Did you know there’s a headache disorder that specifically occurs during or after strenuous exercise? If you’re experiencing this, it could be primary exercise headache. Learn the signs and symptoms, what steps to take if you start having exercise-induced headaches and how to differentiate it from migraine triggered by physical exertion.

While physical activity can be helpful in managing migraine and other health conditions, overexertion may lead to headaches and other symptoms that can be confused with a migraine attack. Primary exercise headache, previously known as primary exertional headache or benign exertional headache, is a rare type of headache disorder that is brought on by and occurs only during or after strenuous physical exercise.

What does primary exercise headache feel like?

Pain from a primary exercise headache is commonly described as bilateral (on both sides of the head) and pulsating. An exercise-induced headache generally lasts from five minutes to 48 hours and is more likely to occur in hot weather or at high altitudes. It may have similar features to migraine, but symptoms are limited to head pain and are not accompanied by prodrome, aura or postdrome symptoms. This is a key distinction between primary exercise headache and a migraine attack triggered by physical exertion.

What should you do if you experience an exercise-induced headache?

Primary exercise headache is not caused by another condition or disorder. If exercise causes you to have a headache, you should see your doctor to rule out potentially serious underlying issues—especially if these symptoms are new and/or you have never been evaluated for primary exercise headache.

Your doctor will conduct a clinical examination and may run tests to rule out possible underlying causes. This may include imaging of the brain and blood vessels to exclude conditions like a brain tumor or a lesion that blocks the flow of spinal fluid, brain bleed, or a problem with the blood vessels in and around the brain.

People who have exercise-induced headaches may also be evaluated for cardiovascular risk factors to rule out heart disease as a cause for their headaches (cardiac cephalalgia). This is particularly important if exercise-induced headache pain radiates to or from the neck or jaw. Possible cardiovascular risk factors include a history of heart attack, coronary artery disease, diabetes, high blood pressure, high cholesterol, obesity and smoking.

How can you treat headaches triggered by exercise?

Although long-term studies of primary exercise headache are very limited, most cases tend to improve and resolve on their own. Your doctor may recommend modifying your exercise regimen and trying certain preventive or acute treatments to help manage primary exercise headache.

You may be able to manage primary exercise headache by following an exercise program that begins slowly and increases in intensity and length over a period of time. Additionally, in cases where headache pain is mild or builds slowly, spending ample time warming up before you begin exercising may help minimize symptoms, as well as avoiding exercise during hot and humid weather or at high altitudes.

Indomethacin may be taken 30-60 minutes before exercise to prevent primary exercise headache. However, be careful to monitor the dosage and frequency of this treatment to avoid stomach irritation. Beta-blockers such as nadolol, atenolol and propranolol have also been reported to be effective for preventing primary exercise headache, and are reasonable options for people who cannot take indomethacin. Since primary exercise headache is generally self-limiting, symptoms should be assessed periodically to reevaluate the need for any acute or preventive treatments.

Looking for additional resources on exercising with migraine and headache disorders? Moderate physical activity can be a good way of managing migraine and reducing common triggers like stress. View our free guide for tips on how to stay active with migraine.

The American Migraine Foundation is committed to improving the lives of those living with this debilitating disease. For more of the latest news and information on migraine, visit the AMF Resource Library. For help finding a healthcare provider, check out our Find a Doctor tool. Together, we are as relentless as migraine.