DEAR DR. DONOHUE: Racquetball is my game, but I am having a problem when I play. Often, I get a headache. It’s not terrible, but it distracts me and is unpleasant. Is this a sign of something really bad? If it isn’t, how can I put a stop to it? – B.Z.

Let me start with the really bad things, rare as they are. If a person has a stiff neck and a fever along with the headache, that points to a serious infection of the brain coverings. Admittedly, a person with such an infection wouldn’t want to play racquetball, but it’s worth mentioning. A headache that comes on abruptly, a headache triggered by a change in head position, a headache that’s the “worst ever” headache are indications of serious problems. If confusion or weakness of an arm or leg accompanies a headache, that’s another sign of real trouble.

Migraine headaches can be provoked by exertion. If a person has a history of having migraine headaches, then the headache might be another migraine. Appropriate steps have to be taken to relieve and prevent such headaches.

In some instances, headaches have been known to be the only sign of heart disease.

Since you have had these headaches for some time and since no other symptoms have appeared, your headaches are most likely exertional headaches, ones that come with exercise. One maneuver frequently provokes these headaches. It’s straining, as though you were going to exhale but with the throat closed off so no air comes out. Weight lifters often do this when they strain to lift a heavy weight. Many athletes do it when they are in a particularly demanding situation without realizing what they’re doing. If you catch yourself doing this, don’t do it.

Taking slow, deep breaths when you have a chance during a game relaxes your body and often prevents headaches, some of which result from the tension of competition. A mild pain reliever like Tylenol taken before playing is another way to prevent exertional headaches.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from

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