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Primary 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 30 minutes
• Cause sharp, stabbing or splitting pain
• Usually affect both sides of your head and are typically most pronounced in the back of your head
• Can be followed by a dull, aching pain for several hours

Secondary cough headaches
Secondary cough headaches often have similar symptoms as primary cough headaches, though they may last up to days, rather than minutes. In order to rule out secondary cough headache, further testing, such as brain imaging, is necessary.

When to see a doctor
Consult your doctor if you experience sudden headaches after coughing — especially if the headaches are frequent or severe or you have any other neurological signs or symptoms, such as imbalance or blurred or double vision.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

Primary cough headaches
The cause of primary cough headaches isn't known, though some researchers suspect that increased pressure in the head (intracranial pressure) caused by coughing and other types of straining may play a role.

Secondary cough headaches
The cause of secondary cough headaches can almost always be traced to a problem in the back of the brain or at the base of the skull, where the brain and spinal cord connect, such as:

• A defect in the shape of the skull.
• A defect in the configuration of the cerebellum, which can result in a portion of the brain being forced through the opening at the base of the skull (foramen magnum), where only the spinal cord should go. Some of these types of defects are called Chiari malformations.
• A brain tumor.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

Primary cough headaches
Risk factors for primary cough headaches include:

• Being older than age 40
• Being a man

Secondary cough headaches
Risk factors for secondary cough headaches include:

• Being younger than age 40

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

You're likely to start by first seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to a neurologist. Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restricting your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including past illnesses and operations, major stresses or recent life changes, and any medical problems that run in your family.
• Make a list of all medications, as well as any vitamins and supplements, that you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For cough headaches, some basic questions to ask your doctor include:

• What is likely causing my symptoms or condition?
• Are there other possible causes for my symptoms or condition?
• What kinds of tests do I need?
• Is my condition likely temporary or chronic?
• What is the best course of action?
• What are the alternatives to the primary approach that you're suggesting?
• I have these other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Should I see a specialist?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment whenever you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you first begin experiencing cough headaches?
• Have your cough headaches been continuous or occasional?
• Have you had a similar problem in the past?
• Have you had other kinds of headache? If so, what were they like?
• Has anyone in your immediate family experienced migraines or cough headaches?
• What, if anything, seems to improve your headaches?
• What, if anything, makes your headaches worse?

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

Your doctor may recommend brain-imaging tests, such as MRI or CT scans.

• Magnetic resonance imaging (MRI). During an MRI, a magnetic field and radio waves are used to create cross-sectional images of the structures within your head to determine any problems that may be causing your cough headache.
• Computerized tomography (CT). These scans use a computer to create cross-sectional images of your brain and head by combining images from an X-ray unit that rotates around your body.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

Treatment differs, depending on whether you have primary or secondary cough headaches.

Primary cough headache
If you have a history of primary cough headaches, your doctor may recommend that you take daily medication to help prevent or reduce the pain.

These preventive medications may include:

• Indomethacin, an anti-inflammatory drug
• Acetazolamide, a diuretic that reduces the production of spinal fluid

Rarely, a spinal tap (lumbar puncture) may be recommended. With this procedure, the doctor removes some of the fluid that surrounds your brain and spinal cord. This may help reduce the pressure inside your skull that may be causing the headaches.

Secondary cough headache
If you have secondary cough headaches, surgery is often needed to correct the underlying problem. Preventive medications usually don't help people who have secondary cough headaches. However, responding to medication doesn't mean that you have a primary cough headache.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

Preventing the actions that trigger your cough headaches — whether that's coughing, sneezing or straining on the toilet — may help reduce the number of headaches you experience. Some preventive measures may include:

• Treating lung infections, such as bronchitis
• Using cough suppressants as needed
• Getting an annual flu shot
• Using stool softeners to avoid constipation
• Minimizing heavy lifting

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.