Epidemiology of Primary Exercise Headache: A systematic review and meta-analysis with comparison between clinic- and population-based settings

Introduction Primary exercise headache (PEH) is a rare primary headache disorder that occurs specifically during or right after physical exertion and lasts up to 48 hours. This study aimed to evaluate the epidemiology of PEH in clinic- and population-based settings. Methods Pubmed/Medline, Embase, ScienceDirect, Scopus, and CINAHL Ultimate were thoroughly searched for articles that presented original data on the epidemiology of PEH and were published up to the 16th of July, 2025. Random-effects meta-analysis was performed in order to calculate the pooled prevalence estimates (PPE), where I2 statistics and prediction intervals (PIs) were used to measure the between-study heterogeneity. The study's structure adhered closely to the MOOSE and PRISMA requirements. The risk of bias in the included research was assessed using the Joanna Briggs Institute Checklist for Studies Reporting Prevalence Data. The protocol of the study was pre-registered on PROSPERO (CRD42024612283). Results Out of the original 2,083 records, 12 articles satisfied all inclusion requirements. The majority of the studies showed a low risk of bias. The headache is a rare finding in clinical-based settings (PPE = 0.46%, 95%CI: 0.18-1.20, 95%PI: 0.01%-14.29%, I2 = 94.86), more common in population-based surveys (PPE = 4.92%, 95%CI: 1.84-12.49, I2 = 98.73), shows a female predominance, and, moreover, typically has onset in the late twenties (27.47 years). Conclusion 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.