Benign headaches are common in bodybuilders. However, several less benign headaches are worth noting:
Low cerebrospinal fluid (CSF) pressure headache: caused by a small dural tear mostly at the thoracic level. Similar to postdural headache. Treated by recumbency, and blood patches if recalcitrant.
Subarachnoid hemorrhage (SAH)
Spontaneous intracranial hemorrhage
Ischemic stroke
Dural sinus thrombosis
All except the first two are exclusively reported in patients on anabolic steroids, growth hormone, and/or “energy” supplements. Make sure to ask your patient about these risk factors.
References
Busche K. Neurologic Disorders Associated with Weight lifting and Bodybuilding. Neurology Clinics. 26 (2008) 309–324
