Abstract
Purpose of Review
Exercise headache refers to headache that is triggered by exercise or exertion. Although secondary causes must be excluded, most cases of exercise headache are benign, idiopathic, and self-limited. This article reviews the revised diagnostic criteria for primary exercise headache (PEH) and discusses recent research into the clinical presentation, epidemiology, pathophysiology, suggested workup, and treatment of this condition.
Recent Findings
Recent studies estimate that PEH affects from 1 to 26% of the adult population. A secondary cause is thought to be present infrequently, but should be explored in all patients with a first or atypical presentation of exercise headache. Red flags for potential secondary causes may include older age at onset and more prolonged headache duration. There is inadequate evidence to include gender as a red flag. No recent trials have been conducted, but experts suggest that avoidance of triggers coupled with short-term NSAID and/or beta-blocker treatment may be effective for patients diagnosed with PEH.
Summary
Larger studies are needed to provide high-quality evidence regarding the pathophysiology and treatment of PEH. However, recent work has shed light on the characteristics of this condition, and the ICHD-3 has provided important updates to the diagnostic criteria for this relatively common and potentially treatable condition.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1–211. https://doi.org/10.1177/0333102417738202.
Sjaastad O, Bakketeig LS. Exertional headache—II. Clinical features Vågå study of headache epidemiology. Cephalalgia. 2003;23:803–7.
•• Rabiee B, Mohammadinejad P, Kordi R, Yunesian M. The epidemiology of exertional headache in the population of Tehran, Iran. Headache. 2015;55:1225–32. https://doi.org/10.1111/head.12610. The authors assessed clinical characteristics of PEH in their large cohort and reported detailed epidemiological findings.
Tofangchiha S, Rabiee B, Mehrabi F. A study of exertional headache’s prevalence and characteristics among conscripts. Asian J Sports Med. 2016;7(3):e30720. https://doi.org/10.5812/asjsm.30720.
Chen SP, Fuh JL, Lu SR, Wang SJ. Exertional headache—a survey of 1963 adolescents. Cephalalgia. 2008;29:401–7. https://doi.org/10.1111/j.1468-2982.2008.01744.x.
Rooke ED. Benign exertional headache. Med Clin North Am. 1968;52(4):801–8.
Pascual J, Gonzalez-Mandly A, Martin R, Oterino A. Headaches precipitated by cough, prolonged exercise or sexual activity: a prospective etiological and clinical study. J Headache Pain. 2008;9:259–66. https://doi.org/10.1007/s10194-008-0063-5.
• Hanashiro S, Takazawa T, Kawase Y, Ikeda K. Prevalence and clinical hallmarks of primary exercise headache in middle-age Japanese on health check-up. Intern Med. 2015;54:2577–81. https://doi.org/10.2169/internalmedicine.54.4926. This large Japanese study addressed the clinical characteristics and epidemiology of PEH in their middle-aged population.
Sjaastad O, Bakketeig LS. Exertional headache. I. Vågå study of headache epidemiology. Cephalalgia. 2002;22:784–90.
van der Ende-Kastelijn K, Oerlemans W, Goedegebuure S. An online survey of exercise-related headaches among cyclists. Headache. 2012;52:1566–73. https://doi.org/10.1111/j.1526-4610.2012.02263.x.
Doepp F, Valdueza JM, Schreiber SJ. Incompetence of internal jugular valve in patients with exertional headache: a risk factor? Cephalalgia. 2007;28:182–5. https://doi.org/10.1111/j.1468-2982.2007.01484.x.
Donnet A, Valade D, Houdart E, Lanteri-Minet M, Raffaelli C, Demarquay G, et al. Primary cough headache, primary exertional headache, and primary headache associated with sexual activity: a clinical and radiological study. Neuroradiology. 2013;55(3):297–305. https://doi.org/10.1007/s00234-012-1110-0.
Hagen K, Wisløff U, Ellingsen Ø, Stovner L, Linde M. Headache and peak oxygen uptake: the HUNT3 study. Cephalalgia. 2016;36(5):437–44. https://doi.org/10.1177/0333102415597528.
Ran Y, Liu H, Zhang M, Dong Z, Yu S. Laugh-induced headache: clinical features and literature review. Headache. 2017;57(10):1498–506. https://doi.org/10.1111/head.13189.
Pascual J, Iglesias F, Oterino A, Vazquez-Barquero A, Berciano J. Cough, exertional, and sexual headache: an analysis of 72 benign and symptomatic cases. Neurology. 1996;46:1520–4.
Alvarez R, Ramon C, Pascual J. Clues in the differential diagnosis of primary cough, exercise, and sexual headaches. Headache. 2014;54(9):1560–2. https://doi.org/10.1111/head.12449.
Wei JH, Wang HF. Cardiac cephalalgia: case reports and review. Cephalalgia. 2008;28(8):892–6. https://doi.org/10.1111/j.1468-2982.2008.01590.x.
Wang M, Wang L, Liu C, Bian X, Dong Z, Yu S. Cardiac cephalalgia: one case with cortical hypoperfusion in headaches and literature review. J Headache Pain. 2017;8(1):1–8. https://doi.org/10.1186/s10194-017-0732-3.
•• Mitsikostas DD, Ashina M, Craven A, Diener HC, Goadsby PJ, Ferrari MD, et al. European headache federation consensus on technical investigation for primary headache disorders. J Headache Pain. 2015;17:5. https://doi.org/10.1186/s10194-016-0596-y. This European consensus guideline provides useful recommendations regarding workup of PEH and other primary headache disorders.
Diamond S. Prolonged benign exertional headache: its clinical characteristics and response to indomethacin. Headache. 1982;22(3):96–8.
Halker R, Vargas B. Primary exertional headache: updates in the literature. Curr Pain Headache Rep. 2013;17:337. https://doi.org/10.1007/s11916-013-0337-8.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
This article is part of the Topical Collection on Headache
Rights and permissions
About this article
Cite this article
Sandoe, C.H., Kingston, W. Exercise Headache: a Review. Curr Neurol Neurosci Rep 18, 28 (2018). https://doi.org/10.1007/s11910-018-0840-8
Published:
DOI: https://doi.org/10.1007/s11910-018-0840-8