Table of Contents

Exertion Headaches

By: Nick Ryan | June 23, 2011 534 Comments

This entry is part 6 of 8 in the series The A.P.E.X. Way

UPDATE: This article was originally published by itself.  As of May 5, 2015 we decided to include it as a part of our series “The A.P.E.X. Way”.

Strenuous, intense physical training can result in what are known as EXERTION HEADACHES.  This article describes exertion headaches, what causes an exertion headache, what to do to avoid exertion headaches, and how to properly transition back into training after suffering from an exertion headache.  The majority of the article centers on exertion headaches that result from lifting weights; however, there is a CrossFit specific section towards the end of the article, updated March 2014.  Endurance athletes that experience exertion headaches after high intensity cardio will find the CrossFit section most helpful. This article is not intended to replace a medical visit.  In fact, if you are reading this because you recently experienced an exertion headache, take a moment and schedule a medical visit.

WHAT IS AN EXERTION HEADACHE?

Exertion headaches are exercise-induced headaches that are correlated with training at a very high intensity.  They most commonly occur after a set of a compound leg movement (i.e. leg press, squat, deadlift) performed to failure or close to failure. Right after the set, sometimes on the final rep, an intense headache occurs typically in the back of the head or in the temples. What scientifically occurs is a forced dilation (expansion) of the blood vessels in your brain beyond their normal thresholds.  This puts pressure on the meninges, (small nerves that cover the brain) which causes the painful headache. Once the heart rate and blood pressure drop, the headache becomes less intense; however, the meninges remain extra sensitive, and are susceptible to future headaches if blood pressure or heart rate spike.

WHAT CAUSES AN EXERTION HEADACHE?

Exertion headaches occur when a combination of the following circumstances are true:

  • DEHYDRATION: Dehydration thickens your blood
  • VALSALVA MANEUVER (Holding Breath): This causes a dramatic spike in blood pressure
  • POOR NECK POSITION: Anything other than a neutral spine causes constrictions on the carotid arteries, the main arteries that deliver blood to the brain.
  • INCREASED HEART RATE: As a set progresses, your heart rate will steadily climb so that by the end of your set it can be close to (or above) your maximal heart rate.
  • HEAVY WEIGHT: The more weight on your body, the more blood pressure will rise while lifting it. Because legs are the strongest muscle group in the body, more weight is needed to reach a level of fatigue or failure.  The correlation between heavy weight and an increase in blood pressure makes compound leg movements more risky than other movements.

The combination of elevated blood pressure, heart rate, thickened blood and constricted arteries can result in a devastating surge of blood attempting to enter the brain, forcibly expanding the arteriole walls and putting pressure on the meninges.

HOW LONG WILL THE HEADACHE LAST?

Exertion headaches have three phases:

  1. INTENSE HEADACHE:  The first phase is the intense, painful headache that occurs during or immediately after an intense workout.  The pain is typically in the temples or back of head.  The feeling can best be described as a grenade exploding in the head.  The headache hits rapidly, and throbs painfully.  This headache will not go away until there is a decrease in heart rate, blood pressure, and all activity has ceased.
  2. DULL HEADACHE:  The second phase is a dull, fatiguing headache that can last for up to 2 weeks.  It typically lingers wherever the initial phase of the headache was felt because that is the area that the meninges flared up.
  3. FULL RECOVERY:  Full recovery depends on the severity of the initial headache and the quality of rest given to the body to recover.  If the body is given the opportunity to heal, dull headaches are typically gone in 1 week.  True full recovery, meaning the ability to perform at the same level as before the headache, will take approximately 2 months.

HOW CAN EXERTION HEADACHES BE PREVENTED?

To prevent an exertion headache:

  • HYDRATE: Drink enough water that you’re urine is clear or faintly yellow (never dark golden) the day before your lift and the day of, and continue to drink water during your workout.  This will ensure that your blood can flow freely and smoothly through your blood vessels.
  • BREATHE: The valsalva maneuver is a valuable tool for creating stability in the thoracic cavity (torso area) that can help prevent lower back injuries during maximal lifts.  It should not, however, be used during sets of multiple repetitions. When performing multiple repetitions, exhale during the positive phase and inhale during the negative phase. You can find more detailed information on breathing techniques here.
  • NEUTRAL SPINE: Unless performing a neck exercise, there is no need for the neck to be bent. Maintaining a neutral spinal alignment allows for proper circulation through the arteries and veins responsible for moving blood in and out of the brain.  While “looking up” may mentally help keep the back straight during a squat or a deadlift, it is not essential.  Keep the head and neck in a neutral position.
  • CONDITIONING:  Developing a healthy heart and lungs that can handle high intensity training can be accomplished with regimented cardiovascular training.  General conditioning along with interval training can help reduce the risk of exertion headaches by developing an efficient and healthy cardiovascular system that can handle the stress.

