Warning: If you’ve experienced severe headaches from exercise, please go see a doctor, or else face the risk of death. Seriously. People don’t drop like flies from strength training, but dying is dying. Don’t risk it. The following article is simply a summary of what I’ve learned about exertion headaches after experiencing them myself. Once again, see a doctor if you’ve experienced severe headaches from exercise.
Ever had an exercise-induced headache? Plenty of people have experienced regular headaches, but my God, you’ve yet to experience a headache until you’ve had an exertional or exertion headache. The best way to describe is as so: you’re in the middle of a set of heavy back squats, when out of nowhere, you feel like you’ve just been clubbed in the back of the head with a lead pipe. It is awful and debilitating, and lingers for the rest of the workout. Today I’m going to discuss my experience thus far with exertion headaches, the supposed cause(s) of exertion headaches, and the measures needed to prevent them in the future.
Exertion Headaches: the Worst Gift Anyone Can Ask For
A few Fridays ago, I was performing back squats, and mid-set, I was the guy who got bludgeoned in the back of the head. Holy moly were those a horrible few minutes of my life. What happened was in between each rep, I’d stop my valsalva maneuver to breathe, then perform the valsalva to do the next rep. Half-way through, I felt a rush of blood from (or to?) my head when relaxing and taking a breath, and the pain came right after.
I immediately re-racked the barbell and walked around holding my head. I swear it felt like my skull was going to burst from pressure. Luckily, the pain subsided after a few minutes to the point that I could drive without crashing my car. A few tablets of acetaminophen later, my head was feeling quite alright. That was my first full-blown experience with exertional headaches.
The following weekend went on as normal, and the following Monday came by. I started my workout with front squats – starting with the bar and ramping up the weight. I didn’t even hit my working weight as a heavier warm-up set caused the exertion headaches again. Boom. Out for the count.
- Exertion headaches seem to be somewhat common.
- They can be a sign of something benign, or something fatal.
- Seeing a doctor after having an exertion headache will result in numerous tests, such as an MRI or spinal tap, being performed to make sure your brain isn’t bleeding. The cause for brain-bleeding would be a ruptured aneurysm.
- Almost all of these folks report having no brain issues and are cleared by their docs.
- It takes a few days to a few weeks to return to training without the exertion headaches returning.
- Some people experience the headaches just once, and others will experience them every now and again.
- There are wide variety of causes that sufferers have speculated.
I was completely taken back by how many people have suffered from exertion headaches. I must’ve read at least 200 different anecdotal accounts online over the period of 1 hour. The most interesting part that I took away from reading about everyone’s experiences was how many supposed causes (both speculated, and suggested by people’s doctors) there are for exertion headaches.
Excessive Blood Pressure and Intracranial Pressure, plus Aneurysms
During heavy lifting, it is typical for a trainee to hold his or her breath. This is called the valsalva maneuver, and it is used to stabilize the torso and spine as to prevent injury and improve lifting efficiency. It works by increasing the pressure of the body cavities found in the torso. Unfortunately, it also increases the pressure in the cavity of the head – known as the intracranial cavity.
Additionally, the body’s blood pressure drops and the heart-rate increases during the valsalva. When the maneuver is stopped and the trainee breathes again, blood pressure rises (sometimes above normal) and heart-rate drops (sometimes below normal).
It’d be fair to say that increased pressure from all angles can be stressful on the brain and its blood vessels. Just imagine squeezing a balloon as hard as you can, and then filling it up with more air. It would eventually go pop! Anyone with a pre-existing aneurysm (a bulging, weak blood vessel in the brain) would risk having a brain hemorrhage. That’s why you want to see a doctor after experiencing an exertion headache – to make sure you didn’t burst an aneurysm you never knew you had and aren’t bleeding internally
Does this mean that the valsalva maneuver is dangerous and should be avoided? For healthy lifters who have been cleared by their doctors, absolutely not.
Without the valsalva maneuver, the torso will struggle to support any significant weights during the squat, deadlift, and etc. The internal pressure keeps the torso rigid so it can effectively support weight while the other joints do the work.
Anyway, the goal here is to maximize rigidity of the torso through the valsalva maneuver, whilst minimizing the stress on the brain’s blood vessels. In an email correspondence back in the late ’90s, a faculty member of the University of Washington asked the late Dr. Mel Siff – author of Supertraining, a scientific strength training textbook that I highly recommend – about his thoughts regarding the valsalva maneuver and injury. Dr. Siff basically said the pressure from the maneuver CAN cause ruptures of the blood vessels, but there are ways of mitigating the risk (Griffin M). Here are his recommendations:
- Russian research indicates that filling the lungs up to 75% capacity with air allows for most core stiffness with the least amount of side effects. So, don’t hold in huge amounts of air when you tighten up. Experiment with holding in different amounts of air in your lungs, and see what “feels” to be the best amount without it being 100% of your lung capacity.
- Don’t wear lifting belts too tight. They should be tight enough, but not overly tight.
- Exhale slightly during the “up” portion of a lift – such as coming out of the hole during a squat. This will “release” some pressure, but not totally lose all of it.
