Headaches Resulting from Playing Sports
By Dr. Brad Eli
Headaches in sports are common and often misunderstood health concerns that significantly affect athletes, both amateur and professional.
For these athletes, peak performance and mental focus are key, so the presence of headaches can disruptive, impairing an athlete’s ability to train, compete, and excel. The diverse presentation of headache disorders poses unique challenges for athletes, coaches, and healthcare professionals.
Understanding the underlying causes and effective management strategies for headaches in athletes is therefore important for both the individual athlete and for sports organizations. By examining the most common sports headache types in detail, we hope to provide guidance for athletes, coaches, and healthcare practitioners to effectively address the influence of headaches on athletic performance and well-being.
Table of Contents
- Headaches Resulting from Playing Sports
- How Extensive is the Headache Problem in Athletes?
- The Critical Role of Trauma in Sports Headaches
- Exertion Headaches Following Intense Physical Activity
- Dehydration Headaches Brought on By Strenuous Exercise
- Post-Traumatic Headaches From Sports
- Cervicogenic Headaches Occuring in Contact Sports
- TMJ-Related Headaches
- Athletes Experiencing Tension Type Headaches
- Can Migraines Diminish Athletic Performance?
- Athletes Who Experience Medication Overuse Headaches
- How to Prevent Sports Headaches?
- SUMMARY: Effective Headache Management & Prevention for Athletes
How Extensive is the Headache Problem in Athletes?
When assessing the headache issue with sports, it’s important to consider variables such as headache type, cause, and duration. Recognizing these categories can inform targeted prevention and management efforts. This can be considerably different for sporadic, short-lived headaches versus those that are persistent and recurrent. The primary headache types that affect athletes are listed in Table below.
|Table: Headaches in Athletes by Type, Chronicity, Cause, and Duration
|5 minutes to 48 hours
|30 minutes to 3 hours
|Acute to Chronic
|Daily up to weeks
|Acute to Chronic
|Daily up to weeks
|Acute to Chronic
|Daily up to weeks
|Weeks to months
|Weeks to months
|Weeks to months
High prevalence of headaches in youth athletes
The prevalence of headaches in youth athletes can be as high as 80% and those classified as having chronic headaches is around 15%, according to a recent multi-center study . Acute headaches typically arise from short-term or reversible causes, while chronic headaches are longer in duration and are often pre-existing conditions. A chronic headache is defined as 15 headaches or more per month for at least three months .
The Critical Role of Trauma in Sports Headaches
It’s important to recognize the pivotal role of trauma in triggering headaches among athletes. The most evident association of trauma and headaches are those that involve traumatic brain injuries. The most common type of traumatic brain injuries are concussions. These are classified as “mild traumatic brain injuries”, but the health consequences of these injuries are far from mild, often leading to symptoms that last for weeks or months. Headaches are the hallmark symptom of concussions in sports, manifesting in up to 90% of concussion cases.
In addition to brain injuries, trauma affecting the neck or temporomandibular joint (TMJ) can also contribute to the occurrence of headaches. Neck trauma is specifically linked to cervicogenic headaches, while injuries involving the jaw and muscle sprain/strain (JAMSS) are associated with TMJ-related headaches. Additionally, chronic headaches may be influenced by various risk factors, such as a personal history of anxiety, depression, or substance abuse disorders.
Exertion Headaches Following Intense Physical Activity
Exertion headaches, sometimes called primary exercise headaches, typically occur during or after intense physical activity and can range in severity from mild discomfort to intense and debilitating pain. Exertion headaches can be triggered by various forms of exercise, including weightlifting, high-intensity interval training, endurance sports, and even activities that involve sudden, forceful movements like jumping or sprinting.
Common characteristics of exertion headaches include:
- Throbbing or pulsating headache.
- Usually on both sides.
- Felt during or immediately after exertion.
- More likely in hot weather or high altitude.
- No prodromal signs or aura (like with migraines) .
Exertion headaches are believed to result from increased blood flow and pressure within the blood vessels in the brain during strenuous physical exertion . Dehydration, heat, and inadequate breathing techniques during strenuous workouts can also contribute to the development of these headaches.
