Primary exertional headache

INTRODUCTION

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 primary 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".)

CLINICAL FEATURES

Exertional headache is characterized by episodes of pulsatile head pain that are brought on by or occur only during or after physical exercise.

Exertional headaches are bilateral and throbbing in quality. They persist from five minutes to 48 hours, are triggered by physical exercise, and may be prevented by avoidance of excessive physical exertion. Exertional headaches are not usually associated with nausea or vomiting [1], although patients who also have migraine may develop exertional headaches with migrainous features [2]. It should be pointed out that the defining features of exertional headache come to us from a relatively small number of case series [1,3-7].

The precise incidence and prevalence of primary exertional headache are unknown, and estimates vary widely. A Danish population-based study of adults found that benign exertional headache had a lifetime prevalence of 1 percent [8], while a study of adults from Norway found a prevalence of approximately 12 percent [9].