Exercise headaches

Definition

Exercise headaches occur during or after sustained, strenuous exercise. Activities most commonly associated with exercise headaches are running, rowing, tennis, swimming and weightlifting.

Doctors divide exercise headaches into two categories. Primary exercise headaches are usually harmless, aren't connected to any underlying problems and can often be prevented with medication. Secondary exercise headaches, on the other hand, are caused by an underlying, often serious, problem within the brain — such as bleeding or a tumor — or outside the brain — such as coronary artery disease. Secondary exercise headaches may require emergency medical attention.

Symptoms

Primary exercise headaches
These headaches:

• Are usually described as throbbing
• Occur during or after strenuous exercise
• Affect both sides of the head in most cases

Secondary exercise headaches
These headaches may cause:

• The same symptoms as primary exercise headaches
• Vomiting
• Loss of consciousness
• Double vision
• Neck rigidity

Primary exercise headaches typically last between five minutes and 48 hours, while secondary exercise headaches usually last at least a day and sometimes linger for several days or longer.

When to see a doctor
If you experience a headache during or after exercise, consult your doctor — especially if it begins abruptly or if it's your first headache of this type.

Causes

Primary exercise headaches
The exact cause of primary exercise headaches is unknown. One theory is that strenuous exercise dilates blood vessels inside the skull.

Secondary exercise headaches
Secondary exercise headaches are caused by an underlying problem, such as:

• Bleeding in the area between the brain and the thin membranes that cover the brain (subarachnoid hemorrhage)
• Abnormalities in a blood vessel leading to or within the brain
• Cancerous or noncancerous tumors
• Obstruction of cerebrospinal fluid flow
• Reduced blood flow in the arteries feeding the heart
• Sinus infection

Risk factors

You may be at greater risk of exercise headaches if you:

• Exercise in hot weather
• Exercise at high altitude
• Have a personal or family history of migraine

Primary exercise headaches occur most often in young men in their 20s. People with secondary exercise headaches tend to be a little older — average age 42 — and of either sex.

Preparing for your appointment

You're likely to start by first seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to a neurologist. Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restricting your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including past illnesses and operations, major stresses or recent life changes, and any medical problems that run in your family.
• Make a list of all medications, as well as any vitamins and supplements, that you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For exercise headaches, some basic questions to ask your doctor include:

• What is likely causing my symptoms or condition?
• Are there other possible causes for my symptoms or condition?
• What kinds of tests do I need?
• Is my condition likely temporary or chronic?
• What is the best course of action?
• What are the alternatives to the primary approach that you're suggesting?
• I have these other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Should I see a specialist?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment whenever you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you first begin experiencing exercise headaches?
• Have your exercise headaches been continuous or occasional?
• Have you had a similar problem in the past?
• Have you had other kinds of headaches? If so, what were they like?
• Has anyone in your immediate family experienced migraines or exercise headaches?
• What, if anything, seems to improve your headaches?
• What, if anything, makes your headaches worse?

Tests and diagnosis

Your doctor will likely recommend an imaging test, especially if:

• Your headaches last more than a few hours
• Your headaches strike suddenly, like a thunderclap
• You're older than age 40
• You have other signs and symptoms, such as nausea, vomiting or vision disturbances

In these cases, different types of imaging tests can help your doctor verify that you have the harmless variety of exercise headache, rather than the type caused by a structural or vascular abnormality.

• Computerized tomography (CT). CT uses X-rays to generate a cross-sectional image of your brain. CT can show bleeding into or around the brain and is often used if your headache occurred less than 48 hours beforehand.
• Magnetic resonance imaging (MRI). This test uses a magnetic field and radio waves to create cross-sectional images of the structures within your brain.
• Magnetic resonance angiography (MRA) and CT angiography. These tests visualize the blood vessels leading to and inside your brain.

Sometimes a spinal tap (lumbar puncture) is needed as well, especially if the headache started abruptly and very recently and brain imaging appears normal.

Treatments and drugs

If no underlying structural or vascular problem is causing your exercise headaches, your doctor may recommend medications to help prevent the headaches.

• Indomethacin, an anti-inflammatory drug, is most commonly prescribed.
• Propranolol, a blood pressure medication, also is used preventively.

If your exercise headaches are predictable, you may be able to take the medication an hour or two before a scheduled event, such as a tennis match or a hike at high altitude. If your exercise headaches are frequent or unpredictable, you might want to take the preventive medicine every day.

Prevention

Exercise headaches tend to occur more often when the weather is hot and humid, or if you're exercising at high altitudes. If you're prone to exercise headaches, you may want to avoid exercising in these types of conditions.

Some people experience exercise headaches only during the performance of certain activities, and may prevent their headaches by avoiding these activities. A warm-up prior to strenuous exercise also can help prevent exercise headaches.