• exertional headache;
  • physical exertion;
  • prevalence;
  • cycling;
  • headache

Background.— Primary exertional headache (PEH) is a long-known phenomenon. Divergent prevalences of between 0.2 and 12.3% are reported among the general population. The aim of this study was to establish the prevalence among an athletic population.

Method.— A link to an online questionnaire was sent to all participants of a tough cycling event held in The Netherlands.

Results.— Four thousand participants filled out the questionnaire. One thousand eight hundred and ten (45%) stated that they had suffered, at least once in their lives, from exercise-related headaches (EHs). Thirty-seven percent (668) of them had those headaches at least once a month and 10% (174) experienced a weekly occurrence. The rate of female cyclists with a history of EHs was 54%. With an increasing age, a decline of EHs was found. Five hundred eighty-one (37%) of the participants used medication for EHs.

Conclusions.— An estimation of the prevalence of PEHs among the studied population by comparison to the International Headache Society criteria resulted in a rate of 26%. The lower prevalence among older cyclists could be caused by avoidance of (high-intensity) exercise due to the burden that EH brings along. PEH appears to be quite common among an athletic population and merits further investigation.