Why Does My Head Hurt When I Cough? Causes & Treatment

By Chris Bodle, MD
Medically reviewed checkmarkMedically reviewed
May 1, 2020

When you think of cough and headache, you might think of illnesses, like influenza. But if you’ve ever experienced a sudden, painful headache when you cough, sneeze, or blow your nose, then you’ve experienced a common condition called a cough headache.

There are two types of cough headaches. Primary cough headaches occur episodically as a direct result of a straining action—including coughing, sneezing, blowing your nose, or even singing or laughing—and they go away on their own. Generally, primary cough headaches don’t indicate an underlying medical condition. And since they usually dissipate in a few minutes, primary cough headaches don’t need treatment.

Secondary cough headaches aren’t caused by a cough, but triggered by straining. Secondary cough headaches, which are far less common, can sometimes indicate a structural issue in the brain. If you have any symptoms of a secondary cough headache, it’s important to consult with your doctor, who can help you determine the appropriate course of action.

What Is a Cough Headache?

Cough headaches are a type of headache that can occur when a person strains while coughing, sneezing, or blowing their nose. There are two kinds of cough headaches; primary and secondary. Primary cough headaches usually aren’t a cause for medical concern; the headache is caused by the cough (or other straining action), not an underlying health problem. They are also commonly self-limited, which means they appear episodically and go away on their own.

Secondary cough headaches are also triggered by a cough, but they are not actually caused by the cough or straining. These types of headaches generally require medical intervention, as they could be caused by a structural problem in a person’s brain.

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What Causes a Cough Headache?

Cough headaches usually occur when a person engages in straining actions, such as:

  • Coughing due to the common cold, allergies, or infections like influenza
  • Sneezing
  • Blowing the nose
  • Laughing
  • Singing
  • Having a bowel movement
  • Lifting something heavy
  • Anything that strains the abdomen

The two types of cough headaches each have their own underlying causes:

Causes of a primary cough headache

As painful and frustrating as they can be, a primary cough headache isn’t a reason for concern, since it’s caused by straining and not an underlying medical issue with the head or brain.

Doctors don’t yet understand what causes a primary cough headache. Some doctors theorize that coughing (or other forms of straining) increases pressure in a person’s abdomen and chest, which could also lead to an increase of pressure in the brain.

Causes of a secondary cough headache

In most cases, secondary cough headaches are caused by structural problems in a person’s brain. One of the most common causes of a secondary cough headache is Chiari malformation type I, which is a defect involving the part of the brain that deals with balance.

Some other common causes of secondary cough headache include:

  • A cerebral aneurysm, which causes weakness in one of brain’s blood vessels
  • A brain tumor
  • A defect in the shape of the skull
  • A spontaneous leak of cerebrospinal fluid (CSF)
  • Low cerebrospinal fluid levels
  • A subdural hematoma, a collection of blood outside the brain’s tissue

Cough Headache Symptoms

Since primary and secondary cough headaches have different causes, they also come with their own, unique symptoms. It’s important to discuss your cough headaches with your physician or a K doctor so you can determine the cause and proper treatment.

Typically, primary cough headaches:

  • Begin abruptly during or immediately after coughing or other forms of straining, like sneezing, blowing one’s nose, singing, laughing, or having a bowel movement
  • Last anywhere from a few seconds to two hours
  • Cause sharp, stabbing, or explosive pain
  • Affect both sides of the head, with more severe pain toward the back of the head
  • May lead to dull, aching pain in the head for hours

Primary cough headaches are more common in men, and they occur more often in people older than age 40.

Secondary cough headaches may include primary cough headache symptoms, along with:

It’s uncommon for people to experience migraine headache symptoms like nausea, vomiting, or sensitivity to noise or light during a primary or secondary cough headache.

Risks and Complications

Since primary cough headaches aren’t related to any specific medical problems, but rather caused by straining activities, there aren’t any associated complications. In very rare cases, someone may have primary cough headache episodes for years.

Generally, once the cause is identified, secondary cough headaches can be resolved with proper treatment. If a person has symptoms of a secondary headache but doesn’t seek medical attention, the headaches and the underlying condition could worsen.

