Spontaneous vertebral artery dissection (VAD) is common after minor neck trauma or abrupt neck manipulation, which may result in stroke. However, violent cough is a less recognised cause of VAD. Only a few cases are reported in the literature. We review the literature and report a case of a 62-year-old man who presented with a headache and neck pain following a period of intermittent coughing, which led to VAD and a cerebellar ischaemic stroke. He responded well to medical treatment and made a full recovery. Therefore, VAD should be considered in the differential diagnosis for patients presenting with neck pain and headache after episodes of violent coughing.