Treatment of Exertion Headaches

Exertion headaches are headaches induced by performing strenuous physical activity.  These terrible pulsating headaches may occur during or after activities such as running, sex, or even coughing.  Most people who experience exertion headaches are also prone to other types of chronic headaches.  Occasionally these headaches are indicative of a more serious underlying health problem, but most are benign.

What Are Exertion Headaches?

The causes of benign exertion headaches are not entirely understood by medical professionals.  The Johns Hopkins Headache Center calls these headaches “idiopathic,” meaning they are “occurring for no obvious reason, not the result of any other underlying disease or process.”  According to Mayo Clinic, the pain may occur because “strenuous exercise dilates blood vessels inside the skull.”

Other causes of exertion headaches can include underlying physical conditions, usually involving either the brain, heart, or associated blood vessels. In some cases however, these headaches may be caused by a much less threatening sinus infection. Patients experiencing exertion headaches will often be diagnosed with an MRI or sometimes a spinal tap to determine whether their headaches are benign or caused by serious health issues.

What Are Exertion Headache Triggers?

Exertion headaches are triggered by strenuous activity.  Particularly activities that strain the abdominal muscles or put pressure on the chest trigger exertion headaches.  Such activities can include running, swimming, weight lifting, rowing, sex, and other similar activities. According to the National Headache Foundation, an exertion headache may also be induced by coughing, sneezing, and straining when moving bowels.

Sometimes severe headaches triggered by exertion are confused with exertion headaches.  While they may be induced by exertion, chronic severe headaches can be recognized as such by symptoms including nausea, vision distortion, sensitivity to light, and others.

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What are the Symptoms of Exertion Headaches?

Symptoms of exertion headaches vary depending on whether they are primary or secondary exertion headaches.  A primary exertion headache is often briefer in duration. According to Mayo Clinic, secondary exertion headaches can be recognized not only by their longer duration, but also by the accompaniment of symptoms such as vomiting, blacking out or fainting, double vision, or neck rigidity.

Because secondary exertion headaches are indicative of serious health problems associated with the brain or heart, patients are urged to contact their doctor immediately if they experience any of these symptoms.  Patients are also encouraged to contact their doctor if they experience an exertion headache for the first time or if the pain comes on abruptly, even if the headache is not accompanied by secondary symptoms.

  • Location: Both primary and secondary exertion headaches are usually felt on both sides of the head.
  • Type: Both primary and secondary exertion headaches are described as a throbbing pain.  Some patients have reported a “sudden popping or bursting” pain.
  • Severity: Pain associated with a primary exertion headache is often severe.  Secondary headaches, according to The Johns Hopkins Headache Center, can be described as “the worst headache of your life.”
  • Duration: A primary exertion headache lasts for about 5 minutes at the briefest, but can last for up to 2 days.  Secondary exertion headaches, on the other hand, often lasts at least 24 hours.  Secondary headaches may continue to be felt for several days.

Types of Exertion Headaches

Medical professionals categorize exertion headaches as either primary or secondary.

Most exertion headaches are primary, and, though painful, are totally harmless.  They are often (but not always) much briefer in duration than secondary exertion headaches.

Secondary exertion headaches are less common and indicative of a serious health problem, such as a tumor, internal bleeding in the brain, or a coronary artery complication.  Secondary headaches are usually much longer in duration than primary headaches and are often accompanied by such symptoms as vomiting, blacking out, neck rigidity, fever, and double vision.  These types of headaches usually will not respond to normal headache treatment but grow worse instead.  Patients sometimes describe these headaches as “new and unusual.”

Risk factors

Susceptibility to primary exertion headaches can be influenced by personal attributes like heredity and age or by climate.

  • Migraines: Studies show that most sufferers of exertion headaches are those who have migraines or who have a genetic history of migraines.
  • Altitude: Exercising at high altitude puts you at greater risk for exertion headaches.
  • Heat & Humidity: Exercising in higher temperatures and humidity puts you at greater risk for exertion headaches.
  • Age: Young adults and teens are more likely to get primary exertion headaches. If you are 50 or older you should be more observant of the signs of secondary exertion headaches.
  • Gender: Some studies have found men more susceptible to exertion headaches.

Treatment Options

Primary exertion headaches are both preventable and treatable.  Persons suffering from exertion headaches have had success with preventing headaches both by pharmaceutical methods and such simple methods as warming up before exercise.

Treatment for secondary exertion headaches usually requires emergency medical care.


  • Warm-up: If you are prone to exercise headaches, warming-up before you exercise may help prevent them.
  • Avoid Heat and Humidity: If you have a history of exertion headaches, try to avoid intense physical activity during warm weather and in high humidity.
  • Altitude: Avoid exercising at high altitude if you have a history of exertion headaches.
  • Holding Your Breath: Some patients have found that they could prevent exertion headaches if they did not hold their breath while they were weightlifting.
  • Melatonin:  Medical professionals have found that the hormonal food supplement melatonin, is effective in reducing and preventing exertion headaches.
  • Propranolol: Propranolol is a drug that regulates blood pressure.  Some brands prescribed to prevent exertion headaches are Inderal (propranolol) and Tenormin (atenolol).
  • NSAIDs: NSAIDs are nonsteroidal anti-inflammatory pain relievers. If taken 1-2 hours before strenuous physical activity, these types of pain medication can often prevent exertion headaches. Migralex is one of such drugs and because these drugs are taken on an empty stomach (you would not want to exercise on a full stomach) Migralex is preferred since it is buffered with magnesium.

Immediate Treatment

Patients who experience symptoms of secondary exertion headaches should seek emergency medical care as soon as possible.  After ruling out the possibility of underlying health problems with their doctor, patients should treat their pain with medication.

Triptans, a type of medication used to block pain signals in the brain, are sometimes prescribed to treat exertion headaches.  Two triptans commonly prescribed are Imitrex (sumatriptan) and Replax (eletriptan).

One of the best ways to get immediate relief is with a strong, anti-inflammatory medication like Migralex (available online).  Migralex is designed to treat the cause of the headache as well as the symptom, making it an ideal solution to exertion headache pain. As NSAIDs, Migralex can be used preventatively and also to relieve pain once the headache has set in.

Extertion Headache Resources