Training with a high level of intensity is part of improving the body’s performance potential, increasing size and strength; however, it can also create an opportunity for an exertion headache.  To avoid exertion headaches during high intensity training sessions, build a solid cardiovascular base, be hydrated, breathe correctly, and maintain a neutral spine. Also, consider performing the larger compound leg movements at the beginning of the workout.  Leg movements are inherently heavy, taxing exercises.  Performing them early in the workout is safer because fatigue, exercise-induced dehydration, and a peaking heart rate won’t be part of the equation yet.

HOW DO I RECOVER FROM AN EXERTION HEADACHE?

There are some simple guidelines that will help with full recovery and full pre-headache performance:

  1. STOP:  Once an exertion headache occurs, STOP. Do not attempt to push through the rest of the training session, it will only worsen the headache and the duration of symptoms.
  2. MEDICAL VISIT:  It is important to rule out any other underlying potential causes.  Aneurysm’s, thunderclap headaches, and slipped discs may be potential causes for similar symptoms and must be ruled out.  If it is an exertion headache, physicians may recommend rest, plenty of fluids and ibuprofen taken every 4 – 6 hours daily to help with the swelling of the meninges.  Or, they may recommend something else which is why it is important to consult the physician.
  3. REST 1 WEEK:  The initial rest phase should be a complete week of total rest from all physical activity, including practices, strength training, cardio, as well as recreational and competitive activities.

If steps 1 – 3 are done without any interruptions, then the headache should subside and the head should feel normal after 1 week.  However, the body is still not ready at this point for pre-headache performance.  At this point, download the A.P.E.X. app and begin the INCEPTION workout progression designed by me specifically for recovery from exertion headaches.   Over the last decade I have fine tuned this program to incorporate the correct volume, introducing compound and lower body movements at the appropriate time, allowing for the highest percentage of full recovery within a 2 month window.  Here are some guidelines for building back up to pre-headache performance:

  1. PHASE 1 (2 WEEKS):  Take two weeks off from any lower body exercises, performing only upper body exercises at 50 – 75% of your pre-headache weight.  By the end of the two weeks, weight should be approaching pre-workout level.  Introduce light cardio, no more than 70% of your Maximum Target Heart Rate (220-Age), for no more than 20 minutes.
  2. PHASE 2 (2 WEEKS):  Introduce single-joint, isolateral leg exercises to the upper body strength program.  This includes leg extensions, leg curls, hip adduction and abduction.  This allows for strength maintenance without loading the frame. Attempting to do compound leg movements such as squats, leg press, or deadlifts prematurely can cause a flair-up of the meninges and another full-blown exertion headache.  Begin increasing intensity of cardiovascular training slowly during this phase.
  3. PHASE 3 (4 WEEKS):  Begin introducing compound leg movements at 50% OF PRE-HEADACHE WEIGHT.  Slowly add back volume and weight each workout.  Begin pushing the cardiovascular system.

If at any point during this recovery plan an exertion headache occurs, then go back to step one which was STOP.  Repeat with physician visit, rest, and slow recovery.  It is important to note that while 2 months of recovery does seem like a long time, these headaches can linger for over 6 months if the body is not allowed to heal.  2 months of strategic recovery is better than 6 months of bull-headed attempts to push through it.

