Exertion Headache Prevention Tips
You’re working out in the gym, and suddenly you find yourself with crippling pain in your head.
Determined to get through your workout, you ignore it as best you can, and a torturous twenty minutes later, wrap up and head home. Thankfully the pain lets up after you stop working out.
Then the next week it happens again. A week later you experience yet another headache while you are exercising. Usually they fade away after you are done, but in some cases, they loom around for hours or even days.
You may even experience light and noise sensitivity or feel nauseous like you do with a migraine. What is going on here?
It could be that you are experiencing exertion headaches (sometimes also called "exertion headaches" “exertional headaches” or “activity-related headaches”). They are no fun at all. In fact, they may make you want to quit working out. That of course is a bad idea. So how can you prevent them?
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In this article, I will give you some tips and tricks. But first, let’s learn a bit more about exertion headaches and how to differentiate them from other common types of headaches which may manifest in a similar way.
What is an Exertion Headache?
An exertion headache is a specific subset of headache which strikes in response to physical activity. Here is what characterizes an exertion headache:
- More common in younger people, starting at adolescence and ranging up to around age 50.
- Usually the headache begins during exercise, generally during peak exertion.
- It is common for the pain to go away after the exertion ceases. Very brief exertion headaches may last only around 5 minutes.
- Some exertion headaches are persistent. They may stick around as long as 2 days after the exertion is over.
- Exertion headaches can feel similar to migraines and include migraine-type symptoms like sensitivity to sound and light, nausea, and vomiting.
- The pain has a throbbing quality and is usually on both sides of the head.
The American Migraine Foundation reports that primary exertional headaches are rare. Reading the list of symptoms above, you will notice that there are quite a few other types of headaches which may easily be confused with exertional headaches. I will talk more about that in a bit.
What Causes Exertion Headaches?
Exertion headaches result when there is increased pressure in the blood vessels inside your brain. When exertion headaches are “primary” (which is the focus of this article), they exist on their own. They are not caused by another condition. When they are “secondary,” they may be resulting from another underlying health problem.
Primary exertion headaches are painful, but do not pose any further threat to your health. Secondary exertion headaches may point toward a serious condition, but not in every case. If you are seeking diagnosis through a doctor, the only way to establish that you have primary exertion headaches is to rule out other underlying conditions.
Should you seek diagnosis? It is always helpful to check in with a medical professional, because you should try to rule out underlying conditions (that is true with migraines or other headache types as well). Some potentially serious conditions which may be associated with secondary exertion headaches include brain tumors, bleeding in the brain, or coronary artery disease. You don’t want to risk missing something like that.
That being said, realistically, proper headache diagnoses are hard to get, so that is something to be aware of going into the process. At least though you can rule out anything serious.
Activities Which Commonly Result in Exertion Headaches
So now you know a bit physiologically about what is going on when you experience a primary exertion headache. Now you are probably wondering what types of activities might trigger that throbbing pain:
- Running, especially endurance running
- Weight lifting
- Scuba diving
- Other high-energy sports
- Physical labor
- Sexual activity
Any activity which requires you to expend a significant amount of physical effort could very well result in an exertion headache if you are prone to them.
Similar Types of Headaches
There are a number of different types of headaches which can pose as exertion headaches. They may present in a very similar manner, and may therefore easily be mistaken for them. For example:
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- Cough headaches: This type of headache is triggered by strain from coughing as well as similar activities like blowing one’s nose, sneezing, or even crying or laughing. Sometimes even straining on the toilet can cause a “cough headache.” They may be primary or secondary in nature. Researchers currently do not know what the cause of primary cough headaches might be.
- Migraines triggered by physical activity: There seems to be some overlap here, as it is common for people with primary exertion headache to also have a history of migraines. In any case, migraines sometimes are triggered or worsened by physical activity, but they are not necessarily exertional headaches. A doctor may be able to help you differentiate between the two.
- Tension headaches: Tension headaches may easily be caused or exacerbated by exertion. This is because you are straining your muscles when you are exercising, having sex, performing physical labor, or so on. Tension headaches tend to feel distinctly different however—often the pain is more “dull” than “throbbing” in quality—though this may vary.
