Exercise-induced headaches: Identifying causes, prescribing remedies, and implementing preventive measures
Exercise is generally beneficial for our health, but for some, it can lead to an unwelcome side effect: headaches. Primary exertional headaches are a type of headache that occurs during or immediately after physical activity, caused by vascular changes and increased pressure inside the skull.
**Causes**
The exact cause of primary exertional headaches is not fully understood, but several theories suggest that cardiovascular and vascular changes during strenuous exercise play a significant role. One leading theory is that intense exercise dilates blood vessels inside the skull, increasing pressure within the fixed volume of the skull, causing headache pain. Overexertion can also cause a rapid rush of blood to the brain, expanding blood vessels and generating pain. Muscle tension in the neck and upper body during strenuous workouts may also contribute.
Risk factors include dehydration, which can worsen headaches, and a history of migraines, which makes primary exercise headaches more common, especially in women. Other underlying abnormalities, such as Arnold-Chiari malformation or subarachnoid hemorrhage, should be ruled out with imaging if headaches present for the first time or are severe.
**Symptoms**
Primary exertional headaches are characterized by a sudden onset of headache during or immediately after exertion, throbbing pain usually felt on both sides of the head, and a duration that can range from minutes to up to 48 hours. The pain may be accompanied by neck muscle tightness or other dehydration symptoms like thirst and dizziness if fluid loss is involved.
**Treatment**
Treatment for primary exertional headaches includes the use of non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, which can be taken preemptively before exercise to prevent headaches. Indomethacin is another option for treatment, while beta-blockers such as propranolol may help reduce frequency in some cases.
Adequate hydration before, during, and after exercise is crucial to prevent dehydration-related headaches. Avoiding overexertion and managing neck muscle tension through proper warm-up and stretching can also reduce the risk of primary exertional headaches.
**Prevention**
Prevention of exercise-induced headaches can be achieved by hydrating with water before, during, and after exercising, rehydrating with electrolyte drinks or oral solutions, warming up and cooling down thoroughly, checking form and posture, wearing footwear that supports proper posture, avoiding skipping meals, eating small, regular meals to manage blood sugar levels, getting enough sleep, maintaining a consistent sleep schedule, exercising moderately each day for at least 30 minutes, and avoiding exercising in extreme heat for long periods.
**Secondary Exertional Headaches**
Secondary exertional headaches occur due to an underlying condition, such as heart disease, stroke, bleeding in the brain, a tear in an artery, reversible cerebral vasoconstriction syndrome, brain tumor or lesion. If you experience new headaches after the age of 40, headaches that last more than a few hours, or other neurological signs, it's essential to see a doctor as soon as possible.
**Low Blood Sugar Headaches**
Exercising without eating can lead to low blood sugar levels, which can cause headaches. Symptoms of low blood sugar include nausea, confusion, sweating, feeling faint or dizzy, shaking, and hunger. To prevent these headaches, it's important to eat carbohydrates before exercising and to replace fluids during and after exercise.
**Migraines**
Migraines are a different type of headache, characterized by throbbing head pain, increased sensitivity to light and sound, nausea, vomiting, fatigue, and other symptoms. Exercising in a hot climate or direct sunlight can trigger a migraine due to excess sweating and bright sunlight. Moderate, regular exercise may help prevent migraines and reduce their severity, but it can also be a trigger for migraines in some people.
**Conclusion**
While exercise-induced headaches can be a nuisance, understanding their causes and taking preventative measures can help manage them. If you experience persistent or severe headaches, it's important to consult a healthcare professional to rule out any underlying conditions.
- Dehydration, caused by insufficient water intake before, during, or after exercise, can worsen headaches, particularly primary exertional headaches.
- A history of migraines increases the likelihood of primary exercise headaches, especially in women, and it's essential to rule out other medical conditions such as Arnold-Chiari malformation or subarachnoid hemorrhage with imaging.
- To treat primary exertional headaches, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can be taken preemptively before exercise or used to alleviate pain, while proper hydration and controlling neck muscle tension through warm-up and stretching can help prevent them.
- Maintaining good mental health is crucial for overall health-and-wellness, and managing mental-health conditions can prevent stress-induced muscle pain and tension, which can contribute to exertional headaches.
- Adequate nutrition plays a significant role in fitness-and-exercise, and eating small, regular meals can help manage blood sugar levels, reducing the risk of low blood sugar headaches that can be caused by exercising without eating.
- Secondary exertional headaches, which can be symptoms of heart disease, stroke, bleeding in the brain, or other serious medical conditions, require immediate medical attention if they occur after the age of 40, last more than a few hours, or are accompanied by other neurological signs.