- Improve your lifting technique. The better your technique is, the more efficient you are at the lift. The more efficient you are at the lift, the more quickly you perform each rep. The more quickly you perform each rep, the less time you spend using the valsalva maneuver. The less time you perform the valsalva maneuver, the less time your brain’s blood vessels are under pressure.
To reiterate, excessive blood pressure AND intracranial pressure caused by the valsalva maneuver can cause exertion headaches. Unfortunately, this may be due to an aneurysm the trainee may have without knowing, and the excessive pressure caused the weakened blood vessel to rupture. If a doctor clears the trainee of any medical issues, then it may be because of general strain on the blood vessels, which are otherwise healthy. Dr. Mel Siff has described a few ways to decrease the pressure and stress on the brain’s blood vessels while still using the valsalva maneuver.
Hydration, Electrolytes, Alcohol, and Caffeine
The rest of the causes of exertion headaches are, unfortunately, anecdotal and really just speculation. However, there are still interesting points to consider nonetheless. Food and diet can alter our blood pressure, and as we’ve just discussed, excessive blood pressure may be partially responsible for exertion headaches.
The proper levels of hydration and electrolytes are important for health, yet people still struggle with imbalances. You’ve got folks who eat salty junk food all day and only get their water from soda/juice/beer/etc., while others drink a gallon of water daily and shun any salt.
I stumbled upon a few accounts online of lifters experiencing exertion headaches, only to solve it by balancing their water-, salt-, and potassium-intake. Some needed more water, others needed more sodium, while the rest needed more potassium. Once again, the key here is balance, not excess. It’s long been known that excessive sodium consumption has been correlated with increased blood pressure, but excessive water consumption has been correlated with increased blood pressure as well (Zorbas, et. al). I’ve been confident that my own water and electrolyte consumption’s been fairly balanced, but it’s still worth noting.
It occurred to me that my headaches occurred during the holiday season. What do the holidays mean for most of us? Lots of alcohol. Lots. I drank quite a bit for Christmas and New Year’s. Knowing that alcohol has a number of effects on the body, the drinking could have very well contributed to my exertion headaches. In fact, significant daily alcohol consumption has been linked to increased blood pressure (Klatsky). Beer may not make the best pre-workout drink, unfortunately.
Finally, there’s caffeine. Caffeine, like alcohol, has a large number effects on the body. Interestingly enough, I just began drinking coffee in recent months. Not surprisingly, caffeine increases blood pressure (Nurminen ML, et. al) (Robertson D, et. al). I personally know of some friends and family who have used caffeinated pre-workout drinks to ill effect: headaches, sky-high pulse, nausea, etc.
The Practical Takeaway: Moderation, Rest, and Seeing the Doctor
None of what I’ve discussed so far should be a reason to stop using the valsalva maneuver, or give up the occasional beer or salty snacks.
Just as I’ve said before, the excessive pressure from performing the valsalva maneuver can be dealt with. It’s a vital technique for explosive movement, and one just has to be careful to not abuse it.
The same principle applies with diet. If drinking lots of water works for you, keep it up. Like a few slices of pizza with Heineken on Friday nights? That’s no big deal. Enjoy having a cup of coffee on Monday mornings to start the week? Then you drink your black bitter stuff. Herman Goerner trained a gym that had a bar attached to it with his a spot for his own personal beer stein (Smith, C). The Saxon Trio drank quite a bit of beer during their careers.
These substances may have an effect on our bodies which may or may not cause contribute to exertion headaches. The thing is, though, that everyone has their vices, dietary peculiarities, and so on. yet, people aren’t dropping like flies from exertion headaches. Chances are, you aren’t living in excess. If you are, cut back on whatever you consume excessively, but continue consuming it in moderation.
With that said, please see your doctor if you’ve experienced exertion headaches. There’s a good chance that your doctor will rule out anything serious, but it doesn’t hurt to be a little overly-cautious. A week or to off may be all you need. That’s all I’ve needed to recover from exertion headaches, anyway.
1. Griffin, M. “Breathing.” University of Washington. 1997. Web.
2. Zorbas, Yan G., Youri F. Federenko, and Konstantin A. Naexu. “Effect of daily hyperhydration on fluid-electrolyte changes in endurance-trained volunteers during prolonged restriction of muscular activity.” Biological trace element research 50.1 (1995): 57-78.
3. Klatsky, Arthur L., et al. “Alcohol consumption and blood pressure: Kaiser-Permanente multiphasic health examination data.” New England Journal of Medicine 296.21 (1977): 1194-1200.
4. Nurminen, Marja-Leena, et al. “Coffee, caffeine and blood pressure: a critical review.” European journal of clinical nutrition 53.11 (1999): 831-839.
5. Robertson, David, et al. “Effects of caffeine on plasma renin activity, catecholamines and blood pressure.” New England Journal of Medicine 298.4 (1978): 181-186.
6. Charles A. Smith. “Hermann Goerner: A Man of Super Power.” The Tight Tan Salcks of Dezso Ban. 1986. Web.
7. Leo Gaudreau. “The Saxon Trio: What They Ate and How They Trained.” Bob Whelan. Web.