Exertion headaches are considered a “diagnosis of exclusion”, meaning that this should be the diagnosis after other more serious conditions have been ruled out. If suspected, these athletes should consider consulting a healthcare professional to evaluate for any underlying conditions and receive guidance on management strategies.
Dehydration Headaches Brought on By Strenuous Exercise
During strenuous exercise, the body loses water and electrolytes through sweat, which can lead to dehydration if not replenished adequately. For this reason, hydration strategies are essential for athletes to maintain peak performance and minimize the risk of these headaches.
What are common characteristics of dehydration headaches?
- Dull ache, sometimes with throbbing or pounding.
- Accompanied by dry mouth and thirst.
- Can manifest with heat cramps, nausea, or dizziness.
- Accompanied by dark urine or decreased urination.
- Passing out or fainting .
The mechanism for these headaches is complex. Dehydration reduces blood volume and increases the concentration of solutes in the blood. This leads to a decrease in cerebral blood flow and oxygen delivery to brain tissues, potentially causing irritation and dysfunction in pain-sensitive structures. Additionally, dehydration can lead to electrolyte imbalances, such as reduced sodium levels, which further affect neurological functions and may contribute to headache development.
Post-Traumatic Headaches From Sports
Post-traumatic headaches can affect athletes who have experienced traumatic brain injuries or concussions. Athletes engaged in high-impact or contact sports are particularly susceptible to these types of injuries.
Post-traumatic headaches can present with various features, including:
- Dull, band like pain (like tension-type headaches).
- Severe pulsing pain (like migraine headaches).
- Sensitivity to light and sound.
The pathophysiology of post-traumatic headaches in athletes is multifaceted. When a head injury occurs, it can lead neurotoxin release in the brain, triggering chemical and blood flow changes that are associated with headache development. The release of inflammatory mediators, such as cytokines, and alterations in the brain’s neurotransmitter levels can contribute to the problem. Failure to address these issues in the acute state can lead to pain sensitization and the characteristic symptoms of post-traumatic headaches.
Interestingly, post-traumatic headaches are significantly associated with temporomandibular joint disorder (TMD) symptoms. In a recent study of concussion clinic patients, 94% of those who had persistent headaches also displayed clinical signs of TMD . This association can be partially explained by shared neuroanatomy between the brain and TMJ, specifically, the trigeminal nerve system.
Cervicogenic Headaches Occuring in Contact Sports
Cervicogenic headaches are common in contact sports, or sports that require repetitive or forceful neck movements, such as wrestling or gymnastics. They may also be associated with whiplash-type injuries.
What are the common symptoms of cervicogenic headaches?
Contact sports may cause the following cervicogenic headache symptoms:
- Unilateral (one-sided) pain.
- Constant dull ache.
- Neck stiffness or limited range of motion.
- Neuromuscular tension in the jaw muscles.
Cervicogenic headaches involve irritation or dysfunction in the structures of the upper cervical spine, such as the vertebrae, muscles, or ligaments. In many cases, poor neck posture, muscle imbalances, or prior neck injuries can contribute to the development of these headaches. When athletes engage in activities that put strain on the cervical spine, it can exacerbate the existing issues, leading to headache symptoms.
Interestingly, cervicogenic headaches are strongly associated with TMDs . This may be because of neuroanatomical connections between the neck and trigeminal nerve in the brainstem, called the “trigeminocervical complex”.
This may be manifest by increased neuromuscular tension in the jaw muscles. If present, cervicogenic headaches may benefit from ancillary treatment with oral appliances and other conservative measures to reduce jaw muscle tension.
TMJ-related headaches can be an independent source of discomfort for athletes. Athletes with frequent jaw clenching or those who experience trauma to the face are at a higher risk of developing TMJ-related headaches.
Hallmark symptoms of TMJ-related headaches include:
- Jaw muscle pain.
- Limited jaw movement.
- Pain that radiates to the temples, forehead, or neck.
- Clicking sounds in the jaw joint.
- Neuromuscular tension in the jaw muscles.
- Pain reproduced by manipulation or palpation of the jaw.
