Table of Contents

Exertion Headaches

By: Nick Ryan | June 23, 2011 587 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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  • Sharon Hanley Yevchak

    I just started a Crossfit 6 week challenge to get fit, stronger and lose weight. I’m following Paleo Diet menu meals from an app which accompanies this challenge. I have completed my first week without issue. I need about 25% of the moves to be modified. Today, Monday, I think I experienced an exertion headache after completing a 400m run/jog/walk as the beginning of our WOD. I got back into the gym and was supposed to complete 40 step-ups with kettle bell at chest with no time to recover. I was totally winded after the 400M. I was breathing rhythmically and trying to recover. While doing step-ups I got a burst of pain beginning in the back right side of my head. I told my trainer. She encouraged me to keep trying after a 30 sec break and drinking water. As I struggled to continue I got another burst of pain at the back left side of my head. I stopped she came over and applied pressure to My right triceps. It seemed to relieve a bit or was it just focusing on the new pain at left side? Then she did same on left side. Didnt really make a difference. Anyway, I can’t describe the pain as a grenade or like my head would explode because I am used to severe headaches. I suffer from migraine headaches and end up vomiting from their pain if I don’t take my med at onset. I did feel nausiated. Since I’m a Newby where does this leave me? I want to continue my challenge. I really do try to not push too hard until I’m confident and can do movements without modifications. She gave me an electrolyte tablet and more water. Had me ‘roll out’ my triceps and recommended magnesium. One trainer Called it a heat headache, another said super tight triceps. By the time I left it was reduced to regular headache pain. At home now 4 hrs later it’s dull and annoying after advil. Suggestions?

  • Nick Ryan

    Tony,

    I don’t think you gave yourself a full-blown exertion headache. Like your trainer is suggesting, I would recommend adjusting diet and sleep habits, increase water consumption, and be cautious as you train for the next few sessions. Bench press is not a normal trigger for them, and since you don’t think there was a distinct incident, there probably was no incident. Keep me posted though, here to help.

  • Tony Piccirillo

    I experienced a, what I would call a reasonably discomforting headache, yesterday while doing bench press. Felt it around the sides of my head, back of my head, and behind my eyes the most, if that makes sense. Tried to get through 5 reps of 225 (done this many times before) and the headache got considerably severe that I dropped what I was doing and went home. As I’m reading down this thread on other people’s experiences, I’m hearing things like the onset they experienced was “the worst headache they’ve ever had” and like “grenades in your head”, but I’m not sure if my headache was that bad. It was definitely a surprising and alarming feeling, but I was not crying or screaming in agony or anything like that, lol. Yesterday I was running on not too much sleep and my breathing during the exercise may not have been the best (can’t really remember). I had had a lot of caffeine throughout the day and took over 2 scoops of C4 pre-workout before getting on that bench. The headache I had lasted for a few minutes and then slowly got better once I left the gym – it did not persist. Throughout yesterday evening and today I would describe my current state headache as not really noticeable unless I focus on it, but for the most part I feel okay, but I do feel a little bit different than before I started that set yesterday. I honestly can’t tell if it’s anxiety (for the possibility of actually having an injury and not being to train for several weeks) or if it’s a “dull” pain that is lingering from yesterday. I’m not too clear on what a dull pain in my head would even feel like to be honest… I hope that makes sense!

    A personal trainer whom I spoke with today said a little magnesium, coconut water (electrolytes), ibuprofen (got it), and the rest of the week off from training should do the trick, and probably no heavy lifting for the rest of the week either. It’s Tuesday now, so until Monday, she suggested. Symptoms are not severe enough where I’ve thought about going to a doctor yet.

    I’ve been weight training for almost 10 years now without having any issues like this. Based on what I’m telling you, is a 2 month break really necessary for me? I feel functional today. Please advise,

  • Nick Ryan

    A Joubert,

    Everything you have said screams classic exertion headache. What can you do to cope with the pain? Stop all exercise. No sex. Drink lots of water. Sleep 8 hrs every night. Take ibuprofen every day. Repeat this for 2 full weeks.

