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Exercise Induced Headaches & Migraines- Causes & Observations

Exercise induced migraine headache

Exercise Induced Headaches & Migraines- Causes & Observations

Even after all these years, the pain is still easy to recall: I was finishing up my last set of bench presses- a skinny but enthusiastic teen who had just started weight training a mere three weeks before, when it hit. In the final throes of my last set, pushing as hard as I could to overcome the forces of gravity I felt a sudden pain on the right side of my head. I finished the set and the workout, but as I kept going I felt the pain growing and growing in intensity. With every repetition sending a searing pulse of what can only be described as bright white pain shooting through my temples. At the end of the workout, my coach asked me if I was alright. In typical male machismo fashion, I nodded that all was well and went my way. I was no stranger to pain. Some would even say that I courted it, given the extreme nature of my martial arts training and my newly found love of weight training. But this was something that I was not ready for, a pain that reached into the depths of my being, and it took everything I had to walk the ½ mile home from the gym under the hot tropical sun. These headaches persisted for what seemed to be an eternity- but lasted only about a month. In the midst of training, it would strike, narrowing my vision with a haze of pain that would descend upon me. A pain that could only be soothed by the darkness of my room and the blissful release that sleep would bring. I began to worry that there was something wrong with me, and that perhaps I couldn’t keep on training the way I did. My goal of transforming myself from a lanky 125lber into a statuesque natural bodybuilder seemed further and further away with every throb of my skull- and yet as suddenly as it started, the headaches just stopped. This phenomenon, which I would later learn was a classic case of exercise induced migraine wasn’t a curse that had befallen me for some unacknowledged transgression, but rather a bane that affects many who engage in intensive physical activity.

Exercise Induced Headaches & Migraines- What Are They?

exercise induced migraine headache
Exercise induced migraines can be extremely painful but seem to go away for most people over time

Exercise induced headaches and migraines have been diagnosed since the time of Hippocrates and yet we still know little about its causes. Often called ‘weightlifter’s headache’, it is associated with intense physical activity- especially unaccustomed levels of exertion. Clinically, these headaches fall into two major groups- exercise induced migraines or effort-exertion headaches.[2,3] Strict classification of headaches in one particular group presents significant diagnostic challenges as individuals can often have symptoms that can appear to fit several categories at the same time and many experts criticize the practice of strict categorization. Head trauma is a significant causative factor in sports related injuries and represent a very distinct group of sport related headaches. However, for the purpose of this article, we restrict our focus to the phenomenon of non-trauma related headaches.


Category 1- Exercise or Sports Induced Migraines


Exercise related migraine headaches usually have the following symptoms:

1. An aura, or visual or sensory warning before the onset of the headache
2. A pounding or throbbing headache of significant intensity lasting several hours.
3. A headache that is confined to one side of the head.
4. Nausea and or vomiting associated with the headache[3]

Exercise related migraines tend to happen more than once and in many cases is a family history of such headaches as well.


Woman suffering from exercise induced headache and migraine
More women than men suffer from exercise induced headaches and migraines



Exercise Induced Migraine Headaches – Apparent Causes

As common as exercise induced migraines may be, we still don’t have a concrete understanding of why and how it happens. Exercise induced migraines tend to be more common in women than in men[3] and the prevailing theory is that it may have some connection to low oxygen levels.[4,5] The low oxygen theory is commonly accepted as symptoms not only appear to be similar in nature to altitude sickness related migraines, but also due to the prevalence of exercise induced migraines among athletes during the 1968 Summer Olympics in Mexico City.[5] A location 7,000 feet above sea level. At sea level such headaches are rare among highly trained athletes which suggests low oxygen levels as a possible trigger.[3] While we are at this point unable to pinpoint the exact cause of exercise induced migraines, there are several factors that have been recognized as aggravating factors.


