Background

A migraine is defined as a recurring headache that lasts between 4 to 72 hours. Migraines are common and affect 15-29% of the general population, though less than 10% of people who suffer from migraines have exercise-induced migraines. Exercise-induced migraines are migraines triggered by exercise. Primary exercise headache is separate from exercise-induced migraine, although these headaches have features that overlap.

Symptoms

A migraine is typically one-sided, lasts 4-72 hours, is described as throbbing, is aggravated by activity and is moderately to severely painful. Typically, there is also associated nausea and/or vomiting, and sensitivity to light and/or sound. Those who are affected usually develop symptoms between 20 to 40 years old.

Primary exercise headache can start during exercise or within 30 minutes of stopping exercise and last from 5 minutes to 24 hours. It is usually bilateral, and throbbing, aching, or pounding. People with exercise-induced migraines typically do not experience nausea or vomiting. People with exertional headaches are at greater risk of heart disease and may benefit from seeing a cardiologist for further evaluation.

Sports Medicine Evaluation and Treatment

If you visit a sports medicine physician, they will ask you several questions about your headaches, including when they happen, how often they happen, if anything helps, if anything trigger them, how long you have had them and how long they last. They will do a detailed physical exam, including a review of your vital signs, listening to your heart, looking at your skin, evaluating your head and neck and assessing for neurologic symptoms. Additionally, an image of the brain such as a CT scan may be necessary if there is any concern for bleeding or a mass in the head.

Since exertional headaches may be a sign of heart disease, your physician may ask you to be seen by a heart doctor for further evaluation. Sports medicine physicians will initially try to control symptoms with lifestyle modifications including good sleep, hydration and sleeping habits, as well as vitamin supplementation. If your migraine cannot be managed with these modifications, your doctor may recommend medications or injections to prevent or stop them.

Injury Prevention

In order to prevent exercise-induced migraines and primary exercise headaches, it is important to note and avoid any triggers that may cause the headaches. These headaches will normally occur in hot weather or at high altitudes. In addition, these headaches typically occur with sustained exercise. Therefore, choosing when, where, and for how long to exercise, as well as maintaining good nutrition, hydration and sleeping habits will help prevent these headaches.

For example, you may consider exercising in shorter bursts spread throughout the day. It is important to have a good warm up and cool down before exercise, and if the sport or activity requires heavy exertion, breathing techniques can be discussed. Medical supplementation may be added to reduce migraines.

Return to Play

Once you are symptom-free and able to perform activity without headache, you could be cleared to play. Again, your doctor may recommend you be seen by a cardiologist for further evaluation of heart or vascular disease prior to being cleared.

AMSSM Member Authors
Jennifer Horawski MD, and Anthony Shadiack, DO

References
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Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018 Jan; 38(1):1-211.
Cutrer, F., 2021. Exercise (exertional) Headaches. [online] Uptodate. Available at: https://www.uptodate.com/contents/exercise-exertionalheadache?search=exercise%20induced%20migraine&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H92135061 [Accessed 28 July 2021].
Nadelson, C., 2006. Sport and Exercise-induced Migraines. [online] American College of Sports Medicine. Available at: https://journals.lww.com/acsm-csmr/fulltext/2006/02000/sport_and_exercise_induced_migraines.6.aspx [Accessed 28 July 2021].