Updated February 21, 2015.

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Coughing is an everyday act for many of us. It may be a sign of bronchitis, a reaction to smoke, or simply a natural reaction to clear that tickle in our throat. While a nuisance, coughing typically does not cause actual pain or distress. But for those who suffer from primary cough headache, coughing is a painful and burdensome act. Primary cough headache is a rare type of headache that typically affects adults over the age of 40 and is more frequent in men.

This condition is also referred to as the Valsalva-maneuver headache, as the headache can also be brought on by straining in addition to coughing. Primary cough headache is not to be confused by benign exertional headache which is a headache brought on by physical or sexual activity.

Symptoms

According to the classification criteria of the second edition of the International Classification of Headache Disorder (ICHD-II), symptoms of primary cough headache include:

• Sudden onset
• Occurring on both sides of the head (Bilateral)
• Short acting lasting from 1 second to less than 30 minutes
• Occurs only with associated coughing or straining
• Symptoms are not explained by another medical condition

Diagnosis

Most likely you will undergo imaging of the brain before your headache specialist or neurologist makes the diagnosis. Imaging of the brain will be done with a magnetic resonance imaging (MRI) and/or magnetic resonance angiography (MRA). This will ensure that there is no other cause for your cough-induced headache, especially since primary cough headache is not common.

Causes of a headache that may mimic primary cough headache but are really secondary headaches include:

• Cerebral Aneurysm
• Arnold-Chiari Type I malformation
• Brain Tumor

When these more ominous causes have been ruled out with brain imaging and a neurologic examination, your doctor will also make sure there is not another primary headache disorder occurring such as a migraine or cluster headache. Migraines and cluster headaches can be exacerbated by coughing or straining. But, remember, a primary cough headache is different from a migraine because it is not associated with nausea, vomiting, photophobia, or phonophobia. Likewise, a primary cough headache is different from a cluster headache because it is not associated with eye tearing (also known as lacrimation) or nose running (also known as rhinorrhea).

Cause

The cause of primary cough headache is not known. One potential mechanism is that the headache is due to increased pressure in the venous system surrounding the brain, which is brought on by coughing or straining. Another mechanism examined in a recent study in Neuroradiology suggests that venous stenosis or narrowing of the veins of the neck or sinuses may also be a cause for primary cough headache.

Treatment

In one study in Neurology at the University of California, San Franscisco, School of Medicine, thirty patients with primary cough headache were offered either indomethacin or a lumbar puncture. Indomethacin is a non-steroidal anti-inflammatory drug or NSAID. This treatment was offered because indomethacin reduces cerebrospinal fluid (CSF) pressure as does a lumbar puncture. Of the sixteen who chose indomethacin (doses varied between 50 and 200mg daily), fourteen had a satisfactory response. Of the fourteen who chose a lumbar puncture, only six patients had a satisfactory response. The eight patients who got no response with the lumbar puncture subsequently underwent treatment with indomethacin. Six of those eight patients experienced headache relief. 

Please note that indomethacin does have limiting side effects. Examples of these include:

• gastrointestinal upset and/or bleeding
• high potassium
• dizziness
• blurry vision
• increased risk cardiovascular events (i.e. heart attacks, stroke)

If your doctor prescribes indomethacin, please review these and other side effects carefully.

What is the Big Picture?

Two key points to take away are:

• Unlike migraine or cluster headache which can be aggravated or intensified by coughing, primary cough headache is triggered by coughing.

• Before being diagnosed with primary cough headache, you should undergo a thorough neurologic exam and brain imaging to rule out other causes or a secondary headache.

Of course, if you have any questions or concerns regarding your headache diagnosis or if you have a new onset headache or one that follows a different pattern, contacting your healthcare provider is important.

<sub>Sources

Cutrer M. Primary cough headache. In: UpToDate, Basow DS (Ed), UpToDate, Waltham, MA, 2013.

Donnet A, Valade D, Houdart E, Lanteri-Minet M, Raffaelli C, Demarquay G, et al. Primary cough headache, primary exertional headache, and primary headache associated with sexual activity: a clinical and radiological study. Neuroradiology 2013; Feb;55(3):297-305.

Headache Classification Subcommittee of the International Headache Society. "The International Classification of Headache Disorders: 2nd Edition". Cephalalgia 2004;24 Suppl 1:9-160.

http://online.lexi.com/lco/action/doc/retrieve/docid/patch_f/7003#rfs. Accessed 3/24/14.

Raskin NH. The cough headache syndrome: treatment.Neurology. 1995 Sep;45(9):1784.</sub>
 

DISCLAIMER: The information in this site is for informational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for advice, diagnosis, and treatment of any concerning symptoms or medical condition.