Epidemiology of Primary Exercise Headache: A Systematic Review and Meta-analysis with Comparison Between Clinic- and Population-based Settings
Objective:
This study aimed to evaluate the epidemiology of primary exercise headache (PEH) in clinic- and population-based settings.
Background:
Physical exertion-related primary headaches include those triggered by prolonged exercise, sexual activity, and Valsalva maneuvers such as coughing. PEH is a specific type of headache that occurs during or immediately after exercise, without underlying cranial pathology. To date, no meta-analyses have assessed the prevalence of PEH. As a result, epidemiological data remain limited and highly variable despite advances in classification. Reported lifetime prevalence in population-based studies ranges from 0.2% to 12.3%. These gaps highlight the need for a systematic review and meta-analysis to synthesize available data. Such evidence would provide clinicians with practical guidance for accurate and timely diagnosis.
Design/Methods:
Major databases were thoroughly searched for articles that presented original data on the epidemiology of PEH. Random-effects meta-analysis was performed in order to calculate the pooled prevalence estimates (PPE), where I2 were used to measure the between-study heterogeneity. The study's structure adhered closely to the MOOSE and PRISMA.
Results:
Out of the original 2,083 records, 12 articles satisfied all inclusion requirements. The pooled mean age of onset of PEH was 27.47 years (95%CI:21.99-32.95). The PPE of PEH among adult patients evaluated for a headache in a clinic-based scenario was 0.46% (95%CI:0.18-1.20)(I2=94.86), there was no sex predominance regarding the frequency of diagnosis. The epidemiology of PEH in the general population was estimated to be 4.92% (95%CI:1.84-12.49)(I2=98.73) and in addition, PEH was more prevalent among females than males.
Conclusions:
Our study showed that PEH is a rare primary headache disorder among adults evaluated for a headache in a clinic-based setting and is significantly more common in the general population. Furthermore, PEH is diagnosed within similar frequency among both sexes in headache-oriented clinics and moreover, predominantly late twenties. However, in the general population, there is a notable female preponderance.
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