CROSSFIT

Since the original post of this article in 2011, and my original post back in 2007, CrossFit has exploded in popularity and has become a huge part of the fitness culture.  WOD’s, CrossFit Games, and CrossFit Gyms have saturated the fitness world internationally.  The reason I mention this because we have noticed a gradual climb in emails, hits, and posts related to exertion headaches coming from CrossFitters.  None of our A.P.E.X. Coaches are CrossFit Certified, A.P.E.X. is not affiliated with CrossFit in any formal way at this point; however, we are all here to train at a high level and I have a tremendous respect for any athlete willing to push themselves hard enough to cause an exertion headache.  Here are some things to consider as a CrossFitter as it relates to exertion headaches:

  1. OLYMPIC MOVEMENTS:  CrossFit incorporates big, compound, technical movements such as snatches, power cleans, jerks, deadlifts and squats
  2. VALSALVA MANEUVER:  Holding your breath can help protect your spine during Olympic movements by creating thoracic pressure, helping your abdominal wall create a stable core
  3. SUPER-SETS:  CrossFit workouts, in general, combine big movements with cardio movements, or big movements with other big movements
  4. NO REST:  CrossFit workouts tend to omit rest between exercises, thus heart rate and blood pressure steadily climb, also leaving no time for water consumption during the workout
  5. COMPETITION:  Competition can help by tapping into adrenaline, resiliency, and a never-quit attitude that can mask pain

Big movements that put weight on your frame cause a spike in blood pressure.  Holding your breath to improve posture during big movements also causes additional spike in blood pressure.  Doing multiple exercises back-to-back without rest causes an additional spike in blood pressure, but mainly an increase in heart rate.  An increase in both heart rate and blood pressure, in a competitive setting, while not being able to calm down or drink water, can lead to an exertion headache.  It will not be early in the workout when you are calm, energetic, and focused, but towards the end when blood pressure and heart rate are peaking out, and your trying to overcompensate to finish the workout by holding your breath as your core fatigues.

CrossFit philosophy dictates that variables 1, 3, 4 and 5 are part of what makes CrossFit workouts intense, and that will not change.  Many people have successfully completed WOD’s without causing an exertion headache; therefore, CrossFit workouts do not inherently cause exertion headaches.  The key to preventing an exertion headache during bouts of intense exercise is coming into the workout rested, hydrated, and mentally focused.  During the workout, you must maintain a good breathing cadence, making sure to exhale during the positive phase, and inhale during the negative phase of the movement.  Late in the workouts when your blood pressure and heart rate are climbing, you must remain calm and focused, regulate your breathing, and concentrating on good body mechanics.  If you do these things, you will be able to perform CrossFit style training free from exertion headaches.

If you do experience an exertion headache during a CrossFit workout, here is the recommended recovery timeline to get back to performing WOD’s at 100% pre-headache performance levels.

  1. STOP:  Once an exertion headache occurs, STOP. Do not attempt to push through the rest of the training session, it will only worsen the headache and the duration of symptoms.
  2. MEDICAL VISIT:  It is important to rule out any other underlying potential causes.  Aneurysm’s, thunderclap headaches, and slipped discs may be potential causes for similar symptoms and must be ruled out.  If it is an exertion headache, physicians may recommend rest, plenty of fluids and ibuprofen taken every 4 – 6 hours daily to help with the swelling of the meninges.  Or, they may recommend something else which is why it is important to consult the physician.
  3. REST 1 WEEK:  The initial rest phase should be a complete week of total rest from all physical activity, including practices, strength training, cardio, as well as recreational and competitive activities.

If steps 1 – 3 are done without any interruptions, then the headache should subside and the head should feel normal after 1 week.  However, the body is still not ready at this point for pre-headache performance.  Here are some guidelines for building back up to pre-headache performance:

  1. PHASE 1 (2 WEEKS):  Focus on cardiovascular conditioning, introduce light cardio, no more than 70% of your Maximum Target Heart Rate (220-Age), for no more than 20 minutes.  Jogging, running, swimming, and hiking are the types of cardio to do during phase 1.
  2. PHASE 2 (2 WEEKS): Begin pushing your cardiovascular system to closer to 90% of your Maximum Target Heart Rate, introducing rowing and other body-weight exercises (burpees, air squats, vertical jumps, lunges, jumping jacks, etc.).  There are “No Equipment” CrossFit workouts that you can test yourself on, seeing how well you can handle intensity before adding in weights.
  3. PHASE 3 (4 WEEKS): Week 1, do WOD’s at 50% of pre-headache WEIGHT and TOTAL VOLUME.  Week 2, do WOD’s at 50% of pre-headache weight, but normal VOLUME.  Week 3, up the weight to 75% of pre-headache weight.  Week 4, attempt with caution, pre-headache weights.