Exercise Induced Migraine: Aggravating Factors

1. Dehydration and inadequate water intake before strenuous physical activity
2. Hypoglycemia brought on from inadequate nutrition before intense exercise
3. Extreme exercise
4. Exertion at high altitudes
5. Exercise in high temperatures[6,7]


Exercise Induced Migraine: Treatments And Recommendations


Proper hydration can play a key role in avoiding exercise induced headaches
In my personal training practice, where high intensity training protocols call for training at near or beyond the point of momentary muscular failure, 1% of trainees (2 individuals over the course of three years) experienced migraine type headaches- usually within their first month of training. This data comes from a fairly large group of 296 people. Interestingly enough, and in line with my personal experience, symptoms subsided within a period of two months. Increased water intake before training as well and adequate pre-workout nutrition is recommended to avoid exercise induced migraines and may account for the cessation of symptoms among clients. Dietary and water intake are regulated among all who train within our system and improvements in adherence corresponded with the reduction of exercise induced migraines. All who suffered from exercise induced migraines self-reported that they did not drink anywhere near the amounts of water recommended on days that the headaches occurred and it is easy to hold these factors as being causative. However’they may simply be correlative as reduced incidence of migraines may also be a result of physiological adaptations to high intensity training as trainees increase their levels of fitness and tolerance to high levels of exertion. Thus, there is no real way to discern what factor actually caused the exercised induced migraines to stop and it bears noting that in only one case was exercise induced migraines clinically diagnosed by a physician. Longer warm up periods have also been recommended as a way of minimizing exercise induced migraines and is often effective as well.


Category II: Exercise Induced/Effort-Exertion Headaches

exertion type headache and migraine after weight training
Exertion type headaches and migraines can often come after intense weight training. Especially if it’s something you are just starting out with.

Effort-exertion headaches are the most common and most diverse of the subgroups of exercise related headaches, and like exercise induced migraines they tend to occur more among women than men.[3] Exertion type or exercise induced headaches appear to occur after strenuous lifting, bending over, running and physical jarring[8] but can also occur after sneezing, coughing and sexual intercourse.[3] Such headaches tend to have the following symptoms:


1. A sudden acute headache that lasts for several seconds to as long as several hours as a result of physical exertion, but without visual or sensory cues beforehand.
2. A gradual headache lasting an hour or longer [3]
3. Pain in the occipital and neck region lasting only a few minutes in duration [9,10]


Exercise Induced/Effort-Exertion Headaches- Possible Causes


Sudden exertion headaches are usually caused as a result of strenuous anaerobic activity like intense weight lifting or sprinting, whereas the gradually building headaches tend to come after more sustained aerobic effort and fatigue.[4] Like exercise induced migraines, the pathogenesis of exercise induced headaches remains unidentified but there are several theories that have been put forward. The possible causes include increased intrathoracic pressure[11,12], compression of blood vessels due to muscular tension[12,13], vasodilation of cerebral blood vessels as a response to stress[14], neck muscle tension and or strain[15], stimulation of nerve cells or fibers that transmit nerve impulses via monoamine neurotransmitters[16] or a combination of these factors.[17] While pathogenesis remains speculative there are some clearly defined factors that appear to trigger exercise induced headaches- factors that are listed below:


Exercise Induced Headache: Aggravating Factors

  1. Poor fitness levels
  2. Altitude
  3. Hot workout environments
  4. Extreme exercise or exertion
  5. Hypoglycemia due to inadequate pre-workout nutritional intake
  6. Alcohol and caffeine consumption [6,7,18]


Exercise Induced Headaches- Observations And Commonly Recommended Treatments
exercise induced headache and migraine- the importance of water
Adequate rest, proper hydration and regular meals can in some cases reduce the occurrence of exercise induced headaches.

