Differential Diagnosis for Headache that Worsens with Cough and Bending Over
Single Most Likely Diagnosis
- Tension Headache or Cervicogenic Headache: These types of headaches can worsen with activities that increase intrathoracic or intra-abdominal pressure, such as coughing, or with movements that strain the neck, like bending over. The mechanism involves the transmission of pain from the cervical spine to the head.
Other Likely Diagnoses
- Migraine: Although migraines are typically associated with nausea, vomiting, and sensitivity to light and sound, some individuals may experience worsening of migraine symptoms with physical activity, including coughing or bending.
- Sinusitis: Inflammation of the sinuses can cause headaches that worsen with bending over or coughing due to increased pressure in the sinuses.
- Idiopathic Intracranial Hypertension (IIH): Headaches in IIH can worsen with activities that increase intrathoracic pressure, such as coughing, due to the transmission of increased pressure to the cerebrospinal fluid space.
Do Not Miss Diagnoses
- Subarachnoid Hemorrhage: Although less common, a sudden, severe headache that worsens with coughing or bending could be indicative of a subarachnoid hemorrhage, especially if accompanied by other symptoms like sudden onset, vomiting, or loss of consciousness.
- Brain Tumor: Headaches due to brain tumors can worsen with activities that increase intracranial pressure, such as coughing or bending, due to the mass effect of the tumor.
- Chiari Malformation: This condition involves the cerebellum extending into the spinal canal, which can cause headaches that worsen with coughing or straining due to increased pressure on the cerebellum and brainstem.
Rare Diagnoses
- Pseudotumor Cerebri (Secondary to Other Causes): Similar to IIH, but with an identifiable cause, this condition can lead to headaches that worsen with coughing or bending.
- Arteriovenous Malformation (AVM): AVMs can cause headaches due to the abnormal flow of blood through the malformation, potentially worsening with increased intrathoracic pressure.
- Cervical Spinal Stenosis: Narrowing of the cervical spinal canal can cause headaches, especially with activities that increase pressure on the cervical spine, like bending or coughing.