Post-exercise headaches

I'm 58, and my daughter is 26, and we both develop headaches after exercise. They don't usually occur after aerobic exercise, but primarily come on after strength workouts. Sometimes the headaches begin during the workout, sometimes shortly after, and sometimes the morning after an evening workout.

They feel like sinus headaches, with pressure behind the forehead, or near the temple. The morning headaches often go away we've been up and about for a while.

I'd be glad to know what we can do about these headaches.

You seem to be describing benign exertional headaches. These are usually brought on by brief, intensive, energy-expending workouts. They can occur with no neurological symptoms, and can last for up to 24 hours. They are usually recurrent, but continuous treatment with nonsteroidal anti-inflammatory drugs can prevent their return.

In a small minority of cases they are due to an intracranial lesion. To rule out this possibility you should have a neurological examination, maybe including MRIs of the head and cervical spine.

Another possibility is "effort migraine." This crops up in people with a history of migraine and tends to run in families, as much as 50 percent of the time. These headaches resemble your description, usually occur at the end of activity, and may be longer and not as intense as benign exertional headaches. Sometimes these are associated with vision problems, hyperventilation, nausea, or vomiting. They can often be thwarted by gradual warmup prior to activity. If they occur frequently a neurological consultation is recommended because it is often hard to differentiate between effort migraine and benign exertional headaches.

There are also vascular headaches, often occurring with long term exercise, such as running or swimming. They can be precipitated by stress factors such as high altitude, heat, dehydration, or hypoglycemia. These headaches can persist for 24 hours after the exercise is finished. They may be associated with migraine and family history. Long warmups help here, too.

Less likely causes include sinus problems, allergic reactions, high blood pressure and environmental pollution. You should also rule out side reactions from medications, withdrawal from caffeine, effects of alcohol, and chronic use of pain medications.

You can also get headaches from muscle contractions due to cervical disk disorders, or TMJ syndromes (jaw abnormality), and they may accompany depression, anxiety, and other emotional upsets.

I suggest you and your daughter see your family doctor armed with a list of all the possibilities and work toward ruling out the ones that don't apply. Identifying the type of headache will lead to the appropriate treatment to control your headaches so that you can enjoy your exercise activities without apprehension.

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