Prevalence and characteristics of exercise-induced headache among elite athletes in Manipur: A cross-sectional study

Background: Exercise-induced headache (EIH) is a recognized but underreported condition among athletes, characterized by pulsatile headaches triggered exclusively by physical exertion. Despite the growing awareness, its prevalence and clinical features in Indian athletic populations remain inadequately studied, particularly in the northeast. Objective: To determine the prevalence and characterize the clinical profile of EIH among elite athletes in Manipur using the International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria. Materials and Methods: A cross-sectional study was conducted at the Sports Authority of India Regional Centre in Imphal from March to May 2025. A total of 88 elite athletes aged 18–35 years undergoing regular structured training were interviewed using a validated questionnaire based on ICHD-3 criteria. Data were analyzed in Statistical Package for the Social Sciences version 25 using descriptive statistics, χ 2 tests, and Fisher’s exact test; a P -value < 0.05 was considered significant. Results: The prevalence of EIH was found to be 13.6% ( n = 12). Affected athletes reported pulsating, bilateral headaches of moderate-to-severe intensity, typically occurring during or shortly after exercise and lasting up to 48 h. Common triggers included running (41.7%) and weightlifting (33.3%), with hot weather (58.3%) and dehydration (33.3%) exacerbating the conditions. While 50% of EIH-positive athletes reported functional impairment in training, only 16.7% had sought medical consultation. A personal or family history of migraine was present in 16.66% and 8.33% of cases, respectively. Exposure to hot weather was significantly associated with EIH ( P = 0.04). Conclusion: EIH was identified in 13.6% (12 of 88) elite athletes in Manipur, most often linked to heat and dehydration. Early recognition, athlete education, and simple preventive strategies such as hydration and heat avoidance may help limit training disruption and improve the performance.