Post-Workout Headaches: Causes and Solutions

Post-exercise headache?

Hello, Dr.
Gao.
Ten days ago, I was doing squats at the gym (with a barbell on my shoulders, performing deep squats) and gradually increased the weight to a total of 30 kg.
During the last two sets, I experienced severe pain in the back of my head.
Since then, any weight-bearing exercise causes pain that radiates from the back of my head to the entire occipital region, with a throbbing pain that syncs with my heartbeat.
The pain only alleviates when I do aerobic exercises.
However, when I squat down to do laundry in the evening, the pain starts again.
Now, if I squat against a wall for 5 seconds or if my head is lower than my heart, the pain in the back of my head returns.
I read online that it might be due to high blood pressure, but when I measured it at home, it was 90/47, with a diastolic pressure lower than my usual 57.
Interestingly, I have no issues when jogging.
What could be going on? Thank you.

Zoe, 20~29 year old female. Ask Date: 2015/08/14

Dr. Gao Chunde reply Neurology

This is a type of headache known as exertional headache.
It typically occurs during intense physical exertion or activities that increase intrathoracic pressure.
The exact physiological mechanism is unclear, but it may be related to impaired autoregulation of intracranial blood vessels, leading to rapid vasodilation and resulting in severe, pulsating headaches.
Some individuals may actually exhibit this as another manifestation of a migraine predisposition.
Generally, it is benign, and resting or taking common analgesics for headaches can provide relief.
It is advisable to warm up adequately before exercising, gradually increase the intensity and volume of workouts, and ensure sufficient hydration and electrolyte replenishment to reduce the likelihood of occurrence.
However, if there is severe headache accompanied by blurred vision, double vision, neck stiffness, slurred speech, limb weakness, or altered consciousness, it may indicate a serious problem, and immediate medical attention is necessary.

Reply Date: 2015/08/14

More Info

Understanding post-workout headaches can be complex, as they can arise from various factors related to exercise intensity, body mechanics, and even hydration levels. Based on your description, it seems that your headaches began after performing squats with a significant weight, and they are triggered by certain movements or positions, particularly those that involve bending or lowering your head.

Possible Causes of Post-Workout Headaches
1. Tension-Type Headaches: These are the most common type of headaches and can occur due to muscle tension in the neck and shoulders, especially during weightlifting. The strain from lifting heavy weights can lead to tightness in the muscles, which may radiate pain to the head.

2. Cervicogenic Headaches: These headaches originate from issues in the cervical spine (neck). If your posture during squats was not optimal, it could have led to strain in the neck muscles and joints, resulting in pain that manifests as a headache.

3. Dehydration: Intense workouts can lead to dehydration, which is a common trigger for headaches. If you are not adequately hydrating before, during, and after your workouts, this could contribute to your symptoms.

4. Blood Pressure Fluctuations: While you mentioned that your blood pressure readings were low (90/47), it’s essential to consider that during intense physical activity, blood pressure can fluctuate significantly. If your blood pressure drops too low after exertion, it could lead to headaches.

5. Vasodilation: Exercise causes blood vessels to dilate, increasing blood flow to the brain. If this process is disrupted or if there is a sudden change in posture (like bending down), it can lead to headaches.

6. Overexertion: If you are pushing your body too hard, especially with heavy weights, it can lead to headaches. Your body may be signaling that it needs a break or that the current weight is too much.

Solutions and Recommendations
1. Proper Hydration: Ensure you are drinking enough water before, during, and after your workouts. Dehydration can significantly contribute to headaches.

2. Warm-Up and Cool Down: Incorporate proper warm-up and cool-down routines. Stretching and mobility exercises can help prepare your muscles for lifting and aid in recovery afterward.

3. Posture and Technique: Focus on your form during squats and other exercises. Consider working with a trainer to ensure that your technique is correct, as improper form can lead to muscle strain and headaches.

4. Gradual Progression: If you are increasing weights, do so gradually. Sudden increases in weight can put excessive strain on your body.

5. Rest and Recovery: Allow adequate recovery time between workouts, especially if you are experiencing pain. Listen to your body and take breaks as needed.

6. Consult a Specialist: If headaches persist despite these adjustments, it may be beneficial to consult with a healthcare provider or a physical therapist. They can assess your posture, muscle tension, and overall fitness routine to identify any underlying issues.

7. Monitor Symptoms: Keep a headache diary to track when headaches occur, their intensity, and any associated activities. This information can be helpful for healthcare providers in diagnosing the issue.

In conclusion, while post-workout headaches can be common, they should not be ignored, especially if they are severe or persistent. By addressing hydration, technique, and recovery, you can potentially alleviate these headaches. However, if the problem continues, seeking professional advice is crucial to rule out any serious underlying conditions.

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