The Exercise-Headache Connection

Whether headaches are a regular part of your life or something you only deal with occasionally, let’s face it:  they are a pain.  Headaches can be brought on by a variety of things, including stress, illness and even weather changes.  But what if your headaches are caused by something that’s supposed to make you feel good and improve your health?

For some people, exercise can trigger headaches during a workout—or when it's over.  If you've ever suffered from an exercise-induced headache, you may wonder whether you have to give up on fitness in order to avoid pain.  Although there is no magic cure, there are things you can do to lessen the frequency and severity of headaches brought on by exercise.     

Symptoms and Causes
For some people, headaches result during strenuous activities such as weight lifting, running, swimming or rowing.  There are two different kinds of exercise headaches depending on their cause: 
  • Primary headaches (also referred to as exertional headaches) are typically described as a throbbing or pulsating pain on both sides of the head that lasts from five minutes to 48 hours.  Because exercise dilates the blood vessels (in order to bring much needed oxygen and nutrients to the working muscles), it is believed that this dilation of blood vessels in the brain itself during exercise can lead to pain in some people—even when their heart rate and blood pressure is similar to people who don't experience exertion headaches.  About 10% of the population experiences this type of headache, which is more common in men than women.
  • Secondary headaches also involve throbbing pain, but can cause vomiting, double vision and even loss of consciousness.  These headaches can last several days or longer and are caused by an underlying problem such as a sinus infection, abnormalities in the blood vessels leading to the brain or reduced blood flow in the arteries leading to the heart.  These symptoms require immediate medical attention.    
Exercising in hot weather or at high altitudes can increase the likelihood of experiencing an exercise headache—even in people who don't normally experience the problem. 

Should I Talk to My Doctor?
No matter how often you experience exertion headache or how serious the symptoms are, it’s best to discuss the problem with your doctor so they can rule out any other medical issues and develop a plan for dealing with them.
Consider starting a diary to document when the headaches occur.  This can help you detect trends and also provide helpful information for your doctor when discussing your symptoms.  Document your answers to the following questions:
  • Do you experience headaches only during (or after) certain exercises? 
  • What is the weather like when you experience exertion headaches?  For example, do you notice you only get the headaches during outdoor workouts when the temperature is above 80 degrees?
  • Does anything about your routine change the likelihood that you'll experience a headache?  For example, do your headaches occur less often when you do an extended warm up or cool down?
  • Does the amount of sleep you got the night before correlate with getting an exercise headache?
  • Does the timing of your pre and post-workout meals have an effect?
  • When do your headaches come on: during exercise or sometime afterward?
  • How intense is each headache and how long does it last?
The more detailed you can be, the easier it becomes to find connections between your behaviors, routine, and the incidence of pain. 

Should You Work Out When You Have a Headache—or Skip It?
If you regularly suffer from primary or secondary headaches during exercise, work closely with your doctor to determine the cause of the headaches and a treatment plan before you develop or continue an exercise program.  Your doctor can give specific advice on exercises he or she recommends, as well as what you should avoid.
It’s never a good idea to try and push through pain

If you have a headache (whether triggered by exercise or something else), consider decreasing the intensity of your workout to something more comfortable. If you were planning to run, take a walk instead.  If the headache is significant, consider taking a day of rest.  Trying to just push through can end up making the problem worse. For general headaches that aren't a chronic problem, use your best judgment. Pick a workout and intensity that feels right to you, or skip exercise if your headache is worsened by exertion or you just don't feel up to it.

There are a wide variety of over-the-counter medications used to treat headaches.  Some can cause issues with dehydration or other side effects if taken before or during a workout.  If you’re not sure which one is right for you, consult your local pharmacist or physician.

Tips to Prevent Exercise-Related Headaches
There’s no guaranteed method for preventing headaches during exercise. While certain techniques may work well for one person, the same might not work for another.  You will want to experiment to figure out how to lessen the chances and severity of your headaches, while maintaining an active lifestyle without too much discomfort.  Here are a number of suggestions that may help.
  • Employ relaxation techniques.  Tension headaches are the most common type of headache among adults.  Acupressure, yoga and various relaxation techniques have been effective in reducing their frequency and severity.  Although this might not have a direct benefit if you experience exercise-induced headaches, it can only help to begin your workout feeling at-ease.
  • Warm up and cool down longer.  Extend the length of your warm up, slowing increasing the intensity of the workout to give your body time to adjust.  If your normal warm up is 5 minutes, try 10-15 minutes, starting at a very low level of exertion and gradually increasing.  Same goes for the cool down: Try to lower your heart rate slowly—not abruptly—until it is back to pre-exercise levels.
  • Gradually increase workout intensity.  Slowly increase intensity and duration of workouts over a period of weeks and months.  It’s never a good idea to go from being sedentary to running for 30+ minutes, for example. But this advice is even more important when you experience exertion headaches.  
  • Focus on your breath. When weight training, be sure to never hold your breath.  This causes pressure that can easily trigger a headache.  Pay attention to your breathing rate during all forms of exercise, keeping your inhalations as smooth as possible. Get more tips for breathing right during any workout.   
  • Make adjustments as needed.  If you’re planning an outdoor workout on a hot day, consider decreasing the intensity (for example, walking instead of running) or opt for an indoor, air-conditioned workout to avoid the heat.  Find activities you enjoy that don’t exacerbate the problem.  If you can’t find ways to run without head pain during or after the workout, try walking, biking or swimming instead.       
  • Explore medication options.  Assuming you don’t have an underlying medical condition that is causing the headaches, there are methods to help prevent them.  Your doctor might suggest an over-the-counter medicine (such as ibuprophen or aspirin) to be taken as needed. There are also stronger medications the doctor can prescribe.  If the headaches are predictable, medication can be taken an hour or two before activity.  If they are unpredictable, your doctor might suggest taking the medication daily.
While exercise can sometimes be challenging or uncomfortable, it should never be painful. Taking the steps to prevent and treat headaches during your workouts will help you adhere to an exercise program—and reap the benefits of an active lifestyle.

Kordi, Ramin, Mazaheri, R., Rostami, M. and Mansournia, M.A. "Hemodynamic Changes After Static and Dynamic Exercises and Treadmill Stress Test; Different Patterns in Patients with Primary Benign Exertional Headache." Acta Medica Iranica 50 (2012): 399-403. Accessed February 20, 2013.

Mayo Clinic. "Exercise Headaches." Accessed February 20, 2013.

Robert, Teri. "Primary Exertional Headache: The Basics." Accessed February 20, 2013.