    Once you have completed 2 full weeks of intentional rest and recovery, you can begin training using the INCEPTION progression that you can download for free in my app, a workout progression I designed specifically for recovery from exertion headaches. It has been a successful plan for thousands of people, especially those that follow it closely.

    You’re biggest obstacle is patience, and not pushing through the pain and making things worse. These will not go away by casually approaching recovery. You have to be intentional about getting better. Unlike a broken leg, exertion headaches have no visible warnings. But like a broken leg, exertion headaches have recovery timelines that need to be followed. You can’t try and run on a broken leg, but you can work out with an exertion headache, and it makes things much much worse doing so. My advice, from one pitbull to another, is to let yourself heal, and then work your way back cautiously, and if you do so, you’ll be back at within the next 2-6 months, depending on flair-ups.

  • Nick Ryan

    OK Takumi, keep me posted.

  • A Joubert

    Hi Nick

    I started feeling severe pain in the back of my head last Tuesday while I was working out at Gym with my personal trainer. We were doing leg presses, dead lifts and squats. At some point the pain in my head was so bad that I thought I might have burst a vein in my head!!!

    We stopped the work out, however during the Wednesday work-out it started again, and on Thursday we had to stop our training session halfway through because I literally thought I was going to pass out from the pain in the back of my head. On Friday I WOKE UP with this pounding headache, and it has not stopped since Friday. I have gone to bed with the pulsating headache in the back of my head, and I have woken up every morning with the same amount of pain since Friday morning.

    I have never suffered from headaches before. The pain is ridiculous.

    When I cough, it feels like my head is going to explode. I have not been able to do any excercise.
    Do you think this could be a typical case of an Exertion Headache?

    I have tried to stay hydrated, the pounding in my head doesn’t stop.

    What else can I do to try and cope with this pain?

  • Takumi Ishida

    Nick,
    Thank you for the advice, your article and your reply were very helpful, the same day it happen to me i went to the hospital and they give me some ibuprofen, but they didn’t told me anything about rest, so i really appreciate the time you take to reply and give a very detailed explanation,I will rest as you told me and I will let you know if I have any further doubt.

  • Nick Ryan

    Farhan,

    The best way to know for sure if you have an alignment issue in your neck is an evaluation from a chiropractor.

  • Nick Ryan

    Anthony,

    Great news. Take your time with INCEPTION. There are 3 phases to the progression, limit yourself to 2 INCEPTION workouts each week with 48 hrs of down time between INCEPTION workouts. You can do mild/easy cardio between INCEPTION sessions. Nothing crazy.

  • Nick Ryan

    Takumi,

    In my article I go into more detail, but leg press is a token exercise for causing exertion headaches. It gets you inverted, causing pooling of the blood in the head. The heavy load on your frame causes further acute spike in blood pressure. Typically you will end up holding your breath some as part of a valsalva maneuver to ensure your hips don’t explode at the bottom of the reps. Sets can go on for a while, especially with the very popular drop set on the leg press, so fatigue, dehydration, and stress become factors to. About the only thing that leg press can’t be blamed for causing an exertion headache is neck position, which is neutral be default. As for the headache during the bench press the next day, that was a flair-up. You need 2 weeks off with rest, water, and ibuprofen before you can begin training. When you do start training, do INCEPTION to get back into things slowly. Let me know if you have any questions, I am here to help.

  • Nick Ryan

    Ulf,

    5 years is a long time to be dealing with these headaches. Have your tried my INCEPTION workouts? It’s a progression of workouts that can get you eased back into training and prepare the body for work. Is your blood pressure at rest in a healthy range? Also, an injury in this case, is doing anything that causes the initial headache. So if you’ve been dealing with exertion headaches for 5 years, the very first one you got 5 years ago is what I am calling, “the initial injury” and every headache you’ve had ever since I am calling, “flair-ups.” Just to make sure we are on the same page with terminology.

