HomeHealth articlesprimary cough headachesWhat Are the Causes of Primary Cough Headaches?

Primary Cough Headaches - Causes, Symptoms, Diagnosis, and Treatment

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A rare subgroup of headache diseases known as primary cough headaches (PCH) is characterized by the sudden onset of an acute headache brought on by coughing.

Written by

Dr. Durga. A. V

Medically reviewed by

Dr. Kaushal Bhavsar

Published At August 31, 2023
Reviewed AtSeptember 29, 2023


A distinct and uncommon type of headache disease known as primary cough headaches (PCH) is characterized by abrupt, severe headaches brought on by coughing, stifling, or Valsalva maneuvers. PCH occurs without any known etiology, unlike secondary cough headaches, which are brought on by underlying anatomical issues. Despite PCH being a relatively uncommon headache disease, it is crucial to recognize and comprehend it to diagnose and treat patients effectively. A brief, explosive headache during or right away after coughing or other comparable actions is the characteristic symptom of PCH. Although it might radiate to other areas, the pain is frequently restricted to the back of the head.

What Is Primary Cough Headaches?

Primary cough headaches, often called "cough-related headaches," are a particular kind of headache brought on by coughing, sneezing, straining, or any other type of physical activity. These headaches occur unexpectedly, last from a few seconds to a few minutes, and are rare. They typically do not have any major medical issues or underlying structural abnormalities. It is unclear what exactly causes primary cough headaches. It is thought that the headache is caused by the brain's pain-sensitive regions being stretched or dilated due to coughing or other vigorous actions that suddenly increase head pressure.

Primary cough headaches frequently go away on their own over time without the need for medical attention. But if individuals suffer from these headaches, they should speak with a medical expert to rule out any underlying illnesses and, if necessary, get the right treatments. To prevent or lessen the headaches, the doctor could prescribe certain drugs like Indomethacin. It is important to note that primary cough headaches are different from secondary cough headaches, which are brought on by underlying medical disorders such as brain tumors, Chiari malformations, or irregularities in the circulation of cerebrospinal fluid. Secondary cough headaches typically have different traits and may need additional medical testing and care.

What Are the Causes of Primary Cough Headaches?

The following are some variables that might facilitate their occurrence:

  • Intracranial pressure suddenly rises when individuals cough or strain.

  • Vascular enlargement in the brain.

  • Brain structures that are sensitive to pain are stretched or irritated.

  • Either a familial or genetic propensity.

  • Abnormalities in the way the brain processes pain.

  • Interference with the control of blood flow to the brain.

  • Pressure changes in the thoracic or abdominal areas are conveyed to the head.

  • Abnormalities in the dynamics of cerebrospinal fluid.

  • A malfunction in the respiratory and cardiovascular systems' ability to work together under stress.

  • The impact of neurochemical abnormalities on pain perception.

What Are the Symptoms of Primary Cough Headaches?

Primary cough headache signs and symptoms typically include:

  1. Sudden Onset: The headache frequently appears out of the blue, during or right after sneezing, laughing, coughing, or performing other intense activities.

  2. Intense Pain: The headache is usually quite painful and acute and is frequently described as stabbing or exploding. Although it seldom lasts more than a few minutes, it often lasts for a few seconds to a few minutes.

  3. Location: The pain is often felt on both sides of the head, with the back of the head (occipital area) being the primary location, though the temples and forehead might also experience pain.

  4. Lack of Additional Symptoms: Unlike migraines or tension headaches, primary cough headaches frequently do not come with additional symptoms like nausea, vomiting, sensitivity to light or sound, or aura.

  5. Recurrence: Primary cough headaches frequently last weeks or months before going away. They tend to reoccur with identical onset and duration patterns. They might also go away for a while before coming back.

How to Diagnose Primary Cough Headaches?

The typical steps in diagnosing primary cough headaches are as follows:

  1. Medical History: The doctor will begin by carefully looking over the symptoms, such as the type of headaches that occur and any triggers, such as coughing or strenuous activity. They will also inquire about the medical history and any relevant information.

  2. Physical Examination: A physical examination will be conducted to assess the patient's overall health and neurological status. The doctor may measure blood pressure and examine the head, neck, and neurological system to rule out any other probable headaches.

  3. Imaging Tests: The doctor may request imaging tests in some situations to rule out other underlying conditions. The brain may be seen, and any anomalies or structural problems can be ruled out with an MRI or CT scan (magnetic resonance imaging or computed tomography).

  4. Differential Diagnosis: Primary cough headaches are a diagnosis of exclusion, requiring the elimination of all other possible headache causes. It is necessary to treat conditions including migraines, tension headaches, and secondary headaches brought on by underlying medical conditions.

What Is the Treatment Plan For Primary Cough Headaches?

Primary cough headaches are often treated with a combination of the following methods:

  1. Observation and Reassurance: Primary cough headaches typically go away independently and are self-limiting. The physician may encourage individuals to watch their symptoms while assuring them that they rarely indicate a major underlying problem.

  2. Avoiding Triggers: One strategy for managing primary cough headaches is recognizing and avoiding things that make individuals cough or strain. Changing one's lifestyle may be necessary, such as refraining from activities that cause coughing fits or taking preventative measures.

  3. Medication: To help control the symptoms, the doctor may recommend medication if the headaches are frequent, severe, or significantly affect the quality of life. This could include nonsteroidal anti-inflammatory drugs (NSAIDs). Indomethacin is commonly used as the first-line treatment for primary cough headaches. It is typically taken before engaging in coughing or straining exercises and can delay the onset of headaches. Propranolol is one example of a beta-blocker drug that may be administered to treat primary cough headaches to lessen their frequency and intensity. If Indomethacin and beta-blockers are ineffective or poorly tolerated, other therapies such as Acetazolamide or antiepileptic drugs like Topiramate could be explored.

  4. Approaches for Managing Headaches: To reduce symptoms, general headache management approaches may be beneficial. These include using cold or hot packs on the head or neck, relaxing with breathing exercises, and getting enough sleep regularly.


Primary cough headaches, often called benign cough headaches, are not dangerous and usually go away on their own. Some treatments can be used to effectively manage the symptoms, even though they might be irritating and interfere with everyday activities. Primary cough headaches are treated with observation, reassurance, avoiding coughing or straining triggers, medications like Indomethacin or beta-blockers to prevent or lessen headache frequency, and general headache management techniques. It is critical to consult with a medical specialist for an accurate diagnosis and a treatment plan suited to one's specific needs. Primary cough headaches can be adequately managed, leading to an improvement in quality of life.

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Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)


primary cough headaches
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