Headaches related to the temporomandibular joint (TMJ) in athletes stem from dysfunction or misalignment of the TMJ, its encompassing muscles, and ligaments. A frequent trigger for these headaches is JAMSS injuries (referenced above), which may occur from both direct sports-related jaw trauma and indirect jaw injuries, like whiplash-type incidents.
Additionally, TMJ-related headaches can be induced and sustained by chronic neuromuscular tension in the jaw following brain or neck injuries. This chronic tension can lead to muscle tension, inflammation, and compression of nearby nerves, all of which can contribute to the development of headaches.
Athletes experiencing TMJ-related headaches should consider consulting with a dentist or TMJ specialist. Prompt treatment with a multimodal strategy is advocated, which includes oral appliance therapy, jaw physical therapy, icing, and rest.
Athletes Experiencing Tension Type Headaches
Tension-type headaches often result from a combination of physical and psychological stressors, making athletes particularly susceptible due to the physical demands of their sports, training schedules, and competitive pressures.
Tension-type headaches are often characterized by:
- Constant, dull pressure without throbbing.
- Often described as a band or vice around the head.
- Involves both sides of the head.
- Pain radiates to the temples, scalp, neck, and shoulders.
Tension-type headaches can be related to chronically elevated muscle tension. Prolonged or intense physical activity can lead to muscle tension in the jaw, neck, and shoulders, contributing to the development of tension-type headaches. Additionally, psychological factors such as stress, anxiety, and sleep disturbances often play a role in triggering or exacerbating these headaches.
Athletes can benefit from adopting a holistic approach to manage tension-type headaches. This can be accomplished by including stress reduction techniques, relaxation exercises, physical therapy to alleviate muscle tension, and ensuring adequate hydration and nutrition. In cases where jaw muscle tension is present, reducing tension in the large muscles of mastication with oral appliance therapy may also help address the problem.
Can Migraines Diminish Athletic Performance?
Experiencing a nild migraine may hinder your athletic ability to perform well, while severe migraine symptoms can leave you unable to participate at all.
Migraine headaches can significantly affect athletes and their performance, posing unique challenges for those striving for excellence in sports. Migraines are a dominant form of headaches in athletes. For those who report chronic headaches, nearly 60% are migraines.
The Journal of Headache and Pain author Muhammad Ali talks about how chronic headaches and sports-related concussions are among the most common neurological morbidities in adolescents and young adults. Its 2.8.2023 “Effects of a history of headache and migraine treatment on baseline neurocognitive function in young athletes“ article reports an “increasingly athletic youth population, with approximately 60% of American adolescents involved in school-affiliated youth sports”.
Common features related to playing sports migraines include:
- Severe, sometimes debilitating head pain.
- Prodromal symptoms like aura.
- Pulsing in one or both sides of the head.
- Nausea and vomiting.
- Sensitivity to light and sound.
Trigger factors for migraines in athletes can be diverse. They may include physical exertion, dehydration, certain dietary choices, hormonal fluctuations, and stress. There’s also a significant association between migraine and TMDs, most likely due to their shared innervation by the trigeminal nerve . Migraines and concussions are also related, where “migraine phenotype” symptoms after a concussion are associated with prolonged recovery times .
For athletes dealing with migraines, a multidisciplinary approach to management is often recommended.
Multidisciplinary migraine pain management may include:
- Lifestyle adjustments.
- Stress management techniques.
- Dietary modifications.
- Preventive medications.
- In some cases, TMD treatment.
Athletes Who Experience Medication Overuse Headaches
Medication overuse headaches (MOHs), also called “medication rebound headaches,” arise from long-term use of pain medications for headaches. Prolonged use of these medications can lead to a paradoxical effect. The very drugs intended to provide relief actually trigger more frequent and severe headaches. Athletes are particularly susceptible to MOHs as they often take pain medications for both headaches and other chronic injuries associated with sports.
Common medication types that can lead to medication rebound headaches:
- Over-the-Counter Painkillers.
- Ergotamine Medications.
- Combination Pain Relievers.
- Caffeine-Containing Medications.
- Narcotic Pain Medications.
The exact mechanisms underlying MOH are unclear. However, it’s believed that changes in the brain’s pain processing pathways and increased sensitivity to pain play a significant role. Risks of developing medication overuse headaches vary among individuals and is influenced by multiple factors. These may include the type of medication used, the frequency of use, and the individual’s susceptibility.
