How to Diagnose Exertional Headaches

Exertional headaches are actually more common than many people think. It is estimated that about 1 in 100 persons have exertion headaches at some point in their lives. Also, in a recently conducted study in Norway, the Vågå Study, as much as 12.3% of the population suffers from exertional headaches.

The triggering factor can vary from performing strenuous activities like weightlifting, biking and swimming, to doing ordinary activities like cleaning the house, gardening or performing any activity that can raise the heart rate to more than 10 seconds. Even exposure to extreme temperatures, humidity and high altitudes can all trigger exertional headaches when not performing any kind of activity.

This is the main diagnostic issue with exertional headaches. Its variable and indistinct clinical presentation, people and even doctors can confuse it with so many other disease entities. The International Headache Society (IHS) created these diagnostic criteria in order to standardize the definition and diagnosis of exertion headaches:

• Pulsating or throbbing headache
• With a 5-minute to 48-hour duration
• Occurs only during or following physical exertion
• Not caused by any other pre-existing disorder

Suspected Diseases

The IHS included “not caused by any other preexisting disorder” as one of the basis diagnosing exertional headaches. Therefore, diagnosing exertional headaches is primarily a diagnosis of “exclusion.” This means that doctors have to exclude all other possible causes of the headache, before they can safely say that it is “exertional.”

Although 80% of exertional headaches are not associated with other diseases. Other potentially serious conditions can increase the risk of experiencing exertional headaches. Some of the most common diseases considered during diagnosis include:

• Subarachnoid Hemorrhage – Bleeding into the subarachnoid space, which is usually caused by ruptured cerebral aneurysm or brain trauma, may trigger a sudden onset of severe headache. It is associated with vomiting, confusion and seizures, and is fatal in 50% of the cases.
• Vertebral Artery Dissection – Spontaneous dissections occur following cough and extreme exercise. The most common manifestation is the presence of severe headache and neck pain, and about 60% of the patients will suffer from cerebral ischemia.
• Cardiac Cephalgia – Although headaches are uncommon among those suffering from cardiac diseases, headache may be the only manifestation of angina pectoris or an impending heart attack. As much as 6% of patients with myocardial infarction presented with exertional headaches.

All of these life-threatening conditions can present as an innocuous exertional headache. As such, the presence of recurrent headaches or the sudden onset of an extremely painful headache always warrants immediate medical attention for diagnostic evaluation.

Diagnostic Studies

Diagnostic or neuroimaging studies used in the diagnosis of exertional headaches involve multiple highly technical procedures that will help locate other conditions that may have caused the headache. Diagnostic tools used include:

• Magnetic Resonance Image (MRI)
• Lumbar Puncture
• Cranial CT scan
• Contrast Studies

These diagnostic studies may help physicians in finding the cause of the headaches. It may also help confirm that no other disease conditions are present. Following these tests, doctors can safely say that the headache is indeed “exertional” in nature.

The diagnosis of exertional headache is truly a long and can be quite a tedious process. Then again, this is but a small price to pay to protect both your health and peace of mind.