UMEM Educational Pearls

Category: Neurology

Title: Headache in the Bodybuilder

Keywords: headache, steroids, bleed (PubMed Search)

Posted: 2/28/2018 by Danya Khoujah, MBBS
Click here to contact Danya Khoujah, MBBS

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.



Busche K. Neurologic Disorders Associated with Weight lifting and Bodybuilding. Neurology Clinics. 26 (2008) 309–324