What is an exertional headache?

Exertional headaches are headaches triggered by some type of physical activity. The types of activity that cause them vary from person to person, but include:

  • strenuous exercise
  • coughing
  • sexual activity

Doctors divide exertional headaches into two categories, depending on their cause:

  • Primary exertional headache. This type is brought on solely by physical activity and is usually harmless.
  • Secondary exertional headache. This type is brought on by physical activity due to an underlying condition, such as a tumor or coronary artery disease.

Read on to learn more about exertional headaches, including how to recognize whether yours is primary or secondary.

The main symptom of an exertional headache is moderate to severe pain that people often describe as throbbing. You might feel it across your entire head or just on one side. They can start during or after strenuous physical activity.

Primary exertional headaches can last anywhere from five minutes to two days, while secondary exertional headaches can last for several days.

Depending on the cause, secondary exertional headaches sometimes have additional symptoms, including:

  • vomiting
  • neck stiffness
  • double vision
  • loss of consciousness

Primary exertional headache causes

Primary exertional headaches are often triggered by:

  • intense exercise, such as running, weightlifting, or rowing
  • sexual activity, especially orgasm
  • coughing
  • sneezing
  • straining during bowel movements

However, experts aren’t sure why these activities cause a headache. It might be related to the narrowing of blood vessels within the skull that happens during physical activity.

Secondary exertional headache causes

Secondary exertional headaches are triggered by the same activities as primary exertional headaches are. However, this response to physical activity is due to an underlying condition, such as:

  • subarachnoid hemorrhage, which is bleeding between the brain and the tissues covering the brain
  • tumors
  • coronary artery disease that affects blood vessels leading to or within your brain
  • sinus infection
  • structural abnormalities of the head, neck, or spine
  • obstruction of flow of cerebrospinal fluid

People of all ages can have an exertional headache. However, people over the age of 40 have a higher risk.

Other things that increase your risk of having an exertional headache include:

  • exercising in hot weather
  • exercising at a high altitude
  • having a history of migraines
  • having a family history of migraines

To diagnose an exertional headache, your doctor will likely start by asking about your symptoms and the kinds of things that tend to cause them. Make sure to tell them about any specific activities that seem to give you a headache.

Depending on your symptoms and medical history, they might also use some imaging tests to check for an underlying issue.

Imaging tests used to diagnose exertional headaches include:

  • CT scan to check for recent bleeding in or around the brain
  • MRI scan to view the structures within your brain
  • magnetic resonance angiography and CT angiography to see the blood vessels leading into your brain
  • spinal tap to measure the flow of cerebrospinal fluid

Treatment for exertional headaches depends on whether your headaches are primary or secondary. Secondary exertional headaches usually go away once you treat the underlying cause.

Primary exertional headaches usually respond well to traditional headache treatments, including nonsteroidal anti-inflammatories such as ibuprofen (Advil). If these don’t provide relief, your doctor might prescribe a different type of medication.

Medications used to treat exertional headaches include:

If your headaches are predictable, you may only need to take medication before doing activities that you know might trigger a headache. If they aren’t predictable, you may need to take medication regularly to prevent them.

For some people, gradually warming up before doing any strenuous exercise also helps. If you’re a runner, for example, try dedicating more time to warming up your body and gradually building up your speed.

For headaches triggered by sexual activities, having less strenuous sex more often may help.

Primary exertional headaches are frustrating but usually harmless. However, they can sometimes be a sign of an underlying condition that needs treatment, so it’s important to follow up with your doctor about your symptoms.

Once you’ve ruled out any other causes, a combination of changes to your physical activity and over-the-counter or prescription medication will likely provide relief.