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Primary Exertional Headache - The Basics

by Teri Robert, Lead Expert

Primary exertional headache (PEH) is a headache brought on by exercise, any form of exercise and is experienced by approximately 10% of the population. It is more common among men than women.

PEH is termed "primary" because it's not caused by another condition or disorder.

PEH is more likely to occur in hot weather or at high altitude, but it can occur in any weather and at any altitude. PEH is more likely to occur if alcohol or caffeine have been consumed prior to or during exercise.

The pain of PEH usually (but not always) comes on suddenly, can be unilateral or bilateral (on both sides of the head), and is often pulsatile. PEH generally lasts from five minutes to 48 hours, and the headache may be accompanied by:

PEH is often self-limiting, which means that it occurs for a period of time, then stops occurring. PEH is often self-limiting to a period of three to six months.

When diagnosing PEH, it is essential that imaging studies be performed to rule out subarachnoid hemorrhage and arterial dissection. Lumbar puncture may also be indicated to rule out issues related to the cerebrospinal fluid and / or cerebrospinal fluid pressure.

Prevention and treatment of PEH:

In cases where the headache is mild or builds slowly, warming up before exercising and / or an exercise program that begins slowly and increases in intensity and length over a period of months may prevent PEH.

Naproxen taken before exercise may prevent PEH in some cases. If participating in exercise more frequently than two or three days per week, care should be taken to avoid medication overuse headache.

Beta blockers (propranolol, timolol, etc.), given in doses similar to those for Migraine prevention have been shown to be effective in preventing PEH. Indomethacin at a dosage of 25-250 mg daily has also been effective in some cases. However, with indomethacin, treatment should be monitored to avoid stomach irritation and / or medication overuse headache. Since PEH is self-limiting, it's suggested that beta blockers be discontinued after six months for reevaluation of the need for the treatment.

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