  • Nick Ryan

    Kayleigh,

    I got my first exertion headache in high school. That’s how this all got started for me. Exertion headaches are not headaches you can “close your eyes and brush off,” so I think there is a chance that you either have migraines or perhaps something simple with hydration. Squats and pull-ups specifically can put stress on your spine, so there’s also a chance that you have an alignment issue in your neck or back that is made worse while performing these 2 exercises. If the headaches go away during the day, then it is definitely NOT an exertion headache. Exertion headaches will linger for months, not hours. My advice would be to up your water intake to ensure your urine is crystal clear, not yellow, the day before you workout and the day of. Also, pay close attention to your neck and back while you train, making sure everything is neutral. “Look up at the ceiling” is a typical coaching cue to help keep low backs safe during squats, but it can put a wicked kink in the cervical spine and cause headaches. Keep good posture in your low back and keep your neck straight, eyes forward and slightly up. Same goes for pull-ups. Maintain a neutral spine. See if this fixes the problem, if not, check back in.

  • Kayleigh Rusk

    Nick,
    I was wondering if this is normal in high school athletes. I get explosive headaches in the back of my head after doing squats and pull-ups. After the wave, I close my eyes for a few seconds and try to brush it off, but it stays with me throughout most of the day. I take a weights class at my school so I’m unable to sit out. This has happened for a few weeks now. Do you think this could be an exertion headache or perhaps something else? And if so what can I do to help other than sit out?

  • Ulf Lonegren

    What if you didn’t have any injury. I’ve had exertion headaches for at least the last 5 years. Over that time I’ve had many substantial breaks where I didn’t even work out and would have fully recovered if this was just an injury. Instead any time I’m working with heavy weight, high intensity, and/or high cardio, the headaches come on strong.

    Today I was doing hand stands during my WOD and that most certainly made things worse than usual. The blood pressure to my head led to a significant exertion headache.

    My hope right now is that if I can improve my cardio substantially I will get the headaches less… but I suppose that might be wishful thinking. I’m considering taking an Ibuprofen before every workout to see if that helps. I’ve tried this before but I can’t remember how effective it was.

  • Takumi Ishida

    my first exertion headache happenned while i was doing leg press, the the following day while i was doing bench press, what do you think that could have been the cause of my headache

  • Farhan

    How to know that im having a spinal alignment issues or an alignment issues which contribute to exertion headache cause i can still fell hurt at my neck and headache.

  • Nick Ryan

    Farhan,

    This may sound complicated, so I’ll be simple initially. I think you have a cervical alignment issue that is contributing, if not fully responsible, for the exertion headache.

    Push-ups are not a “red flag” culprit for a classic exertion headache. Heavy squats, deadlifts, leg press, etc, are typically the culprit. Dehydration, neck position (which causes a constriction on bent carotid arteries), valsalva, and the pressure of the weight itself on the frame, all contribute to the “classic” perfect storm. However, you did experience a grenade-like pain towards the back of the head, near the neck, so this still fits the exertion headache norms from what I’ve learned over the years.

    It’s possible, even probable, that you have an alignment issue in your neck, maybe a bulge, slipped disc, herniated disc, whatever it may be, but an issue that is taking up room and infringing on your carotid arteries as you train. This could be exacerbated during a workout, and could even cause a full blown exertion headache during training.

    Of the folks I’ve spoken with about exertion headaches, I’d give a rough, ballpark estimate of 10% being purely a spinal alignment problem, with no exertion headache at all, just spinal alignment problems causing headaches that worsen with exercise because the spine is moving which makes the problem worse. Another 15% have an alignment issue contributing to an actual exertion headache, which is where I think you fall. Everyone else falls either under classic exertion headache, or simple fixes to hydration and breathing.

    Does ab work cause exertion headaches? No, not for folks for perfectly healthy necks, its not enough weight on the frame or demand on the body. Yes, if you have a cervical alignment problem that being in any position other than a neutral spine will cause pain, swelling, and infringement on blood flow to the brain. The fact you are asking this question Farhan gives me more reason to think you need to see a chiropractor and rule out c-spine issues.

