Exertional headache

With exercise, the muscles require more blood so that there is generalized vasodilatation. This is why the face becomes flushed during exercise.

The blood pressure also rises and this combination causes further stretching of the dilated intracranial blood vessels which can cause headache.

Headache associated with sexual intercourse is an example of exercise headache. It occurs at or near the time of orgasm and can be very severe. Although the pain lasts only a few minutes it can persist after intercourse and last for days. It affects women as well as men. Since the blood pressure can rise more than 50 per cent and the pulse rate double during intercourse, it is surprising that this type of headache is not more common.

High blood pressure

Probably the commonest cause of headache in those with high blood pressure (hypertension) is anxiety over their blood pressure. But there is no doubt that marked (‘malignant’) hypertension can cause severe headache along with other neurological disturbances (hypertensive encephalopathy). Patients with both migraine and high blood pressure often find that when the blood pressure is brought down to normal levels, the intensity and frequency of the migraine attacks lessen.

Strokes

There are two main types of stroke depending on whether the blood vessel to the brain bleeds (cerebral hemorrhage) or is blocked (cerebral infarction). Patients with cerebral hemorrhage nearly always have a headache, particularly if the blood gets into the space surrounding the brain (subarachnoid hemorrhage). This bleeding often arises from a weakened part of a blood vessel which has ballooned out forming an aneurysm, or occasionally from an abnormal congenital group of blood vessels – an angioma. Whatever the cause, the symptoms are usually typical: a sudden pain is felt across the head as if the patient had been struck with a hammer; loss of consciousness may follow. The headache subsequently persists and the irritation of the meninges causes a picture resembling meningitis.