During PHASE 1 and PHASE 2, focus on hydration, breathing, and sleep, and listen to your body.  If you feel like a flair-up may happen, STOP.  The key is getting through PHASE 1 and 2 without a headache while performing at a high level.  Before moving into PHASE 3, you should be dominating body weight WOD’s without any fear of a headache.  For PHASE 3, use the following example for clarification.

EXAMPLE:  WOD – 10 rounds, 10 snatches @ 100 kilos / 30 seconds of speed rope

  1. PHASE 3, WEEK 1:  5 rounds, 10 snatches @ 50 kilos / 30 seconds of speed rope (50% WEIGHT & VOLUME)
  2. PHASE 3, WEEK 2: 10 rounds, 10 snatches @ 50 kilos / 30 seconds of speed rope (50% WEIGHT)
  3. PHASE 3, WEEK 3: 10 rounds, 10 snatches @ 75 kilos / 30 seconds of speed rope (75% WEIGHT)
  4. PHASE 3, WEEK 4: 10 rounds, 10 snatches @ 100 kilos / 30 seconds of speed rope (100% WEIGHT)

The key is to slowly re-introduce weight while under stress.  PHASES 1 and 2 should have prepared your blood vessels for the increase of heart rate, but the spike in blood pressure comes with additional weight on your frame.  Remember, if at any point you experience an exertion headache, you are back to STOP, a MEDICAL VISIT, and 1 FULL WEEK OF REST, so don’t try to skip ahead, it will only delay your full recovery.

FINAL thought

Those of us that have experienced exertion headaches are like pit bulls. We have a high pain tolerance, we push ourselves beyond normal limits, and we are stubborn as hell if we are told to take some time off for any injury, especially one that doesn’t involve a torn muscle or a broken bone.  We all believe we are the exception, and that we can heal like Wolverine.  Remember, an EXERTION HEADACHE is an INJURY TO THE BRAIN. If not taken seriously, it won’t go away and can become worse. Just like any other injury, certain steps must be taken to transition the body back to a high performance level again. So from one pit bull to another, please take the next 2 months to slowly recover and get back to pre-headache performance levels.  If you think you are the exception, you’re not.  Hopefully you find this article to be helpful. If you have any questions, email me at nick@apexllc.org. You can also find other helpful articles on our website at www.apexllc.org. Thanks!

Nick Ryan, CSCS

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  • Nick Ryan

    Anthony,

    Everything you’ve said all suggests the classic exertion headache. I would still recommend a doctor visit, get the peace of mind to know that MRI’s come back clean, and focus on rest, water, and ibuprofen for the next 2 weeks. After 2 weeks completely off from sex and exercise, begin the INCEPTION progression. The program is designed to gradually build you back up to pre-headache strength, but you are still ultimately responsible for pacing yourself. So listen to your body, stick to the plan, and with no setbacks we can be back in business in as few as 2-3 months.

  • Anthony

    Hi all,
    I got the grenade like feeling from simply bench pressing at the very start of my work out.
    I don’t tend to lift heavy weights but this time I increased the load and it happened immediately.
    Warm up was probably not good enough.
    The grenade pain went away a few hours later and 3-4 days later there is the odd minor pain.
    Sometimes I have a minor nausea feeling also.
    Looking to go back doing the recommended INCEPTION work out as I don’t wanna rush back.
    Is there anything else to worry about or am I a standard case ??
    Also this is the best feedback on the Internet by far.
    Cheers
    Anthony

  • Nick Ryan

    Dave,

    Let me know if you need any help along the way. Keep us posted!

  • Dave Splan

    Thank you for such a thorough answer Nick! Your description is spot-on with how I’m feeling. You know your stuff!
    Wow, 6 months to get back to business as usual is brutally long, but I don’t ever want to experience these headaches again!! It’s still lingering after 3 days. I’ll follow your program and get the app.
    Thanks again!!

  • Nick Ryan

    I have not had an exertion headache in 10 years. So don’t lose hope. With some dedicated recovery and changes to you you train, you will be able to get back to it and avoid future issues.

  • James

    Has it stopped for you?

  • Aaron Eash

    Well I was doing some jump rope for a workout about 3 days ago, and I was pushing really hard. About 2 min in I started to get really sharp jabbing pains in my head. And that is how it started. Since then I have just felt tired and drowsy. And I have had this lingering headache that is made worse when I do anything physical, and ever just walking sometime.

