Exercise headaches

Your provider will likely recommend an imaging test, especially if:

• Your headaches last more than a few hours
• Your headaches strike suddenly, like a thunderclap
• You're older than age 40
• You have other signs and symptoms, such as nausea, vomiting or vision disturbances

In these cases, different types of imaging tests can help your provider verify that you have the harmless variety of exercise headache, rather than the type caused by a structural or vascular irregularity.

• Magnetic resonance imaging (MRI). This test uses a magnetic field and radio waves to create cross-sectional images of the structures within the brain.
• Magnetic resonance angiography (MRA) and computerized tomography (CT) angiography. These tests visualize the blood vessels leading to and inside the brain.
• computed tomography (CT) scan. A CT scan uses X-rays to generate a cross-sectional image of the brain. This test can show fresh or recent bleeding into or around the brain and is often used if your headache occurred less than 48 hours beforehand.

Sometimes a spinal tap (lumbar puncture) is needed as well, especially if the headache started abruptly and very recently and brain imaging appears normal.

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

• Indomethacin, an anti-inflammatory drug, is commonly prescribed.
• Propranolol (Inderal, Innopran XL), a blood pressure medication, also is used to prevent exercise headaches.

Other therapies, including naproxen (Naprosyn), phenelzine (Nardil) and dihydroergotamine mesylate (Migranal, Trudhesa), have been reported to be effective in some people.

If your exercise headaches are predictable, you may be able to take a 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 need to take the preventive medicine every day.

You're likely to start by seeing your provider. In some cases, you may be referred to a neurologist. It's good to be prepared for your appointment. Here's some information to help you get ready for your appointment, and to know what to expect from your provider.

What you can do

• Be aware of any pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance, such as restricting your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including past illnesses and operations, major stresses or recent life changes, and any medical problems that run in your family.
• Make a list of all medications, vitamins and supplements you take.
• Take a family member or friend along, if possible. Someone who accompanies you may remember something you missed or forgot.
• Write down questions to ask your provider.

Preparing a list of questions will help you make the most of your time with your provider. For exercise headaches, some basic questions to ask your provider include:

• What's causing my symptoms or condition?
• Are there other possible causes for my symptoms or condition?
• What tests do I need?
• Is my condition likely temporary or chronic?
• What is the best course of action?
• What are the alternatives to the approach you're suggesting?
• I have other health conditions. How can I best manage them together?
• Are there any restrictions I need to follow?
• Should I see a specialist?
• Is there a generic alternative to the medicine you're prescribing?
• Are there brochures or other printed material I can take home? What websites do you recommend?

Don't hesitate to ask any other questions that come up during your appointment.

What to expect from your doctor

Your provider is likely to ask you a number of questions, such as:

• When did you begin experiencing exercise headaches?
• Have your exercise headaches been continuous or occasional?
• Have you had a similar problem in the past?
• Have you had other kinds of headaches? Describe them.
• Has anyone in your immediate family experienced migraines or exercise headaches?
• What, if anything, seems to help your headaches?
• What, if anything, makes your headaches worse?