If you’re prone to getting a headache or migraine after lifting weights, going for a jog, or even just sneezing, you may be experiencing what’s called an exertion headache. These can be a big source of fear and frustration for those who experience them. Let’s break down the mechanism behind these kinds of headaches and how they relate to our neck health.
If you get a diagnosis of “exertion headaches,” you’re often placed in a category with others experiencing the same symptoms. Oftentimes, medication for a condition like this is based on what has worked well for others but doesn’t address the underlying cause. A lot of our patients are seeking out an answer as to why they’re experiencing these kinds of headaches. According to the Cleveland Clinic: “An exertion headache (also known as exercise headache) involves pain during or immediately after physical activity. It comes on quickly and goes away in a few minutes or hours, but can last as long as a couple of days. But there’s usually no underlying disease or disorder.” Based on this definition, an exertion headache is something benign, which means they don’t need to do an x-ray or anything further to look for an underlying cause. This diagnosis often reaches a dead end there. This can be disheartening to those experiencing this condition because the best reasoning you can find is “we don’t know why this is happening but we can describe it.” The result? Avoid your triggers and maybe try this medication to see how it goes. This can be helpful and there’s certainly a time and place for this kind of advice, but we want to understand why this is happening in the first place. When we don’t understand the problem, it makes it harder to navigate and treat. On the other hand, when we can get to the root of an issue or a set of symptoms, it allows us to make meaningful changes throughout our life to directly impact our situation.
Let’s get into what exertion headaches look like. First, we need to understand something called the Valsalva maneuver. The body has a certain amount of stress it can exert with weightlifting, sneezing, running, and even when trying to use the restroom. A Valsalva maneuver is one of the common threads that may occur during these activities. For example, you bear down and hold your breath while trying to exert more force and push the weight, strain in the bathroom, etc. You close your airway while attempting to force air out which increases pressure in the body. This is a Valsalva maneuver. When this pressure increase occurs, it also increases pressure in your neck, sinuses, and may even result in higher blood pressure that has a direct impact on your head. Ultimately, there’s increased stress and strain in your neck and shoulders because of the natural muscle recruitment in these areas to compensate for the lack of breathing. There may be a level of stress and tension in the neck and your tolerance threshold may be slightly higher than where this tension is. In other words, your body can tolerate the amount of tension in the neck and it’s not going to give you a headache. When we add on a Valsalva, it bumps the level of tension above that threshold, which can result in the brain realizing that there’s a problem. This is what can create headache and migraine symptoms. Headaches like these are often a quick onset that goes away fairly quickly, not a multi-day-long migraine.
On the other hand, maybe we can assume it’s an increase in blood pressure and that’s the cause of these headaches. So why are these blood vessels sensitive enough to cause a headache? Most people can sneeze, cough, or exercise without experiencing a headache. It all has to do with how the brain is receiving this sensory input. There are a lot of sensory pathways that cross each other and meet together to create a common pathway to the brain. The brain doesn’t know what’s happening until these signals come in. What’s interesting about these blood vessels in the brain is that they share this common pathway and sensory input overlaps with the upper part of the neck. So, if the brain is getting this signal from the upper part of the neck, it could perceive it as the blood vessels being sensitized (aka the throbbing pounding sensation in the head). When we have a potential blood pressure increase during activity, normally, this shouldn’t cause an issue. If these blood vessels are sensitized, however, the problem may be coming from the neck due to sensory overlap, but the brain is perceiving something different. All of these signals come in at once from the neck, face, and blood vessels making it hyper-sensitive. So what normally shouldn’t be a painful response is resulting in a pounding headache.
Upper Neck Dysfunction and Tension
We often find that the upper part of the neck is the cause for many headache and migraine symptoms. This area is responsible for the majority of our rotation, as well as an important component of flexion, extension, and a little bit of side bending. It does all of this while trying to hold up a 10-12 pound head. Over time, with trauma, posture, or injury, there are a lot of different things that can cause this area to tighten and not move the way it should. We can often compensate well for years before it becomes a noticeable issue. When you have stress in the upper part of the neck, it increases stress down through the mid and lower portion, as well as the majority of your shoulder muscles. Now, all of these other areas have to do more work just to hold the head up. A specific muscle group we need to address in this instance, are your scalenes. Scalenes not only support the neck but can kick in when you breathe. If you tend to breathe through your upper chest, these muscles get used more than they should. These muscles are likely the problem when you’re doing a Valsalva maneuver. Scalenes are also anchored to the ribs and stabilize the neck. This is an area we focus on when someone comes in with an exertion-type headache.
If time goes on, there can even be an issue with the discs in your cervical spine as a result of the added stress. For example, let’s look at rotation. Say you can turn your head 90 degrees but your upper neck isn’t helping. The mid-portion of your neck is now having to take the brunt of that stress. This can be fine for a short period, but when you move that way for years, the mid portion experiences more stress. Not only does this increase the amount of tension through the muscles and make them work harder, but we can see wear and tear on the joints themselves on MRIs and X-rays. Sometimes with that Valsalva maneuver, there’s increased pressure on the disk that’s already sensitized due to stress, and the disk can cause some of this pain pattern that we often see.
The shoulders can also be a source of referral pain to the head. If they’re not efficient with their movement or their resting posture is more forward and rounded, there’s a level of straining involved in daily activities, and then you add the stress from exercise, the shoulders themselves could be referring pain to your head.
When someone comes to our clinic with exertion headaches, we want to assume that there’s an underlying source of tension that’s referring pain to their head. The trigger is the exertion, whether that’s the Valsalva maneuver, blood pressure, or areas that may have an increased level of tension. Then, when you work out, it increases the level of tension past the threshold your body can handle without pain. We want to keep you moving, or even just be able to sneeze or cough without a debilitating headache. Our goal is to empower you and provide education so you can break free from the fear of exertion headaches and dependence on medication, thriving in everything you do. Give our office a call today to see if this could be the right treatment for you.