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