudden leak of cerebrospinal fluid

Cerebrospinal fluid (CSF) leaks can occasionally be the source of headaches that are initially identified as cough headaches. The headache may be brought on by coughing or straining, but the CSF leak is what is really to blame. This is among the reasons it's crucial to visit your doctor if you get a new cough headache.

Although many theories have been put out, the pathophysiology of primary cough headache is not fully known. It is likely connected to an elevated intracranial pressure brought on by coughing, with the central venous pressure rising as a result of the resulting rise in intra-thoracic and intra-abdominal pressure.

In 5 out of 7 individuals with primary cough headaches, a recent investigation using MR venography revealed a transverse or jugular vein stenosis; however, it is still unclear whether this stenosis is a primary or secondary event linked to elevated intracranial pressure. The rise in intracranial pressure brought on by coughing may also lead patients to have decreased pain thresholds.

Raskin also assumed the position of hypersensitive pressure receptors on the walls of venous vessels. Contrarily, Wang hypothesized that cough headache was brought on by CSF hypervolemia, which would induce an increase in intracranial pressure during coughing. The posterior cerebral fossa of individuals with primary cough headache was also observed to be more congested by Chen et al. This might result in a little restriction of CSF flow, which would raise intracranial pressure during coughing.

Although the precise process is uncertain, it is also thought that symptomatic cough headaches are caused by an increase in intracranial pressure.

This appears to be brought on by the cerebellar tonsils drooping below the foramen magnum in people with Chiari malformation type I. Williams recorded two cases of cough headache with tonsillar herniation where a Valsalva maneuver showed a difference in pressure between the ventricles and the lumbar subarachnoid region.

Because of the tonsils' additional displacement into the foramen magnum as a result of this craniospinal pressure dissociation, coughing discomfort may result from compression or tracking on pain-sensitive tissues in the arachnoid space or blood vessels around the tonsils. The fact that the craniospinal pressure dissociation and cough headache vanish following surgery lends credence to this theory.

Cough Headaches: Symptoms

Cough headache signs and symptoms −

  • Begin abruptly with and immediately following coughing or other forms of straining.

  • Usually endure from a few seconds to a few minutes, while some might continue up to two hours.

  • Inflict piercing, splitting, or "bursting" agony

  • Typically impact both sides of your head, with the rear of your head maybe worse

  • May be followed by an hours-long dull ache.

Although secondary cough headaches frequently simply cause a cough headache, they can also cause −

  • More persistent headaches

  • Dizziness

  • Unsteadiness

  • Fainting

  • Ears that ring or hearing loss

  • Vision distortion or double vision

  • Tremor

Cough Headaches: Risk Factors

Risk factors for cough headaches vary widely based on the type and cause of the headache.

Cough Headaches: Diagnosis

To rule out other potential causes of your headaches, your doctor may advise brain imaging procedures, such as MRI or CT scans.

  • Imaging with magnetic resonance (MRI). To identify any issues that might be causing your cough headache, an MRI uses a magnetic field and radio waves to make cross-sectional pictures of the structures inside your skull.

  • CT scan for computerized tomography. In these scans, a computer combines pictures from an X-ray machine that spins around your body to produce cross-sectional images of your brain and head.

  • A spinal puncture (spinal tap). A spinal tap (lumbar puncture) may occasionally be advised. During a spinal tap, the physician extracts some of the surrounding fluid of your brain and spinal cord.

Cough Headaches: Treatment

Depending on whether you have primary or secondary cough headaches, the treatment will vary.

Headache Due to Primary Reason

Your doctor could advise you to take a daily pain reliever if you've previously experienced primary cough headaches to assist avoid or lessen the discomfort.

These prophylactic drugs might consist of −

  • Anti-inflammatory medicine indomethacin, blood pressure-lowering drug propranolol, which relaxes blood vessels

  • Acetazolamide is a diuretic that lowers spinal fluid levels and can lower the pressure inside the skull.

  • Methysergide, naproxen sodium, methylergonovine, intravenous dihydroergotamine, and phenelzine are other treatments for primary cough headaches.

Secondary Headache From Cough

Surgery is frequently necessary to address the underlying issue if you have subsequent cough headaches. Those who get secondary cough headaches are typically not helped by preventive drugs. But just because you're responding to treatment doesn't indicate you have a primary cough headache.

Cough Headaches: Prevention

Here are some suggestions to avoid behaviors that cause your cough headaches, such as coughing, sneezing, or straining when using the restroom, after speaking with your healthcare physician. You could get fewer headaches as a result of this. Preventive steps could include −

  • Treating illnesses like bronchitis or other lung infections that might make you cough

  • Avoiding drugs that have the side effect of making you cough

  • Having a yearly flu shot

  • Stool softeners are used to prevent constipation.

  • Minimizing prolonged bending or heavy lifting

While taking these precautions may help you avoid a cough headache, you should always have your doctor examine you if you get any headaches when coughing or straining.


In respiratory clinics, cough headaches are common and have somewhat distinct features from those in headache clinics. Cough headache risk variables were cough intensity and age between 31 and 50. Age, headache length, and cough severity all have an impact on headache intensity.

Dr. Durgesh Kumar Sinha
Dr. Durgesh Kumar Sinha


Updated on: 31-Mar-2023


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