Purpose of Review Primary exercise headache has gone through many descriptors in the past but generally is a headache that is precipitated by strenuous exercise without significant intracranial pathology. Its presentation can remain vague, often confused with other primary and secondary headache disorders and thus undertreated. This review aims to discuss primary exercise headache in the context of epidemiology, presentation, pathophysiology, differential diagnosis, and treatment. Recent Findings Two large epidemiological studies in Iran and Japan have further characterized a predilection for female patients, comorbidity with migraine, and frequent bilateral nature of headache. Summary While large-scale epidemiological studies have aided in further characterization and determining varying prevalence, a lack of randomized clinical trials in the treatment of primary exercise headache remains. Indomethacin and beta-blocker use remain the mainstays of treatment based on case series with several case reports that urge caution when diagnosing said headache.

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