- Dehydration headaches: Getting dehydrated can easily cause you to experience a pounding headache. Naturally when you are exerting yourself, especially in hot conditions, you are going to sweat a lot, and you could potentially end up dehydrating yourself. This can give you a headache that feels a lot like an exertion headache, but it isn’t one.
- Heat/light-triggered headaches: Some people experience migraines which are triggered by heat and/or bright light. If you are exerting yourself outside on a hot or bright day, even if you are fully hydrated and do not experience primary exertion headaches, you could easily wind up with an unrelated migraine. The migraine simply happened because of the environmental conditions.
So you can see why it is so hard to say that you have exertion headaches. There is a good chance that you are actually experiencing some unrelated tension headache or migraine, or even a cough headache. These are more common headaches than exertional headaches, so they are more likely.
How to Exertion Headaches Are Diagnosed
The International Headache Society (IHS) has outlined the following guidelines for diagnosing an exertion headache:
- The headaches must last 48 hours or less.
- They must be brought on by strenuous exercise and must occur only during or after the exertion (if something else started the headache beforehand, and exertion only made it worse, it is not considered to be an exertion headache).
- The person seeking diagnosis must have experienced at least two headaches which fulfill the criteria listed above.
- The headaches cannot be better explained by another diagnosis in the ICHD-3 classification guidelines established by the IHS.
I suggest clicking through to the link above to read about exertion headaches in more depth. The International Headache Society details more about the circumstances in which these headaches tend to occur, their pulsating characteristics, prevention, and more (I will also talk about prevention momentarily). The society provides a little more insight into causal factors as well.
Factors Which Contribute to Exertion Headaches
If you do experience primary exertion headaches, there are a number of factors which may make it more likely that you will experience one. These include:
- Poor nutritional content in your diet.
- Imbibing alcohol.
- Taking caffeine (a key difference with migraines, which usually benefit from caffeine).
- Having low blood sugar.
- Exerting yourself in high heat.
- Working out in high humidity.
- Performing exercising at high altitudes.
- Changes in barometric pressure in your environment.
If you can avoid these situations and triggers, you may experience fewer exertion headaches.
Steps to Take to Prevent Exertion Headaches
Now that you understand more about what exertion headaches are and how they are differentiated from similar types of headaches, you may be able to start figuring out whether what you are experiencing really qualifies as exertion headaches.
If you do believe you have exertion headaches, here are some steps you can take to try and prevent them going forward.
1. Find a new workout environment.
If you have been working out in hot and humid conditions outside, maybe it is time to get a gym membership or start working out in your own home. If heat and humidity are a part of what is triggering your headaches, you might be able to reduce their frequency or degree just by moving indoors.
You cannot do much about altitude of course (if you live at a high altitude, you can hardly move down a few thousand feet just to exercise each day). But if you start figuring out how barometric pressure is impacting your headaches, you may be able to keep an eye on the weather and work around some of the changes.
2. Reduce your intake of alcohol or caffeine.
If you regularly indulge in alcohol or caffeine, it is possible that either or both are leading to some of your exertion headaches. Try reducing your alcohol intake—doing so will have other health benefits anyway.
As to caffeine, you will have to weigh the benefits and drawbacks of curbing your intake. If you suffer from other migraines and find that caffeine helps you to control them, you might end up paying a higher price by giving up caffeine than you are now by taking it.
You could experiment and see if there is a way to time your caffeine intake in that case so that you maximize its usefulness and minimize its drawbacks. You might manage to work out a schedule where you are able to use the caffeine to treat some of your migraines, but avoid it for long enough leading up to exercise that it doesn’t feed into your exertion headaches.
3. Eat a healthy diet which is rich in nutrition.
Poor nutrition can be a factor in exertion headaches, so if you are eating an unhealthy diet, that could be one of the reasons you are experiencing them.
Sometimes people report that they experience exertion headaches (or something similar) for a period of several weeks, and then they suddenly go away for unknown reasons.
My guess is that in situations like this, a factor which was feeding into the exertion headaches might have been resolved. So for example, someone whose exertion headaches were being triggered in large part by a bad diet who switched over to a more nutritious one might wonder why his exertion headaches seem to have gone away “on their own.”
If you do think your diet is suspect, then see if you can think of any nutritional gaps which you might need to fill. You can also try to eat fewer foods which are inflammatory or have a lot of sugars or additives in them. Keep in mind that it may take a few weeks to see a major difference from a new diet, so stick with it.
