Consider Primary Cough Headache

Primary Cough Headache

This is a primary headache that has sudden onset, with a duration that can vary from just one second up to 30 minutes. It is brought on by, and occurs in association with coughing, straining and/or Valsalva manoeuvre (forcible exhalation against a closed airway, usually done by closing one's mouth and pinching one's nose shut).

Primary cough headache (PCH) does not begin earlier than 40 years of age. The average age of onset is 67 years and up to 80% of sufferers are men. It is an episodic disorder that can last between two months to two years.

The pain begins immediately or within seconds of the trigger, which include coughing, sneezing, nose blowing, laughing, crying, singing, lifting a heavy object, straining on the toilet and stooping. Sustained physical exercise is not a trigger for PCH.

It is moderate to severe in intensity, with a sharp, stabbing, splitting or even explosive quality. The pain can occur on both sides of the head and most sufferers also have a continuous dull headache between attacks.

The symptoms of PCH can occur with other types of headache, and can be seen with brain tumours or disorders involving the back part and the base of the brain, so a magnetic resonance image (MRI) scan of the brain is often recommended as a good screening investigation to help rule out any possible secondary causes.

If this brief description does not match your headache type, go to Section 1 – Q.3

Treatment of Cough Headaches

Acute treatment of individual primary cough headaches is generally not considered because of the short duration of the attacks and the complexity of triggers.

Like many of the other shorter lasting primary headaches, primary cough headache responds almost absolutely to a medication called indomethacin (a non-steroidal anti-inflammatory drug).