Headache From Coughing (Valsalva Maneuver)

Primary cough headache is a rare type of headache that results from coughing, occurring in less than 1% of the population. The diagnosis can only be made by a healthcare provider when other causes of a headache are ruled out first. 

Overview

Primary cough headache typically affects adults over the age of 40. This disorder is also referred to as the Valsalva maneuver headache. Sneezing, laughing, blowing your nose, and straining (like when having a bowel movement) can also bring it on.

Primary cough headache is not to be confused with benign exertional headache, which is a headache brought on by strenuous exercise or sexual activity.

Signs and Symptoms

This type of headache usually comes on suddenly after a person coughs, and occurs on both sides of the head, especially towards the back of the head. It's often described as sharp or stabbing.

How long it lasts is variable, but it's usually short, lasting from a second to a couple of minutes. Although, for some people, the headache may last up to two hours. Some people with a primary cough headache also experience dizziness, nausea, or sleep disturbances.

Diagnosis

Most likely you will undergo brain imaging before your headache specialist or neurologist makes the diagnosis. Imaging of the brain will be done with magnetic resonance imaging (MRI) and/or magnetic resonance angiography (MRA).

A thorough workup will ensure that there is no other cause for your cough-induced headache, especially since a primary cough headache is not common.

There are a number of secondary headaches that may mimic a primary cough headache, and some are life-threatening. Examples include:

• Cerebral aneurysm
• Arnold Chiari Type 1 malformation
• Brain tumor

Your healthcare provider will also make sure there is not another primary headache disorder occurring, like a migraine or a cluster headache. This is because migraines and cluster headaches can be aggravated by coughing or straining.

In other words, it can be a tricky process determining whether your cough is triggering the headache or just worsening it, a critical distinction to make.

Causes

The cause of primary cough headache is not known.

One potential mechanism is that the headache is due to increased pressure in the veins surrounding the brain, which is brought on by coughing or straining.

It could also be caused by narrowing of the veins of the neck or sinuses.

Treatments

Unfortunately, there are no large studies examining the treatment of a primary cough headache—mostly because it's rare, but also because the headache is usually so short-lived that treatment is not necessary.

That being said, indomethacin, an NSAID (nonsteroidal anti-inflammatory drug), is the typical medication of choice. Indomethacin is a prescription medication and does have some potential adverse effects including:

• Gastrointestinal upset and/or bleeding
• High potassium levels
• Dizziness
• Blurry vision
• Increased risk of cardiovascular events (i.e. heart attack, stroke)

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

A Word From Verywell

The big picture here is that primary cough headache is an uncommon headache disorder.

So if coughing or straining is related to your headaches, please seek medical guidance right away to ensure there is nothing more worrisome going on, especially if the headache is sudden and new.

That being said, if a primary cough headache is your diagnosis, the good news is that there is treatment available.

Likewise, if another headache disorder like migraine or a cluster headache is the link between your cough and your headache, treatment is also available.