Cough headache is one of the important provoked headache types.
A cough causes a sudden intense sharp pain, often in the top or back of the head, but any part of the head can be affected.
It is important to make sure that pain is directly caused by coughing (there needs to be no pain before the cough, and pain is only induced by the action of coughing).
The much more common scenario is of a pre-existing pain, such as migraine, being made worse by coughing. After coughing you still have your pre-existing migraine headache.
Strictly speaking, cough headache only occurs as a result of a cough stimulus. However, it is also known that stooping, sneezing or lifting can produce the pain. Weightlifters can get this pain when lifting extreme weights.
How do people describe the pain?
The pain usually occurs on both sides. There is not usually any autonomic activation (that is no tears, nasal congestion or reddening of the eye).
The pain lasts seconds (occasionally 1-2 minutes of severe pain), and once the intense pain has settled, there is sometimes a more prolonged dull ache (1-2 hours). The pain is known to occur in the teeth.
What Causes Cough Induced Headache?
Just like other exercise induced headaches, there is a 10-20% chance that there is a structural problem in the head causing this headache.
Causes of cough induced headache include:
- Chiari Malformation - The most commonly identified cause.
- Meningioma - which can be in the posterior fossa.
- Pituitary Tumour
- Subdural Haematoma - beware that subdural effusions can be associated with intracranial hypotension.
- Brainstem compression from platybasia
- Other Brain Tumour - this is rare
- Intracranial Hypotension
- Cervicogenic Headache - people with pain originating from upper cervical spine joints will describe pain that is made worse or brought on by coughing
The mechanism of headache brought on by coughing is not known for certain.
Patients with the Chiari Malformation may have a ball-valve effect at the base of the brain.
A cough causes a rise in pressure inside the head. This pressure rise worsens the Chiari Malformation, by forcing the cerebellar tonsils further into the spinal canal.
The pressure in the head rises very sharply, and then falls more slowly. The sudden rise in intracranial pressure (Intra = inside, cranial = head) is what causes the sudden pain.
Benign Cough Headache does not have cause identified on investigations. The treatment of primary cough headaches include drugs that are known to reduce intracranial pressure:
Other drugs have been used successfully in the past, again on a case by case basis without proper randomised trials:
- Methysergide (an anti-migraine drug)
- IV Dihydroergotamine
A Lumbar Puncture Procedure has also helped some patients. It is possible that by causing a CSF leak, or increasing compliance of the lumbar part of the dural sac, pressure inside the head falls.