Exercise headaches occur during or after sustained, strenuous exercise. Activities most commonly associated with exercise headaches are running, rowing, tennis, swimming and weightlifting. Doctors divide exercise headaches into two categories. Primary exercise headaches are usually harmless, aren't connected to any underlying problems and can often be prevented with medication. Secondary exercise headaches, on the other hand, are caused by an underlying, often serious, problem within the brain — such as bleeding or a tumor — or outside the brain — such as coronary artery disease. Secondary exercise headaches may require emergency medical attention. The exact cause of primary exercise headaches is unknown. One theory is that strenuous exercise dilates blood vessels inside the skull.

These headaches:

• Are usually described as throbbing

• Occur during or after strenuous exercise

• In most cases affect both sides of the head

Secondary exercise headaches may cause:

• The same symptoms as primary exercise headaches

• Vomiting

• Loss of consciousness

• Double vision

• Neck rigidity

Primary exercise headaches typically last between five minutes and 48 hours, while secondary exercise headaches usually last at least a day and sometimes linger for several days or longer.

When to see a doctor

If you experience a headache during or after exercise, consult your doctor — especially if it begins abruptly or if it's your first headache of this type.

You may be at greater risk of exercise headaches if you:

• Exercise in hot weather

• Exercise at high altitude

• Have a personal or family history of migraine

If no underlying structural or vascular problem is causing your exercise headaches, your doctor may recommend medications to help prevent the headaches.

• Indomethacin, an anti-inflammatory drug, is most commonly prescribed.

• Propranolol, a blood pressure medication, also is used preventively.

If your exercise headaches are predictable, you may be able to take the medication an hour or two before a scheduled event, such as a tennis match or a hike at high altitude. If your exercise headaches are frequent or unpredictable, you might want to take the preventive medicine every day.

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