Riboflavin is generally well tolerated; common adverse effects include yellow discoloration of urine, polyuria, and diarrhea. The CoQ 10 group had a statistically significant improvement in the change between months 1 and 4 in the number of days with nausea and in the number of headache days. Feverfew: Feverfew is another option, and several studies support its use for headaches. The recommendation in the American Academy of Neurology AAN guidelines for migraine prevention is based on five studies with positive results, one negative study, and one study that did not show differences versus placebo when feverfew was given as part of a combination.
Butterbur: Butterbur was previously recommended by the AAN guidelines for migraine prevention. Butterbur should no longer be recommended for migraine prophylaxis. Indomethacin is the first-line choice for short-term treatment of exercise-induced headache. Indomethacin should be administered 30 to 60 minutes before the known exertional trigger, when the trigger cannot be avoided; when the headache frequency is high or triggers cannot be anticipated, indomethacin is often dosed every 8 hours.
This suggests that indomethacin may have an additional mechanism that provides direct vasoconstriction of cerebral blood. Indomethacin is recommended for short-term use because of adverse effects associated with chronic use of nonsteroidal anti-inflammatory drugs NSAIDs.
When long-term or daily headache prophylaxis is needed, beta-blockers are recommended. Caution should be taken when beta-blockers are used in athletes because reductions in heart rate and exercise tolerance may occur. Triptans are another treatment option, particularly when there is a known exertional trigger that cannot be avoided or when the patient does not tolerate indomethacin.
Onset, duration, and route of administration vary among triptans. If prophylactic measures fail, triptans still may provide relief for acute treatment and termination of migraines. Presentation: CT, a year-old male, presented with complaints of migraines occurring during exercise. He had a previous diagnosis of migraine with aura; for the past several months, he experienced a migraine after each running session.
CT reported that he alternated jogging and walking, which helped prevent the migraines, but he was dissatisfied with this strategy because he could not work out for the duration or intensity he desired. What should be recommended to CT?
Recommendation: It was suggested that CT extend the time of his warm-up and gradually increase his exercise intensity over a longer period of time; it was also recommended that he ensure adequate hydration, especially on days he was going to run. In addition, he was started on magnesium supplementation. These measures have allowed CT to run for longer distances and intensities without experiencing an exercise-related migraine for the last 3 months.
Implementation of proper warm-up and nonpharmacologic measures can help prevent exercise-induced migraines in patients who experience them. In patients who need pharmacologic therapy, preventive options such as magnesium, riboflavin, and NSAIDs should be considered.
Appropriate abortive therapy, such as triptans, should be readily available to the patient during exercise for times when preventive measures fail. The International Classification of Headache Disorders, 3rd edition beta version. Johns Hopkins Medicine. Neurology and neurosurgery. Accessed July 25, Headaches precipitated by cough, prolonged exercise or sexual activity: a prospective etiological and clinical study. J Headache Pain.
Williams SJ, Nukada H. Sport and exercise headache: part 1. Prevalence among university students. Br J Sports Med. Koppen H, van Veldhoven PL. Migraineurs with exercise-triggered attacks have a distinct migraine. Nadelson C. Sport and exercise-induced migraines. Curr Sports Med Rep. Exertional headache—a survey of adolescents. Coughing can cause a primary or secondary headache. Primary cough headaches are not usually serious.
Secondary ones may indicate an underlying…. An orgasm headache is one of two types of sex headaches. Here are the symptoms to watch for, how you can manage it, and more.
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Understanding Exertional Headaches. Medically reviewed by Seunggu Han, M. The types of activity that cause them vary from person to person, but include: strenuous exercise coughing sexual activity Doctors divide exertional headaches into two categories, depending on their cause: Primary exertional headache.
This type is brought on solely by physical activity and is usually harmless. Headache: Hope through research. National Institute of Neurological Disorders and Stroke. Accessed Jan. Ropper AH, et al.
New York, N. Cutrer FM. Exertional headaches. Longo DL, et al. Harrison's Principles of Internal Medicine. Primary exertional headache.
International Headache Society. Mayo Clinic Press Check out these best-sellers and special offers on books and newsletters from Mayo Clinic.
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