Headaches of effort: why some people have a headache after…

A diffuse headache that appears just after a run and persists throughout the day… You may have experienced it, it’s what’s known as exertion headaches or “exercise headaches” in English. In most cases, they are painful but benign. However, they can sometimes be a sign of a brain pathology. Hence, it’s important to discuss it with your doctor to rule out any serious issues.

A pulsating bilateral pain
Exertion headaches are characterized by:

• A pain usually bilateral;
• A sensation of a pounding heart in the head (pulsating pain);
• A headache that occurs shortly after physical exertion and can last from 5 minutes to 48 hours (similar to migraine pain).

Affected individuals generally describe moderate intensity headaches, not accompanied by other symptoms but persist over time. A constant feeling of pressure is also part of the reported symptoms.

Due to rapid dilation of vessels in the brain
Several studies have focused on headaches after sports. The exact cause of their occurrence is unknown, but the most likely hypothesis is the dilation of blood vessels in the brain. A review of studies explains that during intense exertion, blood flow increases significantly, leading to rapid dilation of cerebral arteries, resulting in pulsating pain.

Exertion headaches can also be linked to an increase in intracranial pressure. Certain activities like weightlifting involve breath-holding, abdominal contractions, or increased pressure in the thoracic cage, factors that promote a rise in pressure within the skull.

Another possible mechanism for the onset of headaches after sports is an imbalance in blood flow. During exercise, a significant blood flow is directed to the working muscles. The brain must quickly adapt to this change, which can trigger pain.

Risk factors
As seen, there isn’t a single cause for exertion headaches, but various factors can combine. Furthermore, these mechanisms are often triggered or worsened by other factors:

• Dehydration, denoted by headache;
• Heat which, alongside exertion, challenges the body’s temperature regulation, leading to headaches;
• Hypoglycemia as physical exercise can rapidly decrease blood sugar levels, expressing as headaches, fatigue, and dizziness;
• Muscle tension in the neck and shoulders, especially during weightlifting or planking sessions.

Headaches after exercising: when to worry?
Headaches after sports are generally benign. But upon the first occurrence, it’s recommended to consult your doctor as they could reveal a more serious issue such as a vascular disorder (aneurysm rupture), neurological problem, or stroke (cerebral vascular accident).

Consult a doctor urgently if:

• The pain is sudden and severe (like a “thunderclap”);
• You have never felt such pain before;
• The headache is accompanied by other symptoms (vomiting, confusion, fever…).

Tips to avoid post-exercise headaches
The best way to prevent headaches after exercise is to address the risk factors:

• Stay hydrated before, during, and after your workout to avoid dehydration;
• Eat before your workout (carbohydrates and proteins);
• Warm-up;
• Breathe properly (without holding your breath);
• Start your activity gradually (progressive effort);
• Ensure a good posture in the head and shoulders (no stiffness or tension).