Cough Headache Diagnosis

If you get a headache when you cough, then you have a cough headache. The important thing is for your doctor to identify whether you’re experiencing a primary or secondary cough headache.

Since secondary cough headaches can sometimes cause dizziness and fainting, your doctor will likely ask about the specific symptoms you’re experiencing. To rule out a structural issue in your head or brain or other medical conditions, you may have a brain-imaging test like an MRI or CT scan.

Cough Headache Treatment

Since the causes of primary and secondary cough headaches are different, the treatments typically are, too. Your doctor will work with you to identify the type of cough headache you’re suffering from so you can properly treat it.

Primary cough headache treatment

Primary cough headaches usually resolve on their own within four years and don’t require medical interventions like surgery. You can treat your cough headache pain at home, or prevent coughing episodes, with:

  • Over-the-counter pain-relieving medications: like acetaminophen (Tylenol) or ibuprofen (Motrin) may alleviate symptoms.
  • Over-the-counter cough medications: such as dextromethorphan (Triaminic Cold and Cough, Robitussin Cough, or Vicks 44 Cough and Cold) may prevent coughing episodes.

If you have persistent pain associated with primary cough headaches, your doctor might prescribe you a medication that either prevents or reduces pain associated with cough headaches.

Some of the common medications for cough headache include:

  • Indomethacin (Indocen or Tivorbex), an anti-inflammatory drug
  • Propranolol (Inderal or Innopran XL), which relaxes blood vessels and reduces blood pressure
  • Naproxen, a nonsteroidal anti-inflammatory drug (NSAID)
  • Acetazolamide (Diamox), which reduces the amount of spinal fluid and pressure in the skull

If your primary cough headaches stem from pressure in your skull, your doctor might recommend a spinal tap to remove fluid surrounding your brain and spinal cord.

Secondary cough headache treatment

Doctors don’t prescribe preventative medications for secondary cough headaches. These types of headaches usually require treatment since they are the result of an underlying condition in the brain or head.

While the treatment for secondary cough headaches depends on the cause, many cases require surgery. Some of the most common types of surgery related to cough headaches include:

  • Chiari malformation: People with secondary cough headaches due to a Chiari malformation may need surgery to create more space for the cerebellum, which reduces pressure on the brain.
  • Brain tumor: In rare cases, someone might have a secondary cough headache caused by a brain tumor, which could be removed with surgery.
  • Brain aneurysm: Some people with brain aneurysms need surgical intervention to repair a bulging blood vessel in the brain.
  • Cerebrospinal fluid leak: If fluid is leaking from your spine, a surgeon may repair it to avoid complications like meningitis, an infection of the membranes surrounding the brain and spinal cord.

Your doctor will help you identify the best treatment option based on what you’re experiencing.

How to Prevent Cough Headaches

It’s not always possible to prevent a cough headache, but you can decrease the episodes you experience. One of the most effective ways to prevent cough headaches is to avoid the straining actions that cause them. Some possible ways to prevent cough headaches are:

  • Avoiding medications that can cause coughing as a side effect, such as ACE inhibitors, which treat high blood pressure
  • Getting an annual influenza vaccine
  • Taking over-the-counter cough medications if you have a cold
  • Avoiding allergy triggers
  • Avoiding or quitting smoking
  • Treating respiratory infections like bronchitis and pneumonia
  • Using stool softeners or eating a high-fiber diet to prevent constipation

Secondary cough headaches cannot be prevented, since they are caused by a structural problem of the head or brain.

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When to See a Doctor

Always talk to your doctor or a K doctor if you have persistent cough headache episodes that cause you pain. You should also speak with a doctor if you have any symptoms of a secondary cough headache, like fainting or dizziness on top of episodic pain that comes from straining actions.

If you have any of the below symptoms associated with a headache, you should also speak to a doctor:

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K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Chris Bodle, MD

Dr. Bodle is a board certified emergency medicine physician. He received his medical degree from Indiana University School of Medicine, and completed his residency in emergency medicine at Emory University. In addition to K Health, he currently works as an Emergency Medicine physician in an Urban, Level 1 Trauma Center in the south east.

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