Headache after exercise

Definition- what are post-exercise headaches?

Headaches that occur after extensive physical activity can be very stressful for those affected and lead to a significant reduction in sporting activities. The pain often presents itself as pulsating and lasting from five minutes to 48 hours.

Risk factors for the development of this headache are, above all, very intense physical stress, high outside temperatures and high altitudes. This form of headache usually begins in young adulthood and can vary significantly in duration. The duration of the illness is stated from a few days to several years.

Most of the time, spontaneous remissions occur over time, i.e. they subside without a recognizable trigger. In addition to the headache during physical exertion, many patients also have other forms of headache, such as migraines.

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Basically, headaches are divided into two different classes. By definition, primary headaches are associated with no clearly identifiable cause. However, if a clear cause for the headache can be found, it is called secondary headache. In diagnosing this headache, the first step is to clarify possible underlying causes, as these can sometimes be very difficult. For example, cerebral hemorrhages, so-called subarachnoid hemorrhages, masses or malformations of the brain stem can lead to secondary headaches that are clinically very similar.
If none of these causes are present, the headache is classified as primary. It is still not clear how headaches develop after physical activity. It is suspected, however, that a short-term increase in intracranial pressure during activity could possibly contribute to the development of the pain. However, proof of this theory is still pending.

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Headache in heat

It is known that headaches occur much more frequently after physical activity when the outside temperature is high. Since the exact cause of the headache development has not been clarified, this connection has not been fully clarified either. It is known, however, that heat, especially prolonged direct sunlight, can irritate the meninges and thus contribute to the development of headaches. People who suffer from this rare form of headache are therefore advised not to exercise in direct sunlight and to avoid sports at high temperatures.

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Other accompanying symptoms

In addition to the strong, throbbing headache, other symptoms can occur after physical activity. Those affected not infrequently report that they also suffer from severe nausea and even vomiting. If these symptoms are very pronounced, the differential diagnosis of migraines must always be considered.
Furthermore, tiredness, a general feeling of exhaustion or sensitivity to noise as well as dizziness may occur after exercise. Depending on the possible underlying causes, further symptoms are possible, which can be groundbreaking in the diagnosis of the disease.

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In the diagnosis of headaches after sporting activity, the clinical picture of the disease is initially groundbreaking. So the headache only occurs in isolation after exercise and shows a typical pulsating headache that lasts for a few minutes to hours. However, this picture must be distinguished from migraines. The decisive factor in making this distinction, however, can be the isolated occurrence of pain during physical activity, whereas there are significantly more triggers for migraines.
Furthermore, in the diagnosis of this headache, the exclusion of possible serious causes, such as cerebral haemorrhage, is crucial. In most cases, imaging in the form of a CT or MRI is carried out. Ultimately, the diagnosis of primary physical exertion headache is a diagnosis of exclusion, as there is no conclusive test for this condition. However, the use of therapy with indomethacin can be helpful. If the response to this treatment is very good, this can be another indication of the presence of the disease.


Treatment of the headache initially depends on a possible underlying cause. If this can be found, the focus of treatment is on treating this cause. While only a decongestant nasal spray is prescribed for a simple sinus infection, significantly more extensive measures can be taken in the case of bleeding or masses. If, however, no underlying cause can be proven, in the sense of primary headache, the therapy is much more specific with regard to the headache.
Basically, it must be stated that this form of headache is relatively rare and that there are only limited studies on the treatment of the disease. Which pain therapy is ultimately used depends initially on the frequency of sporting activity and thus the pain attacks. The active ingredient indomethacin, which is very similar to ibuprofen or ASA, has proven to be most effective in the treatment of these headaches. If those affected do not do much sport, taking 25-50 mg indomethacin before sport is usually sufficient to prevent headaches from occurring as a prophylactic measure. With more regular physical activity and frequent occurrence of the pain, the therapy can be switched to long-term therapy and indomethacin can be taken three times a day at a similar dose.
Here, however, the synchronous intake of gastric protectors should be considered in order to forestall possible side effects of indomethacin. However, it should always be borne in mind that, in addition to drug therapy, certain non-drug measures should always be taken, such as avoiding vigorous physical activity and avoiding extreme heat.

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Can you prevent headaches after exercise?

There are several steps that can be taken to prevent headaches after physical activity. This includes drinking enough fluids before and after exercise. Sports should also be avoided in high outside temperatures and at high altitudes. If the headache occurs despite these measures, the prophylactic intake of indomethacin, as described above, is an effective method of preventing the development of headaches in most cases.

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How long does headache last after exercising?

A single acute headache attack after exercise can last a few minutes to hours. In contrast, the duration of the illness, the so-called symptomatic phase, can last very differently. While some sufferers only suffer from this headache two or three times, in other patients the course can drag on for years. Usually, however, there is a spontaneous remission, i.e. an unexplained disappearance of the symptoms. A delayed recurrence of the disease has not yet been described.

What is the prognosis?

In principle, the prognosis for this primary form of headache can be described as very good. Spontaneous remission takes place in all patients over the course of a few years and the symptoms can usually be relieved in the symptomatic phase by the use of indomethacin and non-drug measures. This positive picture is clouded, however, if a serious cause can be found to trigger the headache.
While a very good prognosis can also be assumed for sinusitis, the situation is clearly different for cerebral hemorrhage. In this case, rapid diagnosis and treatment are decisive for the prognosis of the patient.