Exercise Headaches – Causes, Types, Symptoms, Treatment

Exercise has a host of benefits on health and wellbeing. However, it can cause certain symptoms and even trigger or aggravate certain conditions in some people. Headaches are one such example. Exercise may trigger headaches that are due to other conditions or even cause certain types of headaches.

What are exercise headaches?

Exercise headaches, also referred to as exercise-induced headaches or exertional headaches, are episodes of head pain caused or triggered by physical activity. It may occur with any strenuous physical activity and this mary vary among individuals. Exercise headaches are more likely to occur with physical activity in hot weather or high altitude.

People who have migraines or a family history of migraines are at greater risk. Exertional headaches are not uncommon. Many people may experience these headaches after physical activity every now and then. It can also occur after sexual activity (orgasmic headache). However, some people are prone to suffering with these headaches every time after physical strain.

Type of Exercise Headaches

There are two types of exercise headaches, referred to as primary or secondary exercise headaches.

Primary exercise headache

Primary exercise headaches arise with or after exercise but are not due to any other condition. In fact the exact cause of these headaches is unclear. Primary exercise headaches are largely benign. It usually does not progress and is overall harmless.

Secondary exercise headache

Secondary exercise headaches also arise with or after exercise but are due to some underlying condition. In this case, exercise triggers the headache caused by the underlying condition or aggravates the pre-existing headache. Secondary headaches can be serious.

Causes of Exercise-Induced Headaches

Exercise is usually not the cause but rather the trigger or exacerating factor. Ths depends on whether it is a primary or secondary exercise-induced headache. However, it is important to understand that the headache may not always be associated with exercise or physical activity. Sometimes a headache may occur at the same time as exercise and it may not be linked.

Causes of Primary Exercise Headache

The exact cause of a primary exercise headache is unknown. It is believed to be due to changes in the blood flow to the brain as a result of the blood vessels dilating (widening). However, there could be other factors at play. A host of different physiologic disturbances can arise with exercise which may therefore lead to headaches.

Certain exercises may cause muscle strain and spasm which can lead to headaches. In fact, it is believed that the increased demand of head and neck muscles causes blood vessels to widen (dilate). Similarly other buichemical changes due to exercise, such as low blood glucose, can also cause headaches. Dehydration is also a possible cause of headaches after strenuous exercise.

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Causes of Secondary Exercise Headaches

Secondary exercise headaches is a result of other conditions. It is important to note that headaches may occur in these conditions even without exercise. These conditions may include:

• Aneurysms, arteriovenous (AV) malformations and other abnormalities of the blood vessels in the brain.
• Benign and malignant (cancerous) tumors. Benign tumors press against the brain and surrounding tissue while cancers invade the health tissue.
• Hydrocephalus, which is the accumulation of cerebrospinal fluid (CSF) in and around the brain that may occur with an obstruction to CSF flow.
• Musculoskeletal abnormalities of the head, neck and/or spine.
• Sinusitis which is often due to an infection although other causes of sinusitis may also present with a headache that is triggered or worsened after exercise.

Sometimes exercise can trigger a migraine attack in some people with a history of migraines. People with a history of migraines are at the greatest risk of exercise-induced headaches. Similarly there is a higher risk of exercise headaches when there is physical strain in hot weather or at high altitudes.

Signs and Symptoms

Exercise headaches are usually described as throbbing in nature. It tends to occur on both sides of the head simultaneously. Typically this headache occurs during or shortly after exercising. However, other headache presentations may also be triggered with exercise. Therefore the headache may not throbbing in nature and can be one-sided.

Primary exercise headaches present exclusively with head pain without other signs and symptoms. However, secondary headaches usually occur with a host of other signs and symptoms that occur. This includes:

• Nausea
• Vomiting
• Visual disturbances like double vision
• Neck stiffness
• Loss of consciousness (uncommon)

It is also important to identify whether these other signs and symptoms are due to other physiologic or pathological disturbances. For example, a drop in blood glucose levels or an increase in blood pressure which frequently occurs with exercise may be responsible for some of these other signs and symptoms.

Treatment of Exercise Headaches

Primary exercise headaches may not require any treatment if it is short-lived and only occurs occasionally. These headaches can can last from a few minutes to several hours. However, if the headaches are severe then treatment may be considered to manage pain. The underlying cause of econdary exercise headaches should be treated although palliative (ease symptoms) and preventative treatment may also be considered.

• Anti-inflammatory drugs like indomethacin and naproxen may be used to treat exercise headaches. Indomethacin may also be used to prevent exercise headaches.
• Anti-hypertensive (high blood pressure) medication like propranolol may also be use dto prevent exercise headaches.

It is imperative that a diagnosis of exercise headaches is made by a medical professional. Diagnostic investigations may be necessary. A host of serious conditions can present with headaches and this could be mistaken for exercise headaches at times. Some of these conditions, like a stroke, can also be life-threatening.

Prevention of Exercise Headaches

Exercise headaches are not entirely preventable. It is important to take medication as prescribed by a doctor. Sometimes this medication may need to be used before exercising in order to prevent a headache. Some of the following lifestyle measures may be helpful in preventing headaches that can arise with physical exertion. However, these headaches are not necessarily exercise headaches.

• Constantly rehydrate with a suitable fluid. Oral rehydrating solutions (ORS) are the best option as it contains the optimal concentration of fluid and electrolytes.
• Eat a small but nutritious meal at least an hour before exercising. If necessary, a small meal after exercising may also be recommended.
• Warm up and stretch as advised by a fitness professional. It can help to reduce muscle strain and injury during strenuous physical activity.
• Ensure that medication for other conditions, such as diabetes and high blood pressure, is taken as prescribed. Do not delay taking medication, especially if strenuous physical activity is to be expected. Exercise can cause rapid changes in the body’s biochemistry.

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