Headache from Coughing: Primary Cough (Valsalva-Maneuver) Headache

A diagnosis made only when more serious causes are ruled out first.

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Coughing is an everyday act for many of us. It may be a sign of bronchitis, a reaction to smoke, or simply a natural reaction to clear that tickle in your throat. While a nuisance, coughing typically does not cause actual pain or distress. But for those who suffer from primary cough headache, coughing is a painful and burdensome act.

This all being said, primary cough headache is a rare type of headache, occurring in less than one percent of the population—so diagnosis of it can only be made by a doctor, when more serious causes of headache are ruled out first.


What is a Primary Cough Headache?

Primary cough headache is a rare type of headache that typically affects adults over the age of 40.This disorder is also referred to as the Valsalva-maneuver headache, since sneezing and straining 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.

What Does a Primary Cough Headache Feel Like?

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, from a second to a couple minutes—although, for some people it may last up to two hours. Some people with primary cough headache also experience dizziness, nausea, or sleep disturbances.

How Does a Headache Specialist Diagnose Primary Cough Headache?

Most likely you will undergo imaging of the brain before your headache specialist or neurologist makes the diagnosis.

Imaging of the brain will be done with a 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 primary cough headache is not common. Although, don't fret if this is your diagnosis—while rare, primary cough headache is a benign disorder and not serious.


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

Cerebral Aneurysm

• Arnold Chiari Type 1 Malformation

Brain Tumor

Your doctor will also make sure there is not another primary headache disorder occurring, like a migraine or cluster headache. This is because migraines and cluster headaches can be exacerbated 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.

What Causes Primary Cough Headache?

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.

How are Primary Cough Headaches Treated?

Unfortunately there are no large studies examining the treatment of 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, a non-steroidal anti-inflammatory drug or NSAID, 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 cardiovascular events (i.e. heart attack, stroke)

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

The Bottom Line

Primary cough headache is an uncommon headache disorder—so if coughing or straining is related to your headaches, please seek medical guidance to ensure there is nothing more worrisome going on. 

That being said, if primary cough headache is your diagnosis, the good news is that there is treatment available. Likewise, if another headache disorder like migraine or cluster headache is the link between your cough and your headache, treatment is also available.


Cordenier A, De Hertogh W, De Keyser J, Versijpt J. Headache associated with cough: a review. The Journal of Headache and Pain 2013;14(1):42.       

Donnet A et al.  Primary cough headache, primary exertional headache, and primary headache associated with sexual activity: a clinical and radiological study. Neuroradiology, 2013;55(3):297-305.

Headache Classification Committee of the International Headache Society. "The International Classification of Headache Disorders: 3rd Edition (beta version)". Cephalalgia 2013;33(9):629-808.

Raskin NH. The cough headache syndrome: treatment. Neurology, 1995;45(9):1784.

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