Can Exercise Cause Headaches?

Primary Exertional Headache: A Rare Type of Headache

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Can exercise cause a headache?. Compassionate Eye Foundation/Taxi/Getty Images

Exercise is a healthy activity that helps relieve stress and boost endorphins. But, whether you enjoy long runs or competitive sports, the last thing you need is a headache after that surge of endorphins from your workout. Primary exertional headache is a rare type of a headache that causes a throbbing head pain, during or after, any form of sustained exertion.

Symptoms

According to the second edition of the International Classification of Headache Disorders (ICHD-II), symptoms of primary exertional headache include:

• Pulsating headache

• Lasting from 5 minutes to 48 hours

• Occurs only during or after physical activity

• Symptoms are not explained by another medical condition

In addition to the above features, an exertional headache typically occurs on both sides of the head and can usually be prevented by avoiding strenuous physical activity.

It should not be confused with a primary cough headache, which is brought on by coughing or the Valsalva-maneuver, or a benign sexual headache which is triggered by sexual activity. The age of onset for a primary exertional headache is in a person's 20s and it is more common in men than women. Finally, according to the International Classification of Headache Disorders (ICHD-II), primary exertional headache may be more likely to occur in hot weather or at high altitudes.

Diagnosis

Before your headache specialist or neurologist makes the official diagnosis of primary exertional headache, you will most likely undergo imaging of the brain. Imaging is done with a magnetic resonance imaging (MRI) and/or magnetic resonance angiography (MRA). This will ensure that there is no other cause for your exertion-induced headache, especially since primary exertional headache is not common. Causes of a headache that may mimic primary exertional headache but are really secondary headaches or signal an emergent medical condition include:

Stroke
Brain Tumor
Subarachnoid hemorrhage
Vertebral artery dissection

Cause

The cause of primary exertional headache is not known.

One potential mechanism is that a headache is due to an incompetent internal jugular vein. The internal jugular vein is a large vein on either side of your neck that collects blood from the brain and face. If the vein is not working well, blood may flow back to the brain instead of to the heart. This leads to increased pressure in the venous system surrounding the brain.

One study in Cephalalgia found that individuals with an exertional headache were significantly more likely to have incompetent internal jugular veins than controls, or individuals without an exertional headaches.

Treatment

Indomethacin, a non-steroid anti-inflammatory drug or NSAID like ibuprofen that is sometimes used to treat gout or arthritis, is the usual treatment for primary exertional headache. It can also be used 30 to 60 minutes prior to exercise to prevent a headache. Ergotamine and propranolol have also been used to help prevent this type of a headache. A few of the side effects of indomethacin include: gastrointestinal upset and/or bleeding, kidney damage, headache, dizziness, and blurry vision. If your doctor prescribes indomethacin, please review these and other side effects carefully.

Key Points:

• Primary exertional headache is a rare type of a headache that occurs during or after strenuous physical activity.
• Before being diagnosed with primary exertional headache, you should undergo a thorough neurologic exam and brain imaging to rule out other causes or a secondary headache.


• Exercise is good for your physical and mental health. If you suffer from primary exertional headaches, talk with your doctor about devising a less strenuous exercise regimen or considering a medication to take prior to physical activity to prevent a headache.
Of course, if you have any questions or concerns regarding your headache diagnosis or if you have a new onset headache or one that follows a different pattern, please contact your healthcare provider.

Sources

Cutrer M. Primary exertional headache. In: UpToDate, Basow DS (Ed), UpToDate, Waltham, MA, 2013.
Doepp F, Valdueza JM, Schreiber SJ. Incompetence of internal jugular valve in patients with primary exertional headache: a risk factor? Cephalalgia 2008; 28:182.
Halker RB, Vargas BB. Primary Exertional Headahe: Updates in the Literature. Curr Pain Headache Rep. 2013; Jun;17(6):337.
Headache Classification Subcommittee of the International Headache Society. "The International Classification of Headache Disorders: 2nd Edition". Cephalalgia 2004;24 Suppl 1:9-160.
Pascual J, Iglesias F, Oterino A, Vazquez-Barquero A, Berciano J. Cough, exertional, and sexual headaches: an analysis of 72 benign and symptomatic cases. Neurology 1996; 46:1520.

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