In my personal training practice, occurrence of acute exercise induced headaches was slightly higher than that of exercise induced migraines- 1.7% as opposed to 1% (a total of 2 trainees self reporting exercise induced migraines and 5 self reporting exercise induced exertion headaches). However, caution must be exercised when comparing these numbers since they are merely casual observations as no formal clinical diagnoses were made in each case. The symptoms of exercise induced headaches mimic that of many other potentially serious neurological disorders and self diagnosis should never be relied upon. That being said, about those who did experience exercise induced headaches at one point or another usually did so early on in their training as well. Self-reported among those who experienced the headaches was consumption off caffeinated drinks pre-workout, inadequate water intake, skipping breakfast and lack of sleep. Like exercise induced migraines, the headaches never persisted among 4 out of 5 who suffered from the headaches. The 5th trainee has only experienced self reported exercise induced headaches for just about a month, however those headaches appear to be decreasing intensity in keeping with the pattern experienced by other trainees whose headaches tended to go away gradually. For those who continued to exercise the headaches usually subsided no longer than one to two months after they began- becoming less and less intense with every occurrence. It is again hard to say what causes the improvement and without clinical verification all observations are speculative at best. However, all who experienced the headaches either stopped drinking coffee, increased their water intake and or made sure that they did not skip breakfast and ate adequate amounts of carbohydrates and fats to fuel their high intensity workouts. Again, these factors may be simply correlative as the increased fitness levels and adaptations to exercise that occur over time may be ultimately responsible or perhaps a combination of all of the aforementioned factors.


A Clinically Viable Method To Stop Exercise Induced Headaches & Migraines

Caffeine is widely consumed around the world in both food and beverages, and it has been shown to have some considerable effect on stopping migraines. As a personal trainer, it is not my place nor practice to recommend the use of any type of drug, however I did come across the use of a particular protocol for the treatment of exercise induced migraines. The book, Where There Is No Doctor has always been a constant companion of mine, and it is a has been a standard among health care workers across the globe for decades. The protocol described to stop a migraine is as follows:

  • Take 2 aspirin with a cup of strong coffee or strong black tea
  • Lie down in a dark quiet place, relax [20]

That said, I did have an online client who complained of headaches immediately after his high intensity weight training sessions and he asked if there was anything I could recommend. I suggested that he consult his physician about the use of caffeine and aspirin as a possible aid and he brought it to his doctor’s attention. She agreed that there was no evidence of any harm coming from it and that it did show some efficacy in several studies [21] and so the next time he had a headache coming on after a workout, he had some coffee with 2 aspirin and retired to a dark place. Miraculously, the headache went away and did so on two more occasions when he did the same thing upon the first onset of symptoms. This was not known in my time, but research now shows that combining caffeine with over the counter analgesic medications, such as acetaminophen, aspirin, and ibuprofen, significantly improves relief of migraine headaches and more so than the use of an over the counter painkiller on its own.[21,22,23,24,25,26] however it would appear that the treatment works best when it is used immediately as symptoms begin to present themselves.


Aside from increasing fitness levels over time, the best treatments for exercise related headaches and migraines are proper sleep to minimize fatigue, good nutrition, adequate hydration and an extended warm up period.[19] Other suggested treatments include keeping a journal of headaches as a way to pinpoint the causative factors- a method I undertook myself but thankfully my migraines stopped before I had a chance to record much of anything. Pharmacological solutions are often suggested as well, however it is recognized in the medical community that there is a need for more large scale studies of athletes who suffer from these headaches. Not only to identify the mechanisms of pathogenesis but also for the creation of standardized treatment protocols. [19] Either way, given the substantial benefits of physical exercise and activity, unless you are advised otherwise by a physician, it is important that you do your best to keep exercising whenever possible . Be sure to always consult your physician about any recurring headaches you may experience even if you believe that they may simply be exercise induced. There is no such thing as being too safe.

High Intensity Bodyweight Training: Ballistic Pushups & Dips!

This was a tough one!

Starts out with ballistic push ups (like clap pushups but without the clap as my wrist is still not 100%) nonstop for 20 reps, then all out on dips for 10 reps.

To say it was painful would be an understatement, but you just have to push through and keep on going.

Still training, hope you are too and as always, Excelsior!!! #naturallyintense

#hometraining #homeworkout #homeworkout #highintensitytraining #naturalbodybuilder #naturalbodybuilding #fitover40 #naturalbodybuildingvideos #chestday #chesttraining #naturalbodybuildingtips #pushups #dips #bodyweighttraining #highintensitytrainingtips #drugfreebodybuilding #calesthenics

13 2

Kevin's Unconventional Biceps Training- 3-6 Minutes a Week!

In this video I go over my biceps training using the Naturally Intense High Intensity Training protocols that helped me go from having arms measuring 11.5 to 12 inches to 18 inches drug free!

