What Are Exertion Headaches (aka Exercise Headaches)?

A headache can occur for various reasons, and it’s not always easy to determine the cause. However, if you can trace your headache to a specific physical activity, such as running or another workout, you may have an exertion headache.

“An exertion headache, also known as an exercise headache, is a headache triggered by physical activity and is often caused by increased pressure in the blood vessels of the brain,” says Reuben Chen, MD, a physical medicine and rehabilitation physician in Dallas.

Exertion headaches — and their subtype, running headaches (which only happen during running) — aren’t generally severe. However, they can certainly be painful.

Exertion headaches differ from other types of headaches in that physical activity triggers them.

In sports medicine and research literature, an “exertion headache” is recognized as a distinct condition, says Colin Tomes, PhD, PT, an assistant clinical professor of health sciences at Moravian University in Bethlehem, Pennsylvania. “This term is crucial because headaches may occur during physical exertion that stem from another cause, which may be of concern.”

That said, the physical event that triggers an exertion headache can vary. It could be anything from running to yard work to sex, says Klee Bethel, MD, an anesthesiologist pain interventionist at the Neil Riordan Center for Regenerative Medicine in Tempe, Arizona.

Regardless of the exact mechanism, however, certain factors increase the likelihood of an exertion headache. They include:

Exercise

An exertion headache is often a result of overexertion during exercise. The combination of dehydration (more on this shortly), pressure inside the skull, and muscle tension that results from intense or prolonged exercise can create a perfect storm for head pain, Dr. Chen says. The high-impact nature of running makes it particularly likely to cause headaches, he adds.

Dehydration

A lack of fluids can be a significant contributor to exertion headaches, especially when exercising outdoors or in high temperatures. “Low fluid levels thicken blood and stress blood vessels, reducing nutrient and oxygen delivery and potentially triggering headaches,” says Dr. Tomes.

Too Much Sun

Tomes recommends gradually increasing your outdoor exercise to acclimate yourself to the heat slowly.

Low Blood Sugar

Poor Exercise Form

Headaches after running, cycling, or strength training could signal an issue with your body mechanics. When your exercise technique isn’t on point, it places excess stress on your muscles and joints, causing tension.

“Muscle tension, particularly in the neck and shoulders from poor posture or overexertion, can compress nerves and blood vessels, contributing to headache onset during physical activity,” says Chen.

Underlying Health Conditions

Not all exertion headaches are as simple as they seem. “Some headaches are secondary to health issues, such as blood vessel problems, heart disease, and structural brain lesions,” says Tomes.

Consult your primary care provider if your symptoms are new or you suspect your exercise headaches have an underlying cause.

A few key features of an exertion headache include, per Tomes:

• Throbbing or Pulsating Pain This is often present on both sides of the head but can be limited to one side of the head.
• Pain Associated With Activity An exertion headache typically starts during or shortly after physical activity.
• Duration Up to Two Days These types of headaches may last anywhere from a few minutes to 48 hours. However, they often resolve within a few hours with rest.
• Other Symptoms You may experience other symptoms alongside an exertion headache, including neck stiffness, nausea, sensitivity to light, and vision changes.

For most people, exertion headaches are more of an annoyance than a concerning health condition. They also typically resolve once physical activity is stopped and rest is taken, says Tomes.

Seek medical attention if a headache is intense, accompanied by a fever, or results in a loss of consciousness (see more on this below).

Exertion headaches are usually treatable with self-care. “After onset, resting in a quiet, dark environment, applying a cool compress to the forehead, and taking over-the-counter pain relievers like ibuprofen or acetaminophen can help alleviate symptoms,” says Chen.

If a cold compress doesn’t do the trick, try heat. Bethel suggests running warm water on the head or neck.

Manual therapies, such as massage, can also relieve tension from exertion headaches, Tomes says. Depending on where your pain originates, you may gently massage your head, neck, jaw, temples, and shoulders, or have someone else do this for you.

Prevention is the most effective strategy for exercise-induced headaches. Here’s how to head off aches and pains:

• Warm up. Spend several minutes doing dynamic (moving) stretches and light exercise to ease into activity. Avoiding sudden, intense efforts can reduce the likelihood of getting a headache, Chen says.
• Hydrate. Drinking plenty of water before, during, and after a workout or other strenuous activity is crucial for preventing headaches. “A good guideline for hydration is to visually examine urine color; anything darker than a pale straw color should be an indicator to drink more fluids,” says Tomes. Add electrolytes (minerals that are depleted during exercise and aid hydration) to your water if you’re exercising in heat and humidity or for longer than 45 minutes.

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• Avoid too much sun and heat. Excessive sweating may cause you to get dehydrated faster. Build heat tolerance by gradually increasing the duration and frequency of outdoor exercise.
• Identify triggers. Notice whether a specific type of exercise, temperature, or time of day triggers your exertion headaches. If so, tweak your workout routine to avoid future headaches.
• Assess your exercise form. A personal trainer, physical therapist, or orthopedist can help determine whether your headaches are related to exercise mechanics. The expert can also help fix your mechanics to stave off headaches down the road.

Most exercise headaches aren’t a significant health concern. However, see your primary care provider if you experience:

• A new-onset exertion headache
• Severe head pain that appears suddenly or won’t go away
• A headache alongside confusion, vision changes, weakness, nausea, or neck stiffness

Chen says these may be signs of an underlying health condition.

Your doctor may order various tests, including blood tests and imaging scans, like computerized tomography (CT) and magnetic resonance imaging (MRI). A CT scan uses X-rays to create images of inside your body. An MRI generates images using magnetic fields.

To rule out serious causes, your doctor may order a lumbar puncture, also known as a spinal tap. It involves drawing fluid out of the lower spine.

• An exertion headache, also known as an exercise headache, is a type of headache triggered by physical activity.
• Most exertion headaches aren’t severe and can be treated at home with rest, over-the-counter pain medications, and hydration.
• See your healthcare provider if you experience new exertion headaches, extreme pain, or additional symptoms such as confusion, vision changes, weakness, nausea, or neck stiffness.