Primary exercise headache, previously known as primary exertional headache, is a rare headache type precipitated by exertion. It is commonly described as a pulsating headache, on both sides of the head. Primary exercise headache is termed ‘primary’ because it’s not caused by another condition or disorder.
The headache is typically triggered in hot weather or at high altitudes, lasting 5 mins to 48 hours, and is brought on exclusively during or after physical exertion. Interestingly up to 50% of patients with primary exercise headache report that they also have headaches meeting criteria for migraine.
The underlying cause of primary exercise headache is unclear. It is important however that patients with new or never evaluated exercise headache be considered for imaging studies to exclude possible underlying causes such as subarachnoid haemorrhage. Individuals over the age of 50 with risk factors for heart attack should be evaluated for heart disease as a cause for their headache (Cardiac Cephalgia). It has been reported however that up to 80% of exertional headache is primary, with no underlying cause identified.
The good news is that primary exercise headache is often self limiting, which means that it occurs for a period of time, and then stops occurring. This is often in the vicinity of 3-6 months. Given the self limited nature of primary exercise headache, people should be advised to avoid excessive exercise or triggering activities if possible.
In cases where the headache is mild or builds slowly, warming up before exercising, and or an exercise program that begins slowly, and increases in intensity and length over a period of months, may prevent primary exercise headache.
Naproxen or Indomethacin taken 30-60 minutes before exercise may prevent primary exercise headache in some cases. Beta blockers have also been reported to be effective and are alternative options in patients who cannot take NSAIDS. Since primary exercise headache is self limiting, it’s suggested that treatments be discontinued after 6 months for reevaluation of their need.
References: Primary Exertional Headache: Updates in the Literature, Curr Pain Headache Rep Halker, 2013, 17:337
Primary Exercise Headache, American Migraine Foundation, March 3, 2017
Note: Information on this site is not a substitute for professional medical advice