Effective management often involves a combination of discontinuing overused medications, addressing the underlying headache disorder, and introducing alternative pain management strategies. Healthcare professionals play a crucial role in helping patients break free from medication overuse and regain control over their headache symptoms.
How to Prevent Sports Headaches?
Preventing headaches in athletes is a critical aspect of maintaining their overall well-being and ensuring optimal performance. Here are some of the most important prevention strategies:
- Trauma prevention: Since so many sports headaches are related to head, neck, and jaw trauma, using proper equipment (such as mouthguards) is critical in headache prevention for athletes.
- TMJ care: Given the strong association between headaches and TMDs, adopting comprehensive TMJ care after sports injuries can potentially mitigate the development of chronic headaches.
- Adequate hydration: Athletes need to remain well-hydrated during training and competition. This prevents not just dehydration headaches, but also exacerbation of a number of other headache types.
- Stress management: The pressures of training, competition, and high-stakes performance can lead to tension and stress, which are common triggers for several headaches types.
- Sleep optimization: Poor sleep is a well-known trigger for a variety of headaches. Ensuring that athletes get proper sleep can go a long way in headache prevention.
SUMMARY: Effective Headache Management & Prevention for Athletes
Understanding the various headache types among athletes is essential for effective management and prevention. Basic strategies, including maintaining hydration, promoting mental health, and using appropriate protective gear to reduce head trauma, play a key role in preventing headaches.
An integrative, non-pharmacological approach that combines these tactics with conservative treatments like oral appliances for neuromuscular tension ensures athletes can excel in their sports while reducing the incidence of headache-related problems.
Dr. Brad Eli, DMD, MS is a graduate of UCLA’s post-doctoral Orofacial Pain program. He specializes in the field of orofacial pain, temporomandibular disorders, and headache treatment and is a member of the Academy of Sport Detistry (ASD). Dr. Eli has also been on the educational staff at university hospitals, pain centers, and the clinical staff of Southern California hospitals. He will be presenting at the 2024 annual meeting of ASD.
 Muhammad Ali, et al, “A multicenter, longitudinal survey of headaches and concussions among youth athletes in the United States from 2009 to 2019,” Feb. 2023, https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-022-01528-3
 Christie Murphy and Sajid Hameed, “Chronic Headaches,” Nov 2023, http://www.ncbi.nlm.nih.gov/books/NBK559083/
 American Migraine Foundation, “Primary Exercise Headache,” Nov 2023, https://americanmigrainefoundation.org/resource-library/primary-exercise-headache/
 Vicente González-Quintanilla, et al, “Update on headaches associated with physical exertion,” Mar 2023, https://pubmed.ncbi.nlm.nih.gov/36786294/
 Cleveland Clinic medical professional, “Dehydration Headache: Dehydration Symptoms & Types of Headaches,” Nov 2023, https://my.clevelandclinic.org/health/diseases/21517-dehydration-headache
 Saves Karpuz, et al, “Evaluation of temporomandibular joint dysfunction in traumatic brain injury patients,” Mar 2023, https://onlinelibrary.wiley.com/doi/abs/10.1111/joor.13445
 Tzvika Greenbaum, et al, “The association between specific temporomandibular disorders and cervicogenic headache,” Apr 2021, https://pubmed.ncbi.nlm.nih.gov/33482538/
 Joseph V. Campellone, et al, “Tension headache: MedlinePlus Medical Encyclopedia,” Nov 2023, https://medlineplus.gov/ency/article/000797.htm
 Linda Sangalli, Dr. Bradley Eli, and James Fricton, “Calcitonin Gene-Related Peptide-Mediated Trigeminal Ganglionitis: The Biomolecular Link between Temporomandibular Disorders and Chronic Headaches,” Jul 2023, https://pubmed.ncbi.nlm.nih.gov/37569575/
 S. K. Klein, et al, “Identifying Migraine Phenotype Post Traumatic Headache (MPTH) to Guide Overall Recovery From Traumatic Brain Injury,” Jun 2022, https://pubmed.ncbi.nlm.nih.gov/35656769/.