Differential Diagnosis for New Headache Worse with Bending Over or Coughing

Single Most Likely Diagnosis

• Tension Headache or Cervicogenic Headache: These types of headaches can worsen with activities that increase intracranial pressure or strain the neck, such as bending over or coughing. They are common and often related to muscle tension or poor posture.

Other Likely Diagnoses

• Migraine: Although migraines can be triggered by various factors, some individuals may experience worsening of migraine symptoms with increased intracranial pressure or physical exertion, such as bending or coughing.
• Sinusitis: Headaches due to sinusitis can be exacerbated by bending over, as this position can increase pressure in the sinuses.
• Idiopathic Intracranial Hypertension (IIH): This condition involves increased pressure within the skull without an apparent cause. Symptoms can include headache that worsens with activities that increase intrathoracic pressure, such as coughing.

Do Not Miss Diagnoses

• Subarachnoid Hemorrhage: A life-threatening condition where there is bleeding into the space surrounding the brain. Although less common, it can present with a sudden, severe headache that worsens with coughing or bending due to increased intracranial pressure.
• Brain Tumor: Tumors within the brain can cause increased intracranial pressure, leading to headaches that worsen with activities like bending or coughing.
• Meningitis: Inflammation of the protective membranes covering the brain and spinal cord, which can cause headache, fever, and stiff neck. Coughing or bending can exacerbate the headache due to increased pressure.

Rare Diagnoses

• Chiari Malformation: A structural defect in the cerebellum that controls balance, which can cause headaches that worsen with coughing or bending due to increased pressure on the brainstem.
• Pseudotumor Cerebri (Secondary IIH): Similar to IIH but with an identifiable cause, such as certain medications or medical conditions. It can present with similar symptoms, including headaches that worsen with increased intrathoracic pressure.
• Arteriovenous Malformation (AVM): An abnormal connection between arteries and veins, which can cause headaches due to the risk of bleeding or increased pressure. Symptoms can worsen with activities that increase blood pressure, such as bending or coughing.