A cough headache (CH) is a rare diagnosis. It is described as a headache that lasts between one second and thirty minutes, as a result of coughing or other actions that cause an acute increase in intra-abdominal pressure, such as the Valsalva maneuver, straining when passing stool, lifting heavy weights and sneezing. Headaches of longer duration, up to two hours, have been reported [1]. All individuals have a 1% risk of suffering from cough headaches during their lifetime [2]. The disease prevalence in specialized headache clinics is similar [3]. In terms of distribution, men are more affected by CH than women, and the diagnosis is usually made after the fourth decade of life.

CH is classified into primary and secondary (also referred to as symptomatic CH), as described by the International Headache Society (IHS) [4]. In primary CH, there is no identifiable cause for the headache. Moreover, primary CH is benign [5]. The typical characteristics of a primary CH are sudden onset of bilateral pain in the frontotemporal or posterior regions of the head, with varying intensities, sometimes described as explosive [1]. Less common presentations include a unilateral headache and toothache [6] [7]. Features such as nausea and vomiting, as well as photophobia and phonophobia, which are commonly experienced in migraines, are not typical of CH.

Secondary CH occurs in response to an existing condition. Secondary CH is, in the majority of cases, caused by the Chiari malformation, type I. Patients with underlying pathology often exhibit a range of other symptoms, besides the headache.

It is assumed that the increase in abdominal pressure in primary CH increases venous pressure and thus intracranial pressure, culminating in CH. A similar mechanism has been proposed for secondary CH. Another hypothesis for primary CH is that there is overcrowding of the posterior cranial fossa [8]. In both classifications, the pathophysiology is not clearly understood.

It is important to note that primary CH is a diagnosis of exclusion, necessitating the investigation and exclusion of other possible causes of a headache.

As a result of the possibility of a causative disease, which is the case in about 50% of patients with cough headaches, radiological investigations have to be carried out in order to rule them out. Alternative causes of CH include posterior and anterior fossa tumors, Chiari malformation, acute sphenoid sinusitis, intracranial cysts, subdural hematoma, cerebral aneurysms, and brain metastatic lesions [1] [9]. Furthermore, other headache conditions exacerbated by coughing may be present. Neuroimaging is thus employed, of which the modality of choice is magnetic resonance imaging (MRI). It is required for diagnosis, and serves as a guide for further treatment plans.

Treatment for primary cough headache often involves managing symptoms. Indomethacin, a nonsteroidal anti-inflammatory drug (NSAID), is commonly prescribed and can be effective in reducing headache frequency and intensity. For secondary cough headache, treatment focuses on addressing the underlying cause, which may require surgery or other interventions.

The prognosis for primary cough headache is generally good, with many patients experiencing relief from symptoms with appropriate treatment. Secondary cough headache prognosis depends on the underlying condition. Once the cause is treated, headaches often improve or resolve completely.

The exact cause of primary cough headache is not well understood. It is believed to be related to increased pressure in the head during coughing or straining. Secondary cough headache is caused by structural abnormalities in the brain, such as Chiari malformation, or issues like cerebrospinal fluid leaks.

Cough headache is a rare condition, with primary cough headache being more common than secondary. It typically affects adults over the age of 40 and is more prevalent in men than women. The exact prevalence is not well documented due to its rarity.

The pathophysiology of primary cough headache is not fully understood. It is thought that the sudden increase in intracranial pressure during coughing or straining may trigger the headache. In secondary cough headache, the pathophysiology is related to the underlying structural abnormalities or other conditions affecting the brain.

Preventing cough headache involves managing triggers. Patients are advised to avoid activities that provoke coughing or straining. In some cases, medications may be prescribed to reduce the frequency of headaches. For secondary cough headache, treating the underlying condition is key to prevention.

Cough headache is a rare type of headache triggered by coughing or straining. It can be primary, with no underlying cause, or secondary, linked to structural brain issues. Diagnosis involves ruling out serious conditions, and treatment focuses on symptom management or addressing the underlying cause. The prognosis is generally favorable, especially for primary cough headache.

If you experience headaches triggered by coughing or straining, it is important to discuss your symptoms with a healthcare provider. They can help determine whether your headaches are primary or secondary and recommend appropriate treatment. Managing triggers and following medical advice can help reduce the frequency and severity of cough headaches.

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