Migraine and headache disorders: relationship to exercise and triggers

Exercise has a complex and paradoxical relationship with headache disorders. Physical activity may act as a trigger or an exacerbating factor for an acute migraine attack while it is also recognised as an evidence-based preventive strategy. Primary exercise headache is a distinct clinical entity and requires careful assessment and exclusion of sinister pathology but may respond to specific management. Imprecise nomenclature and miscommunication can lead both patients and clinicians to become frustrated. In this narrative review, we summarise the epidemiology, phenotype, differential diagnosis and management of primary exercise headache and briefly discuss the relationship between exercise and migraine.