  • Nick Ryan

    Aaron,

    The foggy sensation is like a dull, 3/10 pain that makes you feel like everything is in slow motion. It’s always there, not so much that you can’t function at all, but always in the background. Did you experience an event leading up to these dull headaches? Hope this helps.

  • Nick Ryan

    Dave,

    I hope you find this thread and the app to be valuable tools during your recovery. To answer your questions:

    CAN I EXPECT A FULL RECOVERY? Yes, but slower than you’d like. An exertion headache causes a forced dilation of the blood vessels in the head that then push on the meninges that cover the brain as a protective sensor network. This encroachment on the meninges is what causes the intense headache. The blood vessels will typically calm down within 48 hrs with ibuprofen, water, and sleep. The headache will de-escalate during the first 2 weeks of complete rest, starting as the intense, grenade-like headache, down to a 3/10 foggy dull headache. At the 2 week mark, you can begin INCEPTION, a workout progression I have designed that you can track using the A.P.E.X. app. Think of this workout as methodical doses of strength training that keep you safe from flair-ups. It may seem too easy at first, but you are gaining back the trust of the meninges in the head. If you cross that boundary, they will make you pay. They are doing their job of protecting the brain. It is your job to earn back their trust by doing mild workouts that avoid spikes in blood pressure. The progression takes 2-3 months. At the end, you will be using pre-headache weights for upper body lifts, and climbing back to pre-headache weights for lower body lifts. Baring any flair-ups, you should be back to business as usual within 6 months. Any flair-ups along the way reset the clock though, so tread carefully.

    ARE SOME PEOPLE MORE PRONE TO EXERTION HEADACHES THAN OTHERS? Yes, some people are more prone, but has little to do with genetics, race, or creed. It’s all about the risk factors in how you train. Heavy loads, heart rate increase, ultimate acute dehydration, valsalva maneuver during high rep lifting, and neck position loss of form under fatigue. Sounds like 55 Deadlifts @ 225lbs… Anyone pushing as hard as they can, the true grit pitbull fitness enthusiasts, the olympic lifters, the legalistic Arthur Jones HIT, the CrossFitters, these are the ones “prone” to these headaches, because we expose ourselves through high intensity, best effort caliber of work that can potentially lead to these headaches. The key is really coaching yourself up on how you need to fundamentally change how you train, your form, breathing, spinal alignment, hydration, to be able to train this way and avoid the headaches. I gave myself 3 exertion headaches before my 21st birthday training for football and my freshman year of college. I’m now 31 and training at a high level, headache free for 10 years. I have evolved. You can too.

  • Dave Splan

    Wow you seem like a lifesaver Nick! This is an excellent resource! I have just gotten my second bout of exertion headaches. They were brought on in a Crossfit workout last year- 55 deadlifts at 225, which is a heavyish weight for me. It took a while for them to go away. I just repeated that workout last week and now and the same pounding headaches are back. I’ve had them 4 times since last week, with this last one now sticking around. It’s been over 12 hours of constant pain.
    I’m going to follow your program. Do you know, can people fully recover from this, or are some people just prone to it?
    Thanks!
    Dave

  • Aaron Eash

    Hello Nick,
    I am trying to find out if I am suffering from these headaches, so I was wondering what exactly the fogginess feels like?

  • Nick Ryan

    Bo,

    Great news. Word of caution… This is when you will be tempted to abandon the plan and push to hard too soon. Resist the temptation. While you may be feeling better, you still have a ways to go. Stay the course, keep us updated.

  • Bo Nyberg

    Update: end of last week I went to the gym to start my first session of part 2 in the INCEPTION workout. After 30 minutes I just had the strangest feeling, I hadn’t noticed the fogginess for hours. It really has gotten a lot better over the 7 days. I’m still taking it carefully, following the instructions and increasing the weights very slowly. Not back yet, but getting there!

    Anyone new reading this – I’ve had the fog constant for 3 months and it feels like a new world. Nick’s program is legit and the only thing i’ve found online who offers help for people who have been having this for along time.

