Severe Headaches Triggered by Breath-Holding and Straining: What to Know

Q: Severe Headaches Triggered by Breath-Holding and Straining: What to Know

Hello： Your symptoms are more indicative of a variant of migraine or myofascial pain syndrome. <br>However, if the headache persists for more than three days, it may be necessary to consider the rare possibility of cerebral venous thrombosis, which differs from typical cerebral a

Severe headaches occur when holding breath or straining?

Yesterday, while practicing the jellyfish float and breathing techniques during swimming, I experienced severe pain at the back of my head after completing five breathing cycles, accompanied by mild neck soreness.
However, I did not feel dizzy or nauseous.
Since then, any slight breath-holding or exertion triggers the pain, including when I lie down and try to get up or during bowel movements.
After running today, in addition to the severe pain at the back of my head and neck soreness, I also experienced symptoms of dizziness, and I still feel unwell even after resting.
I have frequently played basketball and gone swimming in the past without experiencing such symptoms.
I would like to know if there is anything I should pay more attention to and whether I need to seek medical attention.
Thank you for your response, and I appreciate your help.

JULIA, 20~29 year old female. Ask Date: 2018/05/18

Dr. Jiang Junyi reply Neurology

Hello: Your symptoms are more indicative of a variant of migraine or myofascial pain syndrome.
However, if the headache persists for more than three days, it may be necessary to consider the rare possibility of cerebral venous thrombosis, which differs from typical cerebral arterial embolism that presents with more distinct symptoms such as limb weakness, slurred speech, difficulty swallowing, and aphasia.
Cerebral venous thrombosis, on the other hand, manifests with less specific symptoms such as headache, seizures, isolated cranial nerve palsy, nausea, vomiting, and blurred vision, with headache being the most common initial symptom.
In the early stages of the disease, symptoms may only include headache due to increased intracranial pressure caused by the venous thrombosis.
At this stage, the headache can easily be misdiagnosed as a common migraine or tension-type headache.
As the disease progresses, the headache becomes increasingly severe, accompanied by seizures, cranial nerve palsy, and even intracerebral hemorrhage, making the diagnosis clearer.

In terms of etiology, cerebral venous thrombosis differs from cerebral arterial embolism.
Common risk factors for cerebral arterial embolism include older age, diabetes, hypertension, and arrhythmias, while the causes of cerebral venous thrombosis include infections, trauma, pregnancy, inflammation, hematological disorders, autoimmune diseases, dehydration, and the use of oral contraceptives.
Regarding treatment, it varies based on the condition and the site of obstruction, with options including anticoagulants and thrombolytics.
Generally speaking, the prognosis for cerebral venous thrombosis is better than that for cerebral arterial embolism.
If symptoms persist, it is advisable to consult a neurologist for further evaluation.
Wishing you good health.

Reply Date: 2018/05/18

More Info

Severe headaches triggered by breath-holding and straining can be concerning, especially if they are accompanied by neck pain and dizziness. Based on your description, it seems that your symptoms may be related to a few potential causes, and it is essential to understand these to determine whether medical attention is necessary.

Firstly, the headaches you are experiencing could be a result of muscle tension or strain. When you hold your breath or exert yourself physically, the muscles in your neck and head can become tense, leading to tension-type headaches. These headaches are often characterized by a dull, aching pain and can be exacerbated by stress, poor posture, or prolonged periods of physical exertion without proper breathing techniques. Given that you mentioned practicing breath-holding during swimming, it is possible that the combination of physical exertion and improper breathing may have contributed to the muscle tension and subsequent headache.

Additionally, the symptoms you described, particularly the severe pain at the back of your head and neck, could also indicate a more serious condition such as a cervical spine issue or even a vascular concern. For instance, if there is any underlying cervical spine pathology, such as a herniated disc or cervical spondylosis, it could lead to nerve compression, resulting in headaches and neck pain. Furthermore, if the blood vessels in the neck are affected during strenuous activities, it could lead to headaches that are more intense and persistent.

The presence of dizziness following your headaches raises further concern. Dizziness can be a sign of various conditions, including vestibular dysfunction, dehydration, or even issues related to blood flow in the brain. If the headaches persist or worsen, or if you experience additional symptoms such as visual disturbances, weakness, or changes in consciousness, it is crucial to seek medical attention promptly.

In terms of management, there are several strategies you can consider. First, ensure that you are practicing proper breathing techniques during your swimming and other physical activities. Avoid holding your breath for extended periods, and focus on maintaining a steady and controlled breathing pattern. Additionally, incorporating regular stretching and relaxation exercises for your neck and shoulders may help alleviate muscle tension and reduce headache frequency.

If your symptoms do not improve with these measures or if they worsen, it is advisable to consult a healthcare professional. A thorough evaluation by a neurologist or a physical therapist may be necessary to assess your symptoms and determine the underlying cause. They may recommend imaging studies, such as an MRI or CT scan, to rule out any structural issues in the cervical spine or brain.

In summary, while your symptoms may be related to muscle tension and strain, the presence of severe headaches, neck pain, and dizziness warrants careful consideration. Proper breathing techniques, muscle relaxation, and medical evaluation if symptoms persist are essential steps to take. Prioritizing your health and well-being is crucial, so do not hesitate to seek medical advice if you feel it is necessary.

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