Exertional headache is one of several relatively uncommon headache syndromes that may occur either as a primary headache or as a headache secondary to potentially malignant processes. Careful evaluation for underlying causes is important for these uncommon types of headache.
This topic will review exertional headache. Other types of uncommon primary headache disorders are discussed separately. (See "Primary stabbing headache" and "Primary cough headache" and "Primary headache associated with sexual activity" and "Hypnic headache" and "Thunderclap headache" and "Nummular headache".)
Headache provoked by exercise may occur either as a symptom of another disorder (secondary or symptomatic exertional headache) or as a primary disorder without an identifiable underlying abnormality (primary exertional headache). The relative frequency of primary versus secondary headaches differs from one case series to another. However, as neuroimaging techniques have improved, the proportion of symptomatic headaches relative to primary headaches has increased.
●In a case series from the 1960s, of 103 patients who presented with exertional (including cough-triggered) headache and a normal neurologic examination, an intracranial lesion developed in only 9.7 percent after three years of follow-up .
●In a literature review from the early 1990s, of 219 nonconsecutive patients with exertional headache that also included patients with cough headache, a structural lesion was found in 22 percent .