Exercise Headache: a 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 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. 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.