4.2.1 Probable primary exercise headache

A 36-year-old marathon runner reports three such episodes over the last training block, part of her recurrent headaches, each one setting in only once she has completed a demanding tempo run or hill session, never while she is actually running. The pain is a tight, squeezing sensation across the forehead that develops in the cool-down period, sometimes as she is stretching. Each time it has taken close to two days to fully clear, which she finds frustrating given her race schedule. She denies chest pain, palpitations or breathlessness during exertion, and says the pain clearly follows rather than accompanies her hardest sessions.