  • Nick Ryan

    Ionut,

    Pre-workouts catch some grief with these headaches, it’s easy to blame them since that much caffeine will cause an increase in heart rate for sure. That being said, I think that pre-workouts can be a contributing factor, but can also function as a scapegoat. The increase in heart rate from pre-workout caffeine does not account for valsalva, hydration, neck position, or training modality, which in my experience, are the main culprit. I don’t know for sure whether the spike in heart rate from caffeine in your pre-workout contributed to your exertion headache or not Ionut. Behavior change for all these other factors is just as important, if not more important, than adjusting caffeine intake. Reason I say this is because I’ve found that making a drastic change to caffeine intake while recovering from an exertion headache is like a masochistic exercise in futility. You can cause withdraw on top of tender meninges, and in good conscience I can’t tell anyone to do that.

  • Ionut

    I’m having a cup of coffee each morning but I’m more concerned about my pre workout that delivers 250mg of caffeine per serving so more than what a cup delivers. Should this be a problem for my future workouts, of course after I fully recover from exertion headache and after I’m sure that I can perform more or less the same as before the e.h., in a more controlled environment taking into account everything that can help to avoid repeating this situation?

  • Farhan

    It takes about 6 hours for the pain to fade away but i still felt little headache but not strong as the first i got it. Yes, i felt like a grenade exploded at my head especially a the neck.

  • Nick Ryan

    Farhan,

    Push-ups and cardio don’t typically cause exertion headaches, but sound more like perhaps you had an alignment issue in your back/neck, or you were dehydrated. Push-ups don’t generate enough of a spike in blood pressure to typically cause an exertion headache. Did the headache go away after the workout? Did you feel like a grenade exploded in your temples or back of head?

  • Farhan

    Nick,
    Im worried because i think i might experiance exertion headache . It happens when i was doing 30 reps of push ups after a few cardio and abs workout. Am i fine?

  • Nick Ryan

    JBL,

    Exertion headaches will not have a long-term impact on your intelligence.

  • JBL

    Do exertion headaches cause any long-term damage to the brain if you rest and heal? Will an exertion headache cause a person to, for lack of a better word, become dumber than they were before the headache or can one recover to a state identical to the one they were in before the injury?

  • Tim Peters

    My neurologist has me going in for an MRI he’s pretty sure I have occipital neuralgia.

  • Nick Ryan

    Tim,

    Temples and back of head are most common areas for exertion headache pain and residual pain. That’s pretty typical.

  • Nick Ryan

    Dale,

    I would make sure with the doctor that nothing else is going on, I’m inclined to think that you are experiencing alignment issues in your neck/back, and not a classic exertion headache.

  • Jordan Cimeni

    I do have some exertion recently,I stop lifting weights since it started last week but I still doing running and playing basketball in preparation for the marathon. It feels better compared in doing lifting but It still occur until now even f I’m doing nothing in my house. I haven’t go to the doctor yet. Do you have any recommendations if what I am gonna do. Thank you

  • Tim Peters

    Does anyone ever get a sharp shooting pain on the top/back region of there head? Can’t tell if this is exertion headache related or not

  • Nick Ryan

    Bo,

    Thanks for the late-term update. Most of the time when folks start feeling better they go back to business-as-usual and don’t give this kind of check-in. I’m glad to hear that you are progressing well with upper body, and don’t feel alarmed that lower body is not ready. I mentioned this to Slavi in a related post, but isolateral single-joint leg exercises (i.e. leg extension machine, leg curl machine) make for good options at your phase for some light work to engage the hamstrings and quads. Normally as a fitness community we shun these lifts, but this is where they really have a home. Big compound leg movements have a tremendous upside, but not for folks coming off an exertion headache. They are high-risk, low-reward in the exertion headache context. INCEPTION will walk you through all this, so just stay the course. You’re not too far away, just tread carefully with legs.

  • Nick Ryan

    Tim,

    Thanks for the updates and for encouraging some the fellas. You are 100% doing this the safe/smart way. A flair-up at any point during recovery brings you all the way back to day 1, 2 weeks off. Remember, it is the meninges, nervous tissue that covers the brain as sensory data, that is triggering the devastating pain. Your blood vessels have already been recently forcibly dilated from the spike in blood pressure from the original exertion headache, and are weakened. As soon as that blood pressure spikes, which could happen with a heavy squat or deadlift, even if everything else feels great, the blood vessels push on the meninges, and BOOM, meninges bring you to the fetal position with another grenade headache and a 6-month reset button. So, from one Pitbull to another brother, take your time, chip away with small victories, and soon you’ll be done with this nightmare. Keep up the strong work though.

