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Dear Dr Nina: I've started to get headaches when exercising and after sex - should I worry?


Strenuous exercise can bring on headaches

Strenuous exercise can bring on headaches

Strenuous exercise can bring on headaches

Advice from our GP on the cause of exercise headaches and what steps you can take to avoid them.

Q. I'm a 45-year-old woman in good health. I started exercising regularly about a year ago and I'm enjoying getting into better shape. Recently, however, I have started getting headaches during, and sometimes after, a workout session. The intensity of the exercise doesn't really vary much for me from workout to workout, so it isn't a case of just reining it in. I also make sure that I am fully hydrated, have eaten an hour or so before exercising, and I sip water throughout. I think I may have experienced these headaches in the past after sex. Is it something I need to worry about?

Dr Nina replies: Exercise headaches are headaches that come on during or after exercise. They occur most frequently in men and there are a number of different types.

Primary exercise headaches occur for no reason and have no underlying cause. They tend to be a tight dull throbbing pain that usually involves pain on both sides of the head. It builds up during activity, can be severe but usually only lasts a few minutes, though may more rarely extend up to 48 hours.

Secondary exercise headaches occur due to an underlying problem with the brain, surrounding structures or muscles and bones of the neck and head. These headaches may be similar to primary headaches but may come on suddenly or involve vomiting, dizziness, blurring of vision, and loss of consciousness and neck stiffness.

The exact cause of primary exercise headache isn't known. Altered blood flow to the head during exertion may play a role. Exertion particularly weight lifting may cause sudden changes in blood pressure which may be a trigger. These headaches can be dramatic and quite frightening. Secondary exercise headaches need to be ruled out as abnormalities in the blood supply to the brain or the presence of tumours or cysts may cause unusual headaches.

If there are any features of secondary headache - if these came on suddenly or in those over 40 - it is advisable to have a brain scan arranged.

An MRI and MR can look at the structure and blood supply to the brain. A normal scan is very reassuring ruling out causes such as tumours, cysts or vascular anomalies. Your doctor may suggest some bloods test to rule out any other cause of unusual headaches. X-rays or scans of the neck will rule out a bony or arthritic cause. Once any abnormality has been ruled out treatment needs to be considered.

Exercise headaches occur more commonly in those who have migraine. They also occur more commonly when exercising in humid conditions or at high altitudes. In many cases these headaches occur for a period of time and then settle and reassurance that these are benign may be all that is required. If headaches are more problematic then treatment may be offered. Indomethacin or Naprosyn are anti-inflammatory medicines that has shown some benefit. They need to be taken about an hour or two before exercise for maximum benefit. If headaches are predictable this may be a way to manage them.

Propranolol is a medicine that was initially designed to control blood pressure. It works by opening up blood vessels. This medicine has been used to help prevent migraine and can be effective for prevention of exertional headache also.

This treatment may be more appropriate if headaches are erratic or unpredictable. It is also important to make sure you hydrate before during and after exercise. Urine should be pale yellow to clear coloured.

Caffeine and alcohol may make these headaches more likely so avoid them near exercise if they are a trigger. Intense workouts involving severe exertion or heavy weights may also precipitate these headaches. A proper warm up period has been shown to help. Increase the intensity of exercise gradually.

How much coffee is too much?

Coffee is a popular “pick me up” drink largely due to the metabolic effects of caffeine — the drug it contains. Caffeine is absorbed quickly into the body and passes to the brain where it acts as a stimulant exciting the brain and nervous system. It also acts as a diuretic increasing the loss of water through the kidneys.

Caffeine has a number of effects in the body. It increases heart rate and alertness. This can lead to a feeling of anxiety or jitters, racing heart, difficulty sleeping, headaches, dehydration or dizziness. If you are used to ingesting caffeine and you stop it suddenly you may experience withdrawal symptoms such as drowsiness, headaches, irritability, nausea and vomiting. Ingestion of large amounts of caffeine may reduce calcium absorption increasing the risk of osteoporosis.

A caffeine intake of over 500mg daily is considered high and may have detrimental health effects. A single shot of espresso has 40 to 75 mg of caffeine. Remember that a large shop bought coffee may have 3 or more of these.

There are some health benefits to coffee consumption. It does contain antioxidants and consuming less than 400mg daily has been associated with reduced risk of cardiovascular disease along with a possibly reduced risk of liver and prostate cancer. However it was suggested that consumption of coffee might increase the risk of urinary tract cancers.

The World Health Organisation has expressed concern about the effects of high caffeine intake on health. Caffeine provides no health benefits and is not necessary in a normal diet. It seems like for coffee, moderation is key.

Health & Living