  • Nick Ryan

    Tim,

    I wish there was a heart rate limit we could use as a benchmark (i.e. 100 bpm and BOOM), but it really depends. Some people have no problems with an increase in heart rate and continue with mild cardio, with spikes in blood pressure being the only issue. For others, any spike in heart rate or blood pressure prompts the pain. You can monitor it and see what works for you, but I don’t have any specific number for you to stay under. Make sure to breath as you work too, stay hydrated at work, and make good sleep a priority.

  • Nick Ryan

    Ryan G,

    If I’m reading this history right, it sounds like the initial headache happened during the CrossFit Deadlift set, and that you’ve had flair-up headaches and a foggy sensation that has not gone away. Is that correct?

    The problem with exertion headaches is that until you give the meninges that protect the brain to calm down, they will remain sensitive and cause headaches and a foggy sensation for years. I’ve spoken with folks that have had symptoms for as many as 2 years. So with the flair-ups you’ve had as you’ve attempted to train with the headaches essentially mean that you are still at square one, and that symptoms will continue until you allow your meninges to calm down. It is likely you also have alignment issues, but until you also address the exertion headache, you will likely not have much reprieve.

    I would treat this like today is day 1. Take 2 weeks off completely from all activity, drink lots of water and sleep. At this point, I highly doubt that your blood vessels are swollen, so ibuprofen will be of little value. Once these 2 weeks of intentional recovery are complete, you can begin the INCEPTION progression in my app, it is a workout progression that slowly adds multi-joint movements, lower body movements, etc, when it is appropriate. Depending on the pace of your headache-free-yet-foggy pace, this will take 2-6 months.

    The wild card for you Ryan is the spinal alignment issues that accompany your symptoms. You will need to take your time, listen to your body, and give yourself the grace to heal. It is better to be intentional about recovery for the next 6 months than continue to cause flair-ups and set-backs and deal with these headaches for many years to come.

  • Ryan G

    Hey nick,
    My headaches and fogginess started up almost 6 months ago. It all started with a crossfit style workout of 21-15-9 deadlifts(285), pull-ups, and push-ups. I knew the weight on the deadlifts was a little too heavy for me, but I tried to break it up and push through. I remember that day I had been recovering from a cold as well. During the round of 15 I started feeling lightheaded and then my headache started and I had to stop my workout. I felt like my head had swollen up like a balloon. it freaked me out because it reminded me exactly of post concussion symptoms I had recovered from earlier in the year. So I took a couple weeks off but the achey swollen feeling and fogginess in my head never subsided and is something I deal with everyday. since then I’ve tried several times to get back in the gym but can never make it through a workout feeling okay. The pressure is always around my temples and top of my head. My neck is often quite stiff as well. Ive taken Advil and aleve the odd day but never consistently. Had a ct scan of my head that came back with nothing wrong. Had massage done on my neck. Chiropractic treatments. Acupuncture. But nothing seems to help. Not sure what to do!? Any advice would be great man thanks! Missing the gym so much 🙁

  • Tim Peters

    Also it’s worth noting that my job requires me to install and move kitchen appliances but I never have headaches at work , I feel great at work when I’m moving around. it’s only after the day is done I get these headache spasms

  • Tim Peters

    Wow. That was an extremely well thought out reaponse. How do you know all this man?

    I bought a fit bit to track my heart rate. Do you have any recommendations on keeping it below a certain level?

    And the caffeine withdrawal headaches definitely sucked ass haha but nothing sucks as much as not being able to workout. I have the app but I keep having minor flair ups. I had one major flair up a month ago from shoveling in a blizzard. Maybe it’s just the cold up here in New Hampshire that’s giving me headaches. The pain is usually in my temple or sides of the head versus the onset of my exertion headache which was back of the head.

  • Nick Ryan

    Michael,

    If it were vascular, chronic swollen blood vessels, a weeping vessel, or a ruptured vessel, an MRI would have shown that. If a chiropractor tinkering made the pain worse, that reinforces that it is an alignment issue… Waking in the morning with the pain, pain in shoulders, jaw, all point to alignment… My recommendation would be to commit to some regular visits with a good chiro, see if you can troubleshoot together on what needs to be done.

  • Nick Ryan

    Subash,

    What type of exercise are you doing at the gym? Since you did not mention a singular event when the headaches started, it makes me think that you are probably dealing with a spinal alignment issue, not an exertion headache. Have you visited with a chiropractor? If exercise and sex cause headaches behind the eyes and forehead, it is more likely to be a c-spine alignment issue causing the pain. Exertion headaches can manifest behind the eyes, but more commonly they are in the temples and back of head.