  • Nick Ryan

    Slavi,

    Thanks for the updates brother, I really appreciate it. I will say one thing. Be careful. At 17, I know you are feeling much better and are enthusiastic about getting after it again; however, do me a favor and hold off on hitting legs with anything above 65% of your 1RM pre-headache for another 2 weeks. Go ahead and CAREFULLY test the waters with upper body movements to stay on pace for your bodybuilding competition, but tread very carefully with your legs. Compound leg movements cause a greater spike in blood pressure due to external pressure the weight puts on your frame. They also generate the greatest spike in heart rate due to the demand the work puts on the body. Lastly, compound leg movements leave you prone to valsalva and neck position issues, which also can contribute to flair-ups. A great bodybuilding alternative is isolateral machine leg work. Extensions and curls. Normally you may or may not avoid these, but I think this is where those machines really shine. So load up one leg at a time, leave your spine out of it, and keep the total weight lower on your frame.

    Right now you may feel like things are better, but I’m warning you, be careful. So for those also reading Slavi’s updates, he is a little ahead of schedule, possibly because of his age of 17, possibly because he connected with me right away and got started down the right path before a flair-up occurred. Slavi, I have you at the 3-4 week mark right now, with a solid 2 weeks off immediately after the headache, and you are progressing well with upper body and beginning to introduce compound leg movements.

  • Tim Peters

    Thanks man nothing worse than not being able to workout. If anything I’m so appreciative for everything I have now you can’t take your health for granted. There’s kids out there our age dying from diseases it could be much worse. I’m at the gym right now feeling great after a 35 minute cardio warmup. I lift every other day, going up in weight by 5 lbs. I started with 5 lb dumbbell curls, today I’m doing 20’s. I’m surprised you can already deadlift I’m deathly afraid of another flair up so I’m taking it extra cautious.

  • Slavi Savanovic

    So how are your workouts now? I did a set of 6 with 275 on deadlifts which isn’t really hard for me, but in the past just doing 225 for 3-4 would start the headache. I have to say a warmup really is important. I usually warm up with slight cardio, then begin to transition my body into exertion type lifts. So I have to overall it seems like my headaches are calming down a bit but I’m still taking it light and easy. I hope yours gets healed up as well, nick knows what he’s talking about, I’m thankful he put this information out for us

  • Bo Nyberg

    Update. So its now almost 4 months since the initial headache, and by (almost to the point) following Nick´s INCEPTION protocol, I can say I´m very close to being back on track. The foggy headache is like a 1/10 only on a small number of occasions during the day, i.e most of the time I don´t even think about it. Neck is still a bit stiff but much much better than before. I haven´t had a flair up but I tried doing squats with just the bar in a very controlled manner and I sort of felt uncomfortable and quit straight away. This all means I´m MUCH better than my initial post, but I´m not yet ready for high rep leg work, which makes sense as I´m not there yet on the INception protocol. So for everyone that is new to this – just follow his protocol to the point, and you will probably be fine (as long as you have done the scans etc)

  • Tim Peters

    I took a few months off then got a slight flair up from benching just 60 lb dumbbells. I think nick is correct in saying you have to recalibrate the meanings to prevent a flair up. Anyways good to hear your back into it man, my doctor I saw told me a strong warm up is very important. He used to work with olympians like the 1980 US luge team and he said that the best thing to do was 30-45 mins of light-moderate cardio before(keeping the HR between 100-130). I’ve been doing this since I saw him and I’ve had no issues.

  • Slavi Savanovic

    Tim,
    I took 2 full weeks of while taking 2 tablets of ibuprofen twice a day during that period. Now after I finished that, I’ve returned to some light weight lifting, I’m actually jus 3 days into it. I promised myself I would take it easy but… today I pushed my self to failure with incline dumbell press, BUT, no headache. It seems like I’m almost fully healed to be honest. I still do a strong warm up, and make sure I’m not pushing myself 100% especially on deadlifts and squats. Take some time off, try to forget about it for a little, and when you return, you’ll be the happiest man alive.