Online Personal Training; Getting workout headaches?

Fitness Tips For 4/2/2008

Understanding How To Avoid Exercise Induced Headache (EIH) By Andrew Baye

If, during an exercise, you ever feel as though you are beginning to get a headache, stop the exercise immediately. Relax for a few minutes, close your eyes and breathe deeply. Then, if you can no longer sense any trace of the headache, continue. If, however, you still feel even a slight head pain, then do not finish the workout. Take a few days off before attempting to train again. If you attempt to work through this head pain, it may develop into an exercise induced headache (EIH).

EIH can be twice as severe as a migraine, and can last anywhere from a few days to two weeks. It was previously believed that EIH was related to tension in the muscles of the neck, similar to tension headaches, and was often addressed by performing a neck extension and/or flexion exercise at the beginning of the workout, to produce fatigue induced relaxation of the neck muscles. This was done to minimize tension in the neck muscles during the more intense exercises involving greater body masses, such as the leg press.

Recent observations by Doug McGuff, MD suggest that EIH may be caused by stretching of the dura mater (outermost of the three membranes covering the brain and spinal cord) as a result of increased BP in the cerebral veins caused by retrograde venous flow towards the brain. The onset of EIH is usually experienced during intense exercises for the legs, hips, and trunk, during which there is a large amount of venous congestion in the pelvis and abdomen. In an article entitled The Mystery of Exercise Induced Headache, in Vol. 5, Issue 3 of The Super Slow Exercise Standard, Dr. McGuff writes,

"This congestion is a result of soft tissue compression, Val Salva and massive venous return from the legs stimulated by intense muscular contraction. This massive venous congestion can create a strong enough force to drive venous flow in a cephalad direction (towards the head). Perhaps, in some subjects, the force is great enough to reverse the gradient of cerebral venous drainage so that venous blood is pushed up through the jugular veins into the confluence of sinuses...

...Theoretically, a threshold level of venodilation and pressure transmission would have to occur before the dura could be stimulated. Once this threshold is reached, look out! Dural stimulation produces severe, sudden onset pain that can persist for days."

In other words, during exercises for the lower body, increased pressure in the abdomen may cause venous blood to be forced back into the cerebral veins, increasing BP in the brain to the point where the dura mater is stretched. If this happens, it's going to feel like a bolt of lightening shot through the back of your skull, cracked it wide open, and exited through one or both of your eyes.

If this theory is correct, the reason that performing exercises for the neck at the beginning of a workout tends to reduce or prevent the onset of EIH would not be due to fatigue induced relaxation of those muscles, and the resulting decrease in tension. Instead, it appears that the increased pressure exerted on the jugular veins caused by edema (the "pump" ) in the surrounding neck muscles decreases retrograde blood flow. This would reduce BP in the cerebral veins, which would reduce the pressure exerted on the dura mater.

It is best not to develop EIH in the first place, but if you do there are measures which can be taken to minimize the possibility of it recurring.

1. Do not hold or force your breath during an exercise. As previously stated, this causes BP to quickly increase to dangerously high levels.

2. Perform neck extension and flexion exercises at the beginning of the workout. Always move extremely slowly when performing neck exercises. A 10/10 movement speed is recommended.

3. If you are performing a full body workout, perform it in reverse order, with exercises for the trunk and lower body last.