Run Monster

The Headache Puzzle.

After the Rock N Roll Half Marathon in Phoenix this past January, I was over the moon. It was a day that I’ll remember fondly for a long time: My race went much better than expected, I had lunch with my parents and my boyfriend afterward, and then the boyfriend and I went back to our hotel and watched NFL playoff games for the rest of the day.

That’s a pretty perfect day in my world.

BUT, there was one aspect of the day that I could have done without – like, really done without – and that is the horrific headache I got shortly after I returning to my hotel room. This headache came on somewhat quickly, over the course of maybe 10-15 minutes, and although that may not seem that quick, the height of intensity that it reached was staggering given that I felt amazing less than half an hour before.

Unfortunately, I am all-too-familiar with headaches. Just over two years ago, I actually went to the emergency room for a headache because it was both extremely painful and totally unresponsive to medicine. It’s not uncommon for me to be woken up by headaches in the night, or to have them build throughout an entire day. Usually, if I take medicine as soon as I feel it, the headache will disappear. I learned this the hard way, of course, after trying too many times to “tough it out,” only to be debilitated.

Now, headache sufferers will be asking: what kind of headaches do you get? And this is a valid question because headaches have all sorts of variations. From what I’ve been able to gather, headaches fall under the main categories of Tension, Migraine, Sinus, Exertional, Cluster, and Rebound. I’ve had all of these types except cluster and rebound headaches. 

The primary exertional headaches, or PEHs, are the ones I’d like to talk about  because as you might be able to guess, lots of runners (apparently!) suffer from PEHs, and this is the type of headache I believe I suffered from after the half marathon.

Primary exertional headaches emerge after bouts of intense physical activity. ‘Primary’ refers to the fact that physical activity is the main cause of the headache, and that the headache is not merely a symptom of a more serious, underlying condition, like a brain tumor or coronary artery disease. (These other types of headache are called Secondary Exertional Headaches, and are much more dangerous and complex to treat.)

Frustratingly enough, the physiological reason for exercise-induced headaches is not understood. High altitude, hot weather, dehydration, caffeine consumption, and greater-than-normal exertion (say, for a race) can all predispose an athlete a PEH, but none of these things is required to land yourself in pain.

As for the sensations these headaches inflict, PEH’s are characterized by the following:

1) Sudden onset

2) Unilateral or bilateral (one or both sides of the head)

3) Throbbing/pulsatile

4) Photophobia (light sensitivity)

5) Phonophobia (sound sensitivity)

6) Nausea; vomiting

Pretty fun stuff, right? I actually named this post ‘The Headache Puzzle’ because before doing more research on the topic, I was unsure of whether I had suffered from a PEH or from a migraine, and I’m sure that many others have had the same confusion. Many of the symptoms of a PEH (one-sidedness, photophobia, nausea, severity) are indicators of a migraine, so a person who suffers from migraines intermittently like I do may not be able to distinguish them.

Historically, I have only been able to distinguish my migraines and my PEH’s by their reaction to medicine. When I went to the emergency room, the nursing staff gave me migraine medicine first and it didn’t make one iota of difference. After an I.V. of fluids and a strong dose of naproxen (ibuprofen), the headache finally started to abate, and I was left to conclude that that one was not a migraine. It was August and I had gone running roughly 6 hours before the headache began, so I now believe it was a primary exertional headache.

My post-race headache was severe and included one-sidedness, photophobia, nausea/vomiting, and throbbing, but it, too, responded to non-migraine medication. My savior of a boyfriend walked to a nearby drugstore and bought me Excedrine Extra Strength, which knocked out the headache with surprising efficacy. This fact alone makes me think that this particular headache was exertional.

I have further concluded that my post-race headache was a PEH because I was at a higher altitude than usual (I had been training at a mile high for the month leading up to the race, but the race was still about 3000 feet higher than my home in PA), I always consume coffee before doing anything in the morning, and I was most definitely running harder than normal.

I remember trying hard to be hydrated before and after the race, and my light-colored urine lead me to believe I succeeded. So I don’t think dehydration was a contributing factor. Given the absence of any sinus problems (like a cold) and the fact that I wasn’t tense or stressed at all after the race, I can also rule out tension headache or sinus headache.

One point which I haven’t made clear enough is why I care so much about what kind of headache I had. The short answer is that I would like to be able to treat and/or prevent headaches effectively, and I can only do that if I know what I’m trying to treat and/or prevent.

It is suggested that taking naproxen before intense activity can help prevent the onset of a PEH. Rebound headaches are caused by the overuse of medication, so it is important not to use this prevention method too often. I, for example, plan only to take preventative medicine if I’m at altitude or if I’m preparing to race. Staying hydrated and limiting intake of caffeine and other diuretics are also recommended modes of PEH prevention. While I won’t eliminate coffee from my morning routine, I will try to over-emphasize hydration and limit my coffee consumption to one cup.

As for treatment, it is crucial to treat both migraines and PEH’s immediately. They only get worse when left untreated. Migraine sufferers should have a migraine-specific medication on hand, and PEH’s can be treated with extra strength naproxen/ibuprofen (as mentioned, I find Excedrine to work well).

More than anything, I wanted this post to bring about awareness of primary exertional headaches. Their similarities with migraines can make them hard to spot initially, and as runners who frequently engage in high-intensity activity, it is good to be on the alert for them. I encourage anyone who suffers from headaches to invest time in determining the type/causes/treatments. Having done research on this topic, I feel empowered because in the future, when I’m afflicted with headache, I will be a better position to understand and treat it.

-Run Monster


4 comments on “The Headache Puzzle.

  1. Lina
    March 16, 2014

    I’m sorry you get these terrible headaches! Headaches are the worst. I have definitely gotten exertion headaches myself, and yes, it’s difficult to tell the difference between them and migraines. Thanks for all the info on preventative measures though…

  2. dgobs
    March 18, 2014

    Wow, thank you for this post! I’ve suffered from bad headaches after races for a while, and I always assumed they were migraines. I thought they were caused by dehydration until I, like you, noticed that I was pretty well hydrated and still getting headaches. I had never heard of PEH until I read this post, and while I feel bad that you’ve been suffering too, I’m relieved to know that this is a thing and it’s not just me and my weird head. Thank you for sharing what you’ve found about PEH, and I hope you’re able to beat your headaches from now on!

    • runmonster
      March 18, 2014

      I hope you’re able to beat your headaches as well! I’m so glad to hear that this post helped you better understand what has been going on with your head. Let me know if you find a magic combination for treatment or prevention!

  3. Lina
    April 10, 2014

    hope you’re writing a recap of the 15K this past weekend! I have been refreshing your blog daily, like a madwoman. Gimme somethin.’ <33333

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