  • Nick Ryan

    Tim,

    Thanks for checking in. Glad the article (and subsequent posts) have been helpful to you. You are not alone, we have been getting 20,000 hits a month over the last 2 years (when we started tracking it) on this topic and the comments you see only account for about half of my correspondence. Good news is that people all over the world are getting after it in the gym which is awesome. Hopefully the article and the app will get everyone back to work and healthy. All that said:

    1) No, there is no other means of evaluating progress other than feeling, an MRI will show normal pictures of blood vessels in the head within 24 hrs of an exertion headache, making it a poor method for tracking progress.

    An MRI (Magnetic Resonance Imaging) uses radio waves sent through your body to then create a digital picture. If you had a ruptured vessel (aneurysm) or a tumor, an MRI would pick that up. That’s why I encourage EVERYONE to go to a doctor to rule out anything “major.” The thing about exertion headaches is that it is an acute (one-time event) forcible dilation of the blood vessels in the head (meaning, the stress during the workout causes the blood vessels to over stretch due to excessive pressure). It is this one-time event that makes the blood vessels push on the meninges, the little sensors that protect and cover the brain essentially. The problem with an MRI is that once the workout is done, the blood vessels calm down, and an MRI will give you a “normal” picture, like nothing is wrong. It is the aftermath of sensitive meninges that cause the foggy sensation and why 2 weeks off is so important. That’s roughly how long it takes for the meninges to “stand down,” so to speak, from protecting the brain.

    2) Caffeine can increase heart rate, and with sensitive meninges, this increase can cause the blood vessels in the head to encroach on the meninges enough that the protective mechanism of the meninges will trigger the headaches to shut you down. So caffeine is not something you want to take in large volumes, it is good you have scaled back. That being said, if you are accustomed to a certain mg/day of caffeine, I WOULD NOT recommend any major or drastic changes to caffeine while recovering from exertion headaches. This could cause caffeine-withdrawl headaches ON TOP OF the exertion headaches, which would just be awful… Gradually scale back, or stay where you’re at. If you’ve been drinking that much regularly, chances are your not even getting the same heart rate spike as you used to, so that has become your “norm.”

    I am happy to talk shop, let me know if you need more clarification and guidance as you bounce back from this. Download the app too, and after 2 weeks start the INCEPTION progression, I designed that using all the guidelines from my article, taking out the guess-work.

  • Nick Ryan

    Bo,

    Good to hear, and thanks for the updates brother.

  • Nick Ryan

    Kelli,

    Another pitbull. We will get along fine.

    It sounds like a classic exertion headache to me, which means that you will need to take 2 weeks completely off with lots of water, continue the ibuprofen, and give the meninges a chance to calm down. If you keep pushing, the headaches will continue and can follow you for another year or more. So the fastest way to get back to pre-headache levels is to start off with rest. As far as the app goes, INCEPTION is the progression that you’ll want to do AFTER you have rested 2 weeks. Once you have completed the INCEPTION progression (there are 3 workouts that slowly build you back up to pre-headache levels), there are other workouts you may like to help keep you training at a high level with keeping in mind staying headache free. Lastly, alcohol may help you relax, but you must drink water to avoid dehydration. Being dehydrated during this recovery process will hurt big time. Keep me posted, strong work, here to help.

  • Tim Peters

    Hi Nick just wanted to start out by thanking you for creating this page. I’ve been dealing with exertion headaches for 3 months now and anyone I tell about them looks at me like I’m high on crack.

    1)is there anyway to evaluate your progress other than feeling? Would an MRI demonstrate the degree of swolleness of my blood vessels?

    2) what are your thoughts on caffeine? Preheadahce I consumed about 1,000 mgs/day, im down to 200 mgs/day and I feel that it is helping. Just wanted to understand the science behind it.

    Once agin thank you Nick,
    Tim

  • Bo Nyberg

    Another small update, just got OK from the MRI, nothing damaged on what could be seen there.