It's an unconventional approach for certain, but it's one that's helped my arms grow and the hundreds of men and women I have trained over the past 30 plus years.

Now, my success isn't due to being genetically gifted, as it took me the better part of 11 years to get my arms up to those measurements.

Which is significant as it works and been been proven time and time again to work for the average man or woman trying to grow their arms without drugs.

It's my hope that these high intensity training protocols can help you as much as they helped me!

Click on my bio link to see the full video on my YouTube channel and thanks as always for taking the time to look at my work!!! Excelsior!!! #naturallyintense

#highintensitytraining #naturalbodybuilder #naturalbodybuilding #fitover40 #naturalbodybuildingvideos #armworkout #bicepsworkout #naturalbodybuildingtips #biceps #armtraining #highintensitytrainingtips #drugfreebodybuilding #barbellcurls

55 8

At the Lancaster Classic Day 2 Elimination Rounds Against European Champion, and World Record Holder Leo Pettersen @leo_barebow_archer

I don't talk much about it but I'm also a competitive barebow archer (surprise!) and last Saturday I had the honor of making it to Day 2 at the Lancaster Archery Classic in the Barebow Division, as I made the top 64 out of 267 competitors and had a chance to shoot with some of the greatest barebow shooters on the planet!

I didn't make it past Leo, but it was a real rush to be there and a huge thanks to my coach, Joe MyGlyn @prolinearchery for helping me get there.

Thanks as well to my good friend @sean_chan33 for all of his help from the very start, to my line buddy Aaron Shea for taking the shot and showing up to support!

My thanks as well to rob_kaufhold for putting on and promoting one of the best archery tournaments on earth!

Thanks also to to everyone who took the time to send a supporting word and I am looking forward to next year!!! #naturallyintense #barebow

#lancasterclassic #lancasterarcheryclassic2024 #lancasterarchery #archery #fitover40 #barebowrecurve #targetarchery

38 9

Dumbo, Brooklyn circa 2004

This shot was taken as part of the promotion for my Naturally Intense DVD and was about a year after my last bodybuilding competition.

It was a grueling photoshoot.

We started at about 10 am and finished around 4pm and I was completely spent, but the more we shot the sharper I looked, so we kept on going.

It's nice to look back from time to time and as tired as I was, we all had a blast!

My thanks to @stephanie_corne_artwork, @https://pulse.ly/itgnag2dec and @ftaz1 for taking the shots!!!

Thanks for watching and as always, Excelsior!!! #naturallyintense

#naturalbodybuilder #naturalbodybuilding #throwback #fifthavenuegym #5thavenuegym #drugfreebodybuilding #naturalbodybuildinglifestyle #gymlife #gymmotivation #naturalbodybuildingmotivation #bodybuilding #blackandwhite #instablackandwhite #bnw

223 12

Can You Build An Impressive Physique Training Only At Home?


I stopped training in commercial gyms as of March 2020 and have been training at home ever since.

Initially I was admittedly worried that I might lose some of my gains or not make as much progress, but that certainly wasn't the case.

I've consistently continued to improve with my high intensity workouts and muscles have no idea where they are training.

As long as the criteria of adequate intensity and overload are met, there will be an adaptive response and your muscles will get bigger and stronger.

So don't worry at all about where you train, focus instead of what will be the best way for you to always be training!

Thanks for watching and as always, Excelsior!!! #naturallyintense

97 3

Kevin's Three Day Training Spilt!

For the past 33 years I have trained three times a week with Naturally Intense High Intensity Training workouts lasting 10, 15 to 20 minutes max.

It's a training split tried and testes not only in it's helping me realize my goal of becoming a successful natural bodybuilder, but it's also helped hundreds of men and women over the past three decades.

I have tested just about every possible training split imaginable and for this particular style of high intensity training, this particular grouping consistently yields fantastic results.

I hope it helps you as much as it's helped me over the years and thanks so much for taking the time to look at my work.

