Q. I get a “cough headache.” Whenever I cough, sneeze, bend over, or laugh, I get an excruciatingly painful pressure headache. Is this common? And, is there anything I can do to treat it?
A. Cough headache is triggered by rapid increases in intra-abdominal pressure when coughing and can occur with other forms of straining such as laughing, sneezing, bending over, or with a bowel movement. The headache occurs in less than one percent of the population and most commonly affects people over the age of 40. Primary cough headaches are usually sharp or stabbing and last from a few seconds to a few minutes, and are generally benign . It is important to rule out secondary cough headaches, which are more serious, last longer and may be associated with dizziness, fainting, or imbalance. There is no known cause of primary cough headaches. Secondary cough headaches can be caused by a Chiari malformation, which is a defect in the cerebellum (the area of the brain that controls balance). It is important to see a neurologist or headache specialist and obtain an MRI of the brain and possibly other neuroimaging studies and/or lumbar puncture to look for other causes of secondary cough headaches (particularly if under the age of 40) such as an aneurysm, tumor, or spontaneous cerebrospinal fluid leak.
There are several medication treatment options for primary cough headaches including anti-inflammatories, beta blockers, acetazolamide (diuretic), and ergotamines. For more serious secondary cough headaches, surgery is often needed to address the underlying problem. Preventive medications usually don’t help significantly in these cases.