Overview

Cough headaches are a type of head pain triggered by coughing and other types of straining. This may include sneezing, blowing your nose, laughing, crying, singing, bending over or having a bowel movement.

Cough headaches are fairly uncommon. There are two types: primary cough headaches and secondary cough headaches. Primary cough headaches are usually harmless, are caused only by coughing and get better quickly without treatment. A primary cough headache is diagnosed only when a provider has ruled out possible causes other than coughing.

A secondary cough headache may be triggered by a cough, but it is caused by problems with the brain or structures near the brain and spine. Secondary cough headaches can be more serious and may require treatment with surgery.

Anyone who has a cough headache for the first time should see their health care provider. The provider can determine whether a cough or something else caused the pain.

Symptoms

Symptoms of cough headaches:

  • Begin suddenly with and just after coughing or other types of straining
  • Typically last a few seconds to a few minutes — some can last up to two hours
  • Cause sharp, stabbing, splitting or "bursting" pain
  • Usually affect both sides of your head and may be worse in the back of your head
  • May be followed by a dull, aching pain for hours

Secondary cough headaches often present with only a cough headache, but you may also experience:

  • Longer lasting headaches
  • Dizziness
  • Unsteadiness
  • Fainting
  • Ringing in the ears or hearing loss
  • Blurred vision or double vision
  • Tremor

A cough headache only happens right after coughing. Other headache pain is not a cough headache if you already had a headache when you coughed, or if you have a headache condition such as migraine. For example, people with migraine might find that their headaches get worse when they cough. This is normal, and not a cough headache.

When to see a doctor

Consult your doctor or health care provider if you experience sudden headaches after coughing — especially if the headaches are new, frequent or severe or you have any other troubling signs or symptoms, such as imbalance or blurred or double vision.

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Causes

Primary cough headaches

The cause of primary cough headaches is unknown.

Secondary cough headaches

Secondary cough headaches may be caused by:

  • A defect in the shape of the skull.
  • A defect in the part of the brain that controls balance (cerebellum). This can happen when part of the brain is forced through the opening at the base of the skull (foramen magnum), where only the spinal cord should be. Some of these types of defects are called Chiari malformations.
  • A weakness in one of the blood vessels in the brain (cerebral aneurysm).
  • A brain tumor.
  • A spontaneous cerebrospinal fluid leak.

Sometimes, what is first diagnosed as a cough headache may be caused by a cerebrospinal fluid (CSF) leak. Coughing or straining may trigger the headache, but the underlying cause is the CSF leak. This is one of the reasons why it's important to see your provider for a new cough headache.

Risk factors

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

Prevention

After talking with your provider, here are some tips to prevent actions that trigger your cough headaches — whether that's coughing, sneezing or straining while using the toilet. This may help reduce the number of headaches you experience. Some preventive measures may include:

  • Treating conditions that would cause coughing, such as bronchitis or other lung infections
  • Avoiding medications that cause coughing as a side effect
  • Getting an annual flu shot
  • Using stool softeners to avoid constipation
  • Minimizing heavy lifting or bending for long periods

While these steps may help prevent a cough headache, any headache related to coughing or straining should always be checked by your provider.

May 17, 2022
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  3. Waldman SD. Atlas of Uncommon Pain Syndromes. 4th ed. Elsevier; 2020. http://www.clinicalkey.com. Accessed April 18, 2022.
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  8. Duvall JR, et al. Headache due to spontaneous spinal cerebrospinal fluid leak secondary to cerebrospinal fluid-venous fistula: Case series. Cephalalgia. 2019; doi: 10.1177/0333102419881673.

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