The International Headache Society classification criteria

The IHS classification and description of primary exertional headache is as follows:

4.3 Primary exertional headache

Previously used terms:
Benign exertional headache

Coded elsewhere:
Exercise-induced migraine is coded under 1. Migraine according to its subtype.

Description:
Headache precipitated by any form of exercise. Subforms such as “weight-lifters’ headache” are recognised.

Diagnostic criteria:

1. Pulsating headache fulfilling criteria B and C
2. Lasting from 5 minutes to 48 hours
3. Brought on by and occurring only during or after physical exertion
4. Not attributed to another disorder¹

Note: ¹ On first occurrence of this headache type it is mandatory to exclude subarachnoid haemorrhage and arterial dissection.

Comments:
Primary exertional headache occurs particularly in hot weather or at high altitude. There are reports of prevention in some patients by the ingestion of ergotamine tartrate. Indomethacin has been found effective in the majority of the cases.

Headache described in weight-lifters has been considered a subform of 4.3 Primary exertional headache; because of its sudden onset and presumed mechanism it may have more similarities to 4.2 Primary cough headache.

Summary and comments:

Primary exertion headache occurs only during or after physical exertion. If exercise brings on a headache for you, it's important to see your doctor so more dangerous issues such as subarachnoid hemorrhage and arterial dissection can be ruled out. The good news is that PEH tends to be self-limiting and stops occurring after three to six months. A change in exercise regimen or treatment can help prevent PEH.

It is important to note that primary exertional headache is not the same as a Migraine triggered by exertion.

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Resources:

The International Headache Society. "International Classification of Headache Disorders, 2nd Edition." Cephalalgia, Volume 24 Issue s1. May, 2004. doi:10.1111/j.1468-2982.2003.00823.x.

Silberstein, Stephen D.; Lipton, Richard B.; Dodick, David W. "Wolff's Headache and Other Head Pain, eighth edition." Oxford University Press. 2008.

Silberstein, Stephen D.; Lipton, Richard B.; Goadsby, Peter J.; Smith, Robert F. "Headache in Primary Care." Isis Medical Media. 1999.

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© Teri Robert, 2009. Last updated December 21, 2009.