Exercise Headaches

Diagnosis

Diagnosing exercise headaches involves determining whether they are harmless or linked to an underlying structural or vascular condition. Your healthcare provider will likely recommend imaging tests if:

• Your headaches last more than a few hours

• The headaches start suddenly, like a thunderclap

• You are over 40 years old

• You experience additional symptoms such as nausea, vomiting, or vision problems

These tests help confirm whether the headaches are primary (benign) or caused by another medical condition.

Imaging tests

Different types of imaging tests may be used to assess your brain and blood vessels:

• Magnetic resonance imaging (MRI): Uses magnetic fields and radio waves to create detailed cross-sectional images of brain structures.

• Magnetic resonance angiography (MRA) and computerized tomography (CT) angiography): Help visualize blood vessels leading to and inside the brain, detecting possible abnormalities.

• Computed tomography (CT) scan): Uses X-rays to generate detailed images of the brain and can identify fresh or recent bleeding around the brain, especially if the headache started within the past 48 hours.

If imaging results appear normal but the headache began abruptly, your provider may recommend a spinal tap (lumbar puncture) to check for bleeding or infection in the cerebrospinal fluid.

Treatment

If no structural or vascular cause is found, treatment focuses on preventing or reducing the severity of exercise headaches. Medications are the most common approach.

Medications for prevention

• Indomethacin: A nonsteroidal anti-inflammatory drug (NSAID) commonly prescribed to prevent exercise headaches.

• Propranolol: A beta blocker used to control blood pressure and prevent exercise-induced headaches.

• Other medications: Naproxen, phenelzine, and dihydroergotamine mesylate have shown benefits in some individuals.

If your headaches occur predictably—for example, during planned physical activities—you may take medication one to two hours before exercise. For frequent or unpredictable headaches, daily preventive medication may be recommended.

Preparing for your appointment

You will likely begin by consulting your primary care provider, who may refer you to a neurologist for further evaluation. Being prepared can help you make the most of your visit.

Steps to prepare:

• Ask about any pre-appointment restrictions, such as fasting or dietary limits.

• Write down all symptoms, even if they seem unrelated.

• Note key personal information, including medical history, stress factors, or family history of headaches.

• List all medications, vitamins, and supplements you take.

• Bring a friend or family member for support and to help remember details.

• Prepare a list of questions to ask your provider.

Questions to consider asking:

• What might be causing my symptoms?

• Are there other possible explanations?

• What tests do I need?

• Is my condition temporary or chronic?

• What treatment options do you recommend?

• Are there alternatives or lifestyle changes that may help?

• Should I see a specialist?

• Are there educational resources or websites you recommend?

What to expect from your provider

Your healthcare provider will ask several questions to better understand your condition, such as:

• When did your exercise headaches begin?

• Are they continuous or occasional?

• Have you had similar issues before?

• Do you experience other types of headaches?

• Is there a family history of migraines or exercise headaches?

• What seems to trigger or worsen your headaches?

• What, if anything, helps relieve them?