Keep training hard and Excelsior!!! #naturallyintense

Excelsior!!! #naturallyintense

#trainingsplit #3daytrainingsplit #threedaytrainingsplit #naturalbodybuilding #naturalbodybuilder #naturalbodybuildingvideo #naturalbodybuildingmotivation #naturalbodybuildingtips #drugfreebodybuilding #bodybuilding #highintensitytraining #highintensitytrainingtips

147 26

405 Stiff Leg Deadlift for 7 Reps! High Intensity Training.

First leg workout of the year and already pushing it!

I haven't done a stiff leg deadlift over 315lbs for about 3 years at this point, and I did my last set with 315lbs and comfortably got to 10 reps and decided I had far too much gas left in the tank and that I should go up in weight.

So I did.

I figured I might get a solid 6 reps in, but I made it to 7 and I think I could have gone on to get a full 10 reps BUT that's when good judgement prevailed.

As a bodybuilder having not trained this heavy for so many years, the shock of this much weight would be more than enough to stimulate muscle growth, and doing more reps wouldn't yield any greater returns, only increase the likelihood of injury.

It's not about the numbers, it's about training to a point where you achieve your goal, and it's important to have a goal in mind as a bodybuilder based on increasing muscle mass rather than hitting a particular number.

Besides, if in my 20's I never did more than 405lbs on a stiff leg deadlift, it doesn't make any sense going heavier than when I am almost 50!

Could I deadlift more at this point?

Absolutely but just because you can doesn't mean you should!

So keep those weights in a good working range, keep it safe and as always Excelsior!!! #naturallyintense

#hometraining #homeworkout #homeworkout #roguerack #highintensitytraining #naturalbodybuilder #naturalbodybuilding #fitover40 #naturalbodybuildingvideos #backworkout #naturalbodybuildingtips #backtraining #highintensitytrainingtips #drugfreebodybuilding #fitoverforty #deadlift

71 20

Turning 50 in a few months...

Not much of a big deal for me as I still feel pretty much the same but I hope that my example helps show what can be done with a lifetime commitment to eating well and training consistently!

Thanks for coming along on the journey and as always, Excelsior!!! #naturallyintense

#naturalbodybuilder #naturalbodybuilding #healthylifestyle #fitover40 #drugfreebodybuilding #naturalbodybuildingmotivation #natty #fitness

242 41
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Featured everywhere from the Wall Street Journal to CBS News, Kevin Richardson’s Naturally Intense High Intensity Training have helped hundreds lose weight and transform their bodies with his 10 Minute Workouts. One of the top natural bodybuilders of his time, Kevin is also the international fitness consultant for UNICEF and one of the top personal trainers in New York City.


Exercise Induced Headaches Causes & Recommendations References:

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2. Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia 1988
3. Williams SJ, Nukada H. Sport and exercise headache: Diagnosis and classification. Br. J. Sp Med 1994
4. Atkinson R, Appenzellar 0. Headache in sport. Seminars in Neurology 1981
5. Jokl E. Olympic medicine/sports cardiology. Ann Sports Med 1984
6. Dalessio DJ. Effort migraine. Headache 1974
7. Massey EW. Effort headache in runners. Headache 1982.
8. Moskowitz MA. Neurogenic versus vascular mechanisms of sumatriptan and ergot alkaloids in migraine. Trends Pharmacol Sci 1992
9. Rooke ED. Benign exertional headache. Med Clin North Am 1968
10. Perry WJ. Exertional headache. Physician and Sportsmedicine 1985
11. Lambert RW Jr, Burnet DL. Prevention of exercise induced migraine by quantitative warm-up. Headache 1985
12. McCarthy P. Athletes’ headaches: not necessarily ‘little’ problems. Physician and Sportsmedicine 1988
13. Cleveland H. Headaches: a weighty problem for lifters? Physician and Sportsmedicine 1984
14. Rose CF. Headache: definitions and classification. In: Vinken PJ, Bruyn GW, eds. Handbook of Clinical Neurology Vol 48, Amsterdam, Netherlands: Elsevier, 1986
15. Paulson GW. Weightlifters headache. Headache 1983
16.Roos R. Luge participation is hard on the head. Physician and Sportsmedicine 1986
17.Jordan BD, