Can Exercise Cause Headaches?

Primary Exertional Headache: A Rare Type of Headache

Exercising
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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 third edition of the International Classification of Headache Disorders, a primary exertional headache is pulsating, lasts less than forty-eight hours, and occurs only during or after physical activity.

In addition, an exertional headache typically occurs on both sides of the head, unlike a migraine, which is commonly one-sided.

A primary exertional headache should not be confused with two other primary headache disorders called primary cough headache (brought on by coughing or the Valsalva-maneuver) or a benign sexual headache (brought on by sexual activity).

Diagnosis

Before your headache specialist or neurologist makes the official diagnosis of primary exertional headache, you will most likely undergo imaging of the brain in order to rule out other health conditions. Imaging of the brain is done with a magnetic resonance imaging (MRI) and/or a magnetic resonance angiography (MRA).

Causes of a headache that may mimic primary exertional headache but are really secondary headaches or signal an emergent medical condition include:

Experts also advise that people with cardiovascular risk factors and exercise-induced headaches have an evaluation for coronary heart disease, especially if a headache occurs only with exercise, is not consistent with a migraine, and/or radiates to or from the neck or jaw.

Cause

The cause of primary exertional headache is not known. Some experts believe that pressure from the abdomen and chest during exercise is transmitted into the skull, causing expansion of pain-sensitive blood vessels.

Alternatively, exertional headaches may be due to a blood vessel problem, like 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, which may lead to increased pressure in the venous system surrounding the brain.

To support this theory, one study in Cephalalgia found that people with exertional headaches were significantly more likely to have incompetent internal jugular veins than people without exertional headaches.

Treatment

Indomethacin, a non-steroid anti-inflammatory drug or NSAID, 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 an exertional headache and had been found to be quite effective.

That said, indomethacin is associated with a few serious adverse effects, like:

  • Severe allergic reactions, including anaphylaxis
  • Gastrointestinal upset and/or bleeding
  • Cardiovascular events (for example, heart attack and stroke)
  • Kidney damage
  • Elevation of liver enzymes
  • Dizziness and other nervous system disturbances

If your doctor prescribes indomethacin, please review these and other potential adverse effects carefully.

Besides indomethacin, other treatments sometimes prescribed by doctors are ergonovine, naproxen, phenelzine, and propranolol.

A Word From Verywell

In summary, primary exertional headache is a headache that occurs during or after strenuous physical activity. Due to its relative rareness, before being diagnosed with this headache disorder, you should undergo a thorough neurologic exam by a headache specialist or neurologist, as well as brain imaging, to rule out other causes for your headache.

Lastly, exercise is good for your physical and mental health, so If you experience 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.

View Article Sources
  • 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. (2016). Primary exertional headache. Swanson JW, ed. UpToDate. Waltham, MA: UpToDate Inc.
  • 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 Headache: Updates in the Literature. Curr Pain Headache Rep. 2013; Jun;17(6):337.
  • Headache Classification Committee of the International Headache Society. "The International Classification of Headache Disorders: 3rd Edition (beta version)". Cephalalgia 2013;33(9):629-808.