Exertion Headaches: A Pain, but Probably Not Dangerous

You're halfway through a grueling workout when your head starts to hurt. Before you know it, you've got such an intense headache that you have to stop exercising. What's going on?

Exertion Headaches: A Pain, but Probably Not Dangerous
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It's probably an exertion headache, also called an exercise headache. These uncommon headaches come on during exercise and may last a short time or as long as two days, according to Sarah Vollbracht, MD, a neurologist and headache specialist with NewYork-Presbyterian Medical Group Westchester in Eastchester, New York.

The good news is that most headaches that start during exercise or other types of strenuous exertion usually aren't caused by a serious health condition, according to the American Migraine Foundation.

Read more: What Causes Exertion Headaches While Lifting Weights?

The Facts on Exertion Headaches

An exertion headache usually affects both sides of your head. It may feel throbbing, and it usually begins after a sustained bout of physically strenuous exercise. Exertion headaches are more likely to happen when you exercise in hot weather or at a high altitude, but they can occur in any circumstance, according to the Mayo Clinic. Though it may last as long as two days, an exertion headache is more likely to last from five minutes to a few hours.

It may be hard to know whether your headache is worrisome without seeing a doctor. Dr. Vollbracht says if it's the first time you've gotten a headache during or right after exercise, call your doctor's office right away. Your doctor may order an imaging test, such as an MRI or CT scan, to rule out a dangerous underlying cause.

Important: If you have a sudden, severe headache—sometimes referred to as a thunderclap headache—call 911 and get emergency help immediately. This type of headache may indicate a very serious condition, such as bleeding in the brain. Dr. Vollbracht also says to call 911 if you have a sudden headache with any neurological symptoms, such as numbness or weakness in the face, arms or legs.

An Exertion Headache Diagnosis

Once your doctor rules out any conditions that could have caused the headache, you may be diagnosed with "primary exertion headache," meaning that your headaches develop on their own and aren't connected to an underlying medical issue.

According to the International Classification of Headache Disorders, the criteria for a diagnosis of primary exertion headache are:

  • Having had at least two headaches brought on during or soon after exercise
  • Having had headaches that lasted less than 48 hours
  • Having no other condition that caused the headaches

It's not known exactly how or why such headaches develop during or after exercise. Dr. Vollbracht says it's possible that exertion from strenuous exercises like weight-lifting might increase the pressure in the brain. She notes that sometimes people who get migraines may get an exertion migraine — one that's triggered or made worse by exercise.

Read more: 5 Types of Terrible Headaches and How to Ease the Pain

Don't Let Exertion Headaches Keep You on the Sidelines

The good news is that people who get exertion headaches usually get them for just a limited period of time, such as over the course of about three to six months. If your headaches are severe, you may need to avoid long bouts of strenuous exercise until you stop having them, according to the American Migraine Foundation.

If your exertion headaches start off mild and then progress, bracketing your workouts with longer warm-up and cool-down sessions may help stop them. Participating in an exercise program that starts off easy and slowly builds in intensity may also help you prevent an exertion headache, the foundation states.

Dr. Vollbracht says another option is to take preventive medications, such as indomethacin (a nonsteroidal anti-inflammatory drug), 30 to 60 minutes before exercise. "Exercise is part of a healthy lifestyle, and with pre-treatment, most exertion headaches will remit or become manageable," she says.

Is This an Emergency?

To reduce the risk of spreading COVID-19 infections, it is best to call your doctor before leaving the house if you are experiencing a high fever, shortness of breath or another, more serious symptom.
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