Exercise Headaches

Overview

Exercise headaches are headaches that occur during or after strenuous exercise. They can happen during various activities such as running, rowing, tennis, swimming, and weightlifting. Health care providers divide exercise headaches into two categories: primary and secondary. Primary exercise headaches are usually harmless and can often be prevented with medication. Secondary exercise headaches, on the other hand, are caused by an underlying problem, such as bleeding or a tumor in the brain, coronary artery disease, or structural irregularities in the head, neck, or spine. These types of headaches may require emergency medical attention. Symptoms of exercise headaches include throbbing pain on both sides of the head, and in the case of secondary exercise headaches, additional symptoms may include vomiting, loss of consciousness, double vision, neck stiffness, and more. Risk factors for exercise headaches include exercising in hot weather, exercising at high altitude, and having a personal or family history of migraine. If you experience a headache during or after exercise, it's best to consult your healthcare provider.

Understanding the disease

Symptoms

The symptoms of primary exercise headaches include a throbbing headache that occurs during or after strenuous exercise, affecting both sides of the head in most cases. Secondary exercise headaches may cause the same symptoms as primary exercise headaches, as well as additional symptoms such as vomiting, loss of consciousness, double vision, neck stiffness, and a headache that lasts at least a day or longer.

Risk Factors

Risk factors for developing exercise headaches include exercising in hot weather, exercising at high altitude, and having a personal or family history of migraine.

Development

Exercise headaches can develop into two categories: primary exercise headaches and secondary exercise headaches.

1. Primary exercise headaches: The exact cause of primary exercise headaches is unknown. One theory suggests that strenuous exercise dilates blood vessels inside the skull, which could lead to headaches. These headaches are usually harmless and can often be prevented with medication.
2. Secondary exercise headaches: These 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), irregularities in a blood vessel leading to or within the brain, cancerous or noncancerous tumors, obstruction of cerebrospinal fluid flow, sinus infection, or structural irregularities in the head, neck, or spine. Secondary exercise headaches may require emergency medical attention as they can be a sign of a more serious issue.

Assessment and Diagnosis

Triage

If you experience a headache during or after exercise, it is advisable to consult your healthcare provider. You should call your provider right away if the headache begins abruptly or if it's your first headache of this type. Additionally, make an appointment with your doctor if tension-type headaches disrupt your life or you need to take medication for your headaches more than twice a week. Even if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different. Occasionally, headaches may indicate a serious medical condition, so it's important to seek medical advice in such cases. Remember, if you have any signs or symptoms such as fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness, or speaking difficulties, seek emergency care immediately.

Diagnosis

To diagnose exercise headaches, your healthcare provider will typically recommend an imaging test. If you have continuous headaches or other symptoms like nausea, vomiting, or vision disturbances, your provider may order Magnetic Resonance Imaging (MRI), Magnetic Resonance Angiography (MRA), or Computerized Tomography (CT) Angiography. These tests can help rule out any structural or vascular irregularities causing the headaches. In some cases, a spinal tap (lumbar puncture) may also be necessary.

Management and Treatment

Prevention

Exercise headaches can be prevented to some extent by avoiding certain triggers. Some prevention strategies include:

1. Avoiding exercising in hot and humid weather or at high altitudes, as these conditions may increase the risk of exercise headaches.
2. Engaging in a warm-up session before strenuous exercise.
3. Avoiding specific activities that tend to trigger exercise headaches, such as running, rowing, tennis, swimming, and weightlifting.
4. Ensuring proper hydration before, during, and after exercise.
5. Gradually increasing the intensity and duration of your workout to avoid sudden, intense exertion.
6. Managing stress through relaxation techniques like deep breathing, yoga, meditation, or progressive muscle relaxation.
7. Maintaining a healthy lifestyle with regular sleep, a balanced diet, and regular exercise. If you still experience exercise headaches despite these preventive measures, consult your healthcare provider for further advice.

Home Remedies

Home remedies that may help alleviate exercise headaches include:

1. Rest: If possible, rest in a quiet, dark room after strenuous exercise.
2. Hydration: Drink plenty of water to stay hydrated during and after exercise.
3. Snacking: Eating a small snack, such as a piece of fruit or a granola bar, can help maintain blood sugar levels and prevent headaches.
4. Over-the-counter pain relievers: Taking ibuprofen, aspirin, or acetaminophen can help relieve mild to moderate exercise headaches.
5. Cold or warm compress: Applying a cold or warm compress to the neck and forehead may provide relief.
6. Massage: Gently massaging the temples or the back of the neck can help alleviate tension.
7. Deep breathing exercises: Practicing deep breathing or slow breathing techniques can help relax and reduce stress.
8. Avoiding triggers: Identify and avoid specific triggers that may provoke exercise headaches, such as intense exercise in hot weather or specific activities.
9. Gradual exercise: Gradually build up your exercise routine to avoid sudden intense physical exertion.
10. Staying well-hydrated and maintaining a balanced diet can help prevent headaches. Remember, if your exercise headaches persist, worsen, or are accompanied by additional symptoms, consult your healthcare provider.

Treatment

The treatment for exercise headaches depends on whether an underlying structural or vascular problem is identified. If no such problems are found, preventive medications may be recommended. Commonly prescribed medications include:

1. Indomethacin: An anti-inflammatory drug that can help prevent exercise headaches.
2. Propranolol (Inderal, Innopran XL): A blood pressure medication that can also be used to prevent exercise headaches.
3. Naproxen (Naprosyn), phenelzine (Nardil), and dihydroergotamine mesylate (Migranal, Trudhesa): Other therapies that have been reported to be effective in some people. In some cases, taking a medication an hour or two before a scheduled event may be sufficient. However, if the exercise headaches are frequent or unpredictable, daily preventive medicine may be needed. It is important to consult with a healthcare provider to determine the most appropriate treatment based on individual circumstances.

Preparing for medical consultation

Preparing for an appointment for exercise headaches involves being aware of any pre-appointment restrictions, writing down any symptoms you're experiencing, including those related to exercise, and gathering information about your exercise routine and headaches. It's also helpful to bring a family member or friend along and to make a list of any questions you may have for your doctor. In addition, it's important to note any major stresses or recent life changes that could be affecting your headaches, and to make a list of all medications, vitamins, or supplements you're taking. Here are some additional tips specific to exercise headaches:

• Keep a headache diary: Record when and how long your headaches occur, their intensity, and any possible triggers. This can help you identify patterns and provide valuable information to share with your doctor.
• Be prepared to discuss your exercise routine: Describe the type, duration, and intensity of your workouts, as well as any recent changes in your routine. This can help your doctor understand the possible relationship between your exercise and headaches.
• Bring a family member or friend who can provide additional information: They may be able to provide insights into your exercise habits and headaches that you may have missed or forgotten.
• Be ready to discuss other potential triggers: In addition to exercise, be prepared to discuss any other factors that could be triggering your headaches, such as stress, dehydration, or lack of sleep.