Primary exertional headaches
1. Prophylactic Ibuprofen 800mg four hours prior to practices and games.
2. If no relief/prevention of symptoms, may try Indomethacin or triptan in same fashion.
3. Chronic prophylaxis, such as beta-blocker or other migraine-preventative agent, would be last resort.
The athlete’s headaches continued to decrease in frequency and severity. Ibuprofen helped to relieve his headaches. Ultimately, he was lost to follow up, as he did not return to football after receiving clearance for full contact activity.
The athlete was cleared for full contact activity, but ultimately did not return to football due to suspected social stressors.
Initial treatment of exercise-induced migraine headaches should focus on proper warm-up before exercise, minimization of environmental risks, proper sleep hygiene, and good nutrition and hydration(1). If these treatments are inadequate then pharmacological treatments may be tried. Beta blockers should be used cautiously as they will blunt the cardiovascular training response to aerobic exercise.
1. Sport and exercise-induced migraines.
Curr Sports Med Rep. 2006 Feb;5(1):29-33. Review.
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