Cough Headache: Causes, symptoms, treatment, Ayurveda understanding

Article by Dr Manasa S, B.A.M.S

What is cough headache?

Have you ever experienced a headache soon after coughing or sneezing or blowing up the nose? Then you are most likely to be experiencing a condition known as ‘cough headache’.

‘Cough Headaches’ are rare type of headaches and are most commonly triggered by coughing or straining.

Nature of Cough Headache

Cough headaches are bilateral in nature but can be unilateral as well. The pain ranges from moderate to severe in intensity and is described as sharp and throbbing in character. Cough headache reaches its peak after coughing and straining and settles down over several seconds to few minutes. In some cases, patients have reported headaches lasting up to two hours.

Types of Cough Headaches

Cough headaches are primarily of two types, primary and secondary cough headaches.

Primary cough headache

Primary cough headaches are triggered by coughing and straining. A minority of patients with Primary Cough Headache (PCH) experience headaches lasting up to two hours, with associated symptoms such as vertigo, nausea, and sleep abnormalities. Vomiting, light or sound sensitivity, and lacrimation are not commonly associated with PCH. This condition is most prevalent in individuals over 40 years old, with an average age of presentation around 60. While initially believed to be more common in men, research suggests no correlation between sex and PCH. The symptoms can be debilitating. Preventive treatment strategies, including addressing any underlying pulmonary diseases causing chronic cough, is recommended.

Salient features of Primary cough headache

• Are triggered due to coughing, sneezing, singing, laughing, crying, bending, having a bowel movement or other straining movements.
• Are uncomplicated and settles down without any treatment.

Pathophysiology of primary cough headache

The exact cause of primary cough headache is not clearly understood. Studies postulate that coughing causes sudden increase in intra-abdominal and intra-thoracic pressures. This subsequently leads to an increase in the central venous pressure. This activates nociceptive neurons. This causes headache. The other postulate states that the cause could be hypersensitivity of pressure-sensitive receptors near the venous vessels. The reason behind the hypersensitivity could be a hidden or a previous infection. One more postulate theorize that cough headache could be due to more crowded posterior cranial fossa.

Secondary cough headache

Secondary cough headaches though triggered by cough are caused by an underlying condition.

Salient features of Secondary cough headache

• Triggered by coughing but there is an underlying disorder associated with brain or structures near brain and spine
• Are more serious and need treatment

Causes of cough headache

Primary cough headache

The cause of primary cough headache is unknown and they are triggered by coughing, sneezing, crying and other straining activities.

Secondary cough headache

Below mentioned are some important causes for secondary cough headache –

• Chiari malformations – A defect in the structure of the skull where the brain, or cerebellum, descends through the base of the skull into the spinal canal.
• Defect in the shape of the skull
• Brain tumour
• Spontaneous cerebrospinal fluid leak
• A weak blood vessel that ballons out to push on tissue around the brain-cerebral aneurysm

Symptoms of cough headache

Symptoms of primary cough headache

• It begins suddenly just after coughing or other straining activities
• It typically lasts for few seconds to few minutes and very rarely up to two hours.
• Pain is sharp, stabbing, splitting or burning in nature
• Most of the time it affects both sides of the head and may be worse in the back of the head
• Nausea, vomiting, sensitivity to light and sound are not associated with primary cough headache.

Symptoms of secondary cough headache

Secondary cough headaches are also presented with the same type of symptoms. On the other hand, the other symptoms as those mentioned below are also observed in this type of headache –

• Severe pain in the head
• Locations of the headache keeps varying
• Dizziness
• Fainting
• Long lasting headaches
• Unsteadiness
• Blurred vision or double vision
• Sensation of ringing in the ears or loss of hearing
• Tremors

Diagnosis of cough headaches

The diagnosis of these coughs is done through –

• Detailed history
• Physical examination
• CT scan
• MRI

Management and treatment

Primary cough headache is not serious and they subside on their own without any kind of treatment.

When the pain is severe, then taking painkillers like indomethacin helps to relive the symptoms associated with cough headache.

Management of secondary cough headache

• Surgery is advocated for Chiari malformation to change the shape and to relieve pressure.
• Surgical procedure to seal off the aneurysm, or a flow diverter to deprive it of blood.
• Surgery, radiation, and chemotherapy are usually thought of in brain tumours

Can cough headaches be avoided?

Though the exact cause for cough headache is not clear, few measures can be taken to prevent the episodes of headache. These measures include –

• Checking out with doctor to know if one is having any lung or upper respiratory tract problems and getting an effective treatment for the same.
• Checking with the healthcare professional to know if the medications he or she is currently taking are responsible for their cough.
• Taking stool softener if there is constipation so as to avoid straining during defecation.
• Avoiding straining activities like bending, lifting heavy weights or other objects.

When to contact the healthcare provider?

One should consult doctor, if he or she observes one or more of the below mentioned conditions –

• Extreme pain of sudden onset
• Faintness, dizziness, or loss of balance
• Headache that is lasting for more than two hours
• Headache associated with fever, chills, or unexplained weight loss
• Frequent headache due to cough
• Headache that is altering in location, frequency and intensity

Prognosis

Most primary cough headache episodes resolve completely within 30 minutes and are not serious in nature. Secondary cough headache needs prompt evaluation to outline the treatment protocols.

Ayurveda perspective of Cough Headache

Ayurveda has not explained any variety of cough which matches with the explanation of ‘Cough Headache’.

At the same time, it is important to note that ‘headache’ has been mentioned in the below mentioned contexts related to description of ‘kasa – cough’ –

1. Samprapti of Kasa (Charaka Chikitsa) – In the pathogenesis of kasa vis-à-vis cough, Master Charaka explains that the aggravated vata obstructed in the lower portion of the body abruptly and swiftly moves upwards and get lodged in the channels in the upper parts of the body and also in the throat and chest. Later it occupies the empty spaces of the head and causes cough with painful symptoms. Here we can see that there is a mention of the vayu occupying the cavities or spaces in the head or, to keep it brief, afflicting the head. Later we may see that ‘shira shula’ i.e. headache being mentioned as one of the symptoms of ‘Vataja Kasa’. Summing up, we can conclude that severe aggravation in kasa or a vataja type of cough can cause severe headache followed by severe cough. This might be considered as the earliest explanation of ‘cough headache’.
2. Lakshana of Vataja Kasa – Vataja Kasa is one among the five types of Kasa. The description of vataja kasa explains the dry variety of cough associated with other painful symptoms. ‘Shira Shula’ vis-à-vis headache is one among the various symptoms of vataja kasa.

Treatment approach – Cough Headache shall be understood on the lines of ‘Vataja Kasa’ and its symptoms and shall be treated alike. Principles of ‘Vataja Shirashula’ or general line of treatment of shirashula shall also be followed because the disease is basically a headache. The treatments are interchangeable. Importantly, vata mitigating foods and lifestyle practices, hot comforts, rest, and medicines in oil or ghee base should be included in treating this condition.

Related Reading –

‘Vataja Kasa’ – causes, symptoms, treatment

Kasa – causes, pathogenesis, types, treatment