PAIN MANAGEMENT Headache • Migraine headache • Tension headache • Cluster headache • Rebound headaches • Primary cough headaches • Ice cream headaches • Exercise headaches • External compression headaches • Spinal headaches • Thunderclap headaches • Sex headaches • Chronic daily headaches • Sinus headaches

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You know exercise is good for you. But did you know that exertion can leave you with a pounding headache?

Headaches triggered by any form of exercise are known as exertional or exercise headaches. Strenuous activities such as running and lifting weights are common culprits.

Exercise headaches have no underlying cause other than exertion. Although annoying, exercise headaches aren't serious. Proper diagnosis is important, however. Sometimes headaches after exercise are due to a serious underlying cause — such as bleeding in the brain.

Exercise headaches cause throbbing pain on both sides of your head. The pain may last from five minutes to 48 hours. The pain may get worse when you bend over, cough or strain. Sometimes, exercise headaches are accompanied by nausea and vomiting.

What causes exercise headaches is unclear.

Exercise headaches are more likely to occur while you're exercising in hot weather or at a high altitude. Caffeine and alcohol may play a role as well.

Although many people who have migraines also experience exercise headaches, these headaches are just as common among people without migraines.

Exercise headaches aren't serious. But more than 10 percent of people who have exercise headaches may have a serious underlying condition, such as increased pressure or bleeding within the brain.

If you experience a headache after exercising, consult your doctor — especially if it's your first headache of this type.

If the headache disappears within a few hours after exertion and you have no other neurological signs or symptoms, diagnostic tests may not be needed.

Your doctor may recommend a magnetic resonance imaging (MRI) exam 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 and vomiting

In these cases, an MRI can help your doctor verify that you have an exercise headache — which isn't serious — rather than a headache caused by a more serious problem. During the exam, a magnetic field and radio waves will be used to create cross-sectional images of the structures within your brain.

Sometimes a spinal tap (lumbar puncture) is needed to exclude bleeding in the brain due to a ruptured aneurysm (a bulge in an artery). With this procedure, the doctor will remove a small amount of the fluid that surrounds your brain and spinal cord.

Exercise headaches aren't associated with any complications.

Exercise headaches often disappear on their own. When acute treatment is needed, the medication indomethacin may provide relief by reducing pressure within the brain. Other nonsteroidal anti-inflammatory drugs, such as aspirin and ibuprofen, may be effective as well. If the headaches have migraine characteristics, medication such as a triptan may be helpful.

If you have a history of exercise headaches, your doctor may recommend preventive therapy with indomethacin — either on a daily basis or before certain activities. Propranolol and various other drugs also can be used for preventive therapy.

To help prevent exercise headaches, avoid the specific activities that trigger them. Exercising regularly can help, too.