  • Bo Nyberg

    Thats great news. Im trying to be as careful as I can here. But given that the fogginess increases after the work out and remains (haven’t been to the gym since friday and the foggy sensation hasn’t come down to pre workout levels)….I’m paranoid :/

  • Nick Ryan

    Bo,

    The fogginess is going to be present the entire duration of your recovery, that is typical. An increase in the fogginess sensation after an INCEPTION workout is also normal. As long as you are not experiencing pain with the fogginess, you may continue with the program. A “flair-up” is when the pain associated with an exertion headache (i.e. grenade in temples/back of head) comes back, but typically less than the initial. The foggy sensation is the result of the meninges remaining sensitive, and this will last like I’ve said, for the entire 2-6 months of recover, to a smaller and smaller degree as time goes on.

  • Bo Nyberg

    would really appreciate your feedback on this…so difficult to find help on these things

  • Bo Nyberg

    Hi again Nick,

    Update: The first two weeks of INCEPTION are now over without any flair up. I have been feeling a reduction in the fogginess up until just before the weekend when I felt it coming back somewhat to pre INCEPTION levels. Maybe because I went two days in a row and also went for a long walk after one of the sessions? I don’t know – anyway my question is now since the fogginess has become worse do I go back to a 2 week rest period or do I continue with the INCEPTION workout plan?

  • Bo Nyberg

    Thank you Nick. I take my recovery very seriously which is why I’m back here asking questions. Will do as you suggest.

  • derra

    Hi nick after trial an error I have found that low dose indomethacin infrequently maybe 2 times weekly with 3mg melatonin taking on a nightly basis to be the best way to alleviate around 60-70 percent of headache issues personally speaking…I decided to not take the amitriptyline as it’s an anti depressant

  • Nick Ryan

    Bo,

    Unfortunately the foggy sensation will only subside, not go away completely, for potentially the entire duration of the INCEPTION progression. If you feel a headache immenant, back off and avoid a flair up. A flair up will reset the entire recovery back to day 1, 2 weeks off. So it is critical to be very cautious and intentional about performing the workout with an awareness of how your head feels. The foggy sensation will subside in time, but not completely for most people, for anywhere from a month to 6 months depending on setbacks and the severity of the initial headache.

    As a side note, if there are parts of the warm-up that cause the headache to worsen, don’t do them. I’ve had some people send me private emails asking about jumping jacks, or the drop squats, all parts of the warm-up, that made the headache worsen. My advice to them is the same as what I will tell you Bo, listen to your body and avoid flair-ups at all costs. So if 1 or 2 of the warm-up movements worsen the foggy sensation, skip them. That being said, if everything in the warm-up puts you on the verge of a flair-up, don’t do the workout. The warm-up in this situation is a trouble shooting session as much as it is a means of preparing the body for work. So use it to your advantage, and take your time, especially the first few weeks of ARIADNE’S MYSTERY.

    If this has been ongoing since December 10th and you continued training through January and part of February, you are likely going to have the foggy sensation for the foreseeable future. Just take things slow, be methodical about training, breathing, hydration, and sleep. Allow yourself to ease back in with the INCEPTION progression. At your checkpoints, answer the questions honestly, and heal up at your own pace.

  • Bo Nyberg

    Hi Nick,

    Update: I tried the INCEPTION workout and it went ok – started to feel some headache in the first yoga position on the app so immiedeatly quit after that. Haven’t been close to another round BUT this dull headache persists. It is better during the day but comes back during the late afternoon/evening. I saw you wrote this 2 years ago:

    //Thanks for sharing your story. It sounds like you have done all the major tests to rule out anything more severe, and everything came back clear. The best way to deal with an exertion headache is ibuprofen, rest, and avoiding things that cause a spike in blood pressure and heart rate (sex, exercise, poor diet) for 2-4 weeks until the foggy headache subsides. Unfortunately there is no magic answer other than rest and time that heals this injury. Keep us posted on your recovery, and thanks again for the post. //

    Now, do you recommend that I take another 2 weeks off and see if the foggy headache subsides, or is it ok to continue with the INCEPTION as long as I don’t get another flair up?

    Also, I checked my training log. The headache occured on December 10th in the leg press. I actually went back to the gym on december 11th, didn’t feel any pain when doing my normal stuff, continued to train for a few weeks but avoided leg press and everything that made me feel any sensation in my head. But the foginess got worse which is why I took the last two weeks off, finally.

  • David

    Thank you for your reply Nick, very much appreciated. I will definitely get it checked out.