This type of headache is also called primary exertional headache or benign exertional headache. This is a headache triggered by any physical exercise, but typically of a strenuous type. The headache generally lasts between 5 minutes to 48 hours. It may occur on one or both sides of the head. It may occur more commonly in hot weather or high altitudes. In some patients, exercise can trigger a migraine and this is termed exertional migraine, and is of a pulsating, throbbing, or pounding type of pain.
It is most often a benign headache syndrome, but can also be associated with Chiari malformation, spinal fluid leak, vascular disorders, brain tumors, other structural abnormalities, aneurysm, tearing of an artery (dissection), other vascular abnormalities, or other “secondary causes”. Therefore, an evaluation with brain scans (brain MRI and brain and carotid artery MRA, or brain and carotid CTA) to exclude these potential treatable causes is necessary. It cannot be diagnosed until examination, further history, a recurrent pattern, and evaluations to exclude other causes of the headache have been performed with a physician. This headache requires urgent evaluation at the nearest emergency department for testing and evaluation, especially the first time that it occurs. One of the main diagnoses that needs to be evaluated for is a blood vessel related headache such as subarachnoid hemorrhage from aneurysm rupture (brain bleed).