4. Mind your blood sugar levels.
If you have dips in blood sugar levels which are leading to exertion headaches, try to figure out why you might be having that issue in the first place. Do you routinely skip meals? Are you drinking a lot of alcohol? Are you taking too much insulin and/or not eating a lot of carbohydrates? Even exercising itself can lead to low blood sugar.
Avoid alcohol, and try not to skip or delay your meals. Eat at the same regular intervals each day which keep you functioning at your best. Make sure you are not taking too much insulin.
Obviously you cannot avoid exercising, but you can try to wait until your blood sugar is at an optimum level before you do it. As to eating more carbs, that is up to you. A low-carb diet has a lot of benefits, so you may not want to do this.
But if you do decide to increase your intake, this guide from the UCSF Medical Center can help you quickly get 15-30 grams of easily absorbed carbs. This can be done by eating sweets or fruits or drinking a bit of juice. You can also try glucose gel or tablets.
5. Try ergotamine tartrate or indomethacin.
There are a couple of mediations which have been used successfully to treat exertion headaches. One of them is ergotamine tartrate. The medication works to narrow blood vessels, which in turn helps to curb the throbbing pain of exertion headaches, migraines and cluster headaches.
To take ergotamine tartrate, you put a tablet under your tongue and wait for it to dissolve when you first feel a headache coming on. Your doctor will help you figure out the best dosage for your needs.
Because ergotamine tartrate is only intended for use on an as-needed basis, you should avoid taking it except when you absolutely need it. If you over-use it, you could end up developing rebound headaches, which would make your situation worse.
Another drug which is sometimes prescribed for exertion headaches is indomethacin. This medication is classified as a nonsteroidal anti-inflammatory drug (NSAID). It is also sometimes used to treat arthritis, bursitis, gout, and tendonitis. It is generally taken with a full glass of water. In some cases it is taken on an ongoing, regular basis, while in other situations, it is taken as-needed. In your situation, your doctor will probably tell you to take it at the first signs of a headache.
If you do not want to get a prescription medication, you can also consider over-the-counter alternatives. Ibuprofen for example is an NSAID, which means it works on the same basis as indomethacin. You may find that this is enough to keep your headaches from getting out of hand while you are exerting yourself
6. Treat other headache conditions if you suffer from them.
One type of headache can easily feed into another, which can result in compounding pain. So if you also determine that you suffer from migraines, tension headaches, or other types of headaches alongside exertional ones, you should do what you can to treat them.
Think about it. If you have an exertion headache, you are going to feel stressed. If stress is a migraine trigger, you might then get a migraine on top of an exertion headache.
Another example might involve tension headaches. Maybe you tense up from the pain of your exertion headache while working out, which then causes muscle strain, leading to a tension headache.
It is easy to imagine situations where a migraine or tension headache could fuel an exertion headache too. You might be tempted to drink a couple cups of coffee to treat an existing migraine, which then spawns an exertion headache when you work out later that day.
So if you can, look for effective ways to treat these other types of headaches which will not provoke exertion headaches.
Read this article for advice on swiftly and effectively relieving tension headaches. As to dealing with migraines, it is a good start to identify your triggers—see this article. You can also take a healthy herbal supplement with ingredients like butterbur, feverfew and chaste tree berry which can help to prevent migraine pain.
7. Treat any underlying issues which may be involved.
Hopefully if you do have exertion headaches, they are either primary exertion headaches or they are secondary headaches with a fairly innocuous underlying cause.
Regardless, the only way to find out for sure is to see your doctor. If there are underlying issues, serious or otherwise, treating them should help to relieve your exertional pain. Left untreated, they will continue to bother you. And if you do catch a serious underlying issue, it could potentially save your life.
Finding out you may have exertion headaches can be discouraging, but it is no reason to give up your favorite activities. There are a lot of things you can do to manage, prevent and treat these headaches.
Get diligent about your diet, control your alcohol and caffeine consumption, monitor your blood sugar, and choose your workout environments with care. Treat other types of headaches you might have, take medications as necessary, and be sure to talk to a doctor to rule out any underlying health conditions. Hopefully you will soon be experiencing more enjoyable workouts!