Posted October 20, 2023 by Matthew Romans
One unusual circumstance that we do occasionally experience at Total Results is what is called an exercise-induced headache (EIH). This type of headache only comes about through high-intensity weight training, and can occur either gradually or suddenly. While it is unpleasant and often scary to experience, I must emphasize that it is not a dangerous or medically threatening condition, and it is more of a hindrance than anything else. An exercise-induced headache is also quite rare; I would say that I see it in approximately ten percent of the clients that I have worked with. If we take the time to understand the nature of this type of headache and what causes it, we can minimize the severity of the headache and prevent it from happening in the future.
What exactly is an EIH? In my experience it occurs suddenly, first manifesting as a dull, achy discomfort that starts in the back of the head and intensifies as it moves up and forward. It often occurs with beginning clients, even when the intensity of effort is not that high. If not addressed immediately, it can present very similarly to a migraine and be accompanied by difficulty with vision. In very serious cases, this headache can persist even once the exercise has been terminated and lasts for a couple of days. In really extreme cases that I have read about, it can last for up to two weeks. Once you have experienced an EIH, the chances are greater that it will happen again unless proper measures are taken. There is no question that this is an unpleasant scenario to have to go through. Allow me to say again that as scary as this situation sounds, it does not mean that you have a brain tumor or aneurysm. Nevertheless, it is something that needs to be discussed with the prospective client during the preliminary considerations portion of an initial consultation.
What causes an EIH? There are certain types of form discrepancies that can predispose an exercise subject to experience an EIH, namely facial grimacing, Valsalva, neck extension, and excessive gripping. Ken Hutchins, in his book "Super Slow - The Ultimate Exercise Protocol", talks about working with a client that experienced recurring EIH at Nautilus as far back as 1980. Since this client exhibited excellent form and performed none of these form discrepancies, he suspected that there had to be another cause. Unfortunately, for many years this other cause remained an enigma, and most of the emphasis was on prevention and treatment of EIH. It was only with Dr. Doug McGuff's insight that we were able to get a better understanding of this strange phenomena. He explained that EIH was the result of stretching of the dura, the outer covering of the brain, that occurred due to a bottleneck of venous blood working its way back to the heart. As Hutchins explains, "And when the venous return exceeds the compliance of the upper body, it accumulates in the head and stretches the dura or covering of the brain, emitting a classic thunderclap-type pain. Our collective hypothesis is that this is the root cause of most EIH presentations." I also suspect that weak neck musculature may be a factor, but I cannot prove this. The silver lining, of course, is that because EIH happens as a result of venous return of the blood back to the right side of the heart, it confirms our long-held belief that Total Results high-intensity strength training is the most effective way to improve cardiovascular conditioning.
How do we treat EIH? The first emphasis should be placed on prevention. Clients must maintain proper neutral head position at all times during each exercise and avoid the aforementioned behaviors such as Valsalva, facial grimacing, tensing the neck muscles (except when performing cervical extension and flexion exercises), and excessive gripping. Breathing should be done freely and continuously throughout each exercise. Following these protocols should significantly reduce your risk for encountering an EIH. In the event that an EIH does occur, there are responsibilities that need to be met on the part of both the instructor and the client. The client must immediately notify the instructor if any head pain arises that was not there prior to the beginning of the workout (also tell your instructor if you have a headache when you arrive for your workout). Do not wait until after the exercise has been completed; time is absolutely of the essence. This must be taken seriously, and the "no pain, no gain" approach does not apply. Once notified, the instructor will terminate that particular exercise and have the client safely unload from the resistance. The instructor will have the client sit quietly with their eyes closed (do not talk) for up to five minutes. If the head pain does not subside completely after five minutes, the workout will be terminated. It is important to make this distinction, because it is not enough to say that the pain is "better." The pain must vanish completely in order to continue the workout, because the likelihood of the head pain worsening increases significantly. Usually, if the headache is caught and treated in time it will go away and never again become an issue. If an EIH recurs, there are strategies that we can use going forward to avoid this problem from becoming ongoing. Often we will change the order of the exercises in a workout (performing upper body exercises first before the lower body, as EIH often happens on the Leg Press), perform a neck extension exercise at the beginning of the workout (to strengthen and also relax the neck muscles for the remainder of the workout), or simply redefine the point of muscular failure as that point just before head pain starts (at least for a few workouts). These measures have been quite successful at rehabilitating clients from a recurring EIH; in fact, I can only think of one client in over twenty years that we were not able to successfully cure of EIH.
An exercise-induced headache is certainly an unpleasant and scary experience to have to go through, but being prepared by your instructor for this possible occurrence means it won't be completely unexpected if it does happen. Prevention is the key to avoiding it, and efficient communication between the client and the instructor will help rectify the situation quickly. Experiencing a headache doesn't have to mean quitting high-intensity exercise, and if you look at the silver lining it means you are truly involved in something that stimulates meaningful physical change. These headaches are rare events, and my hope is that most of you reading this article have never and will never experience this situation. We believe in educating our clients and covering all the bases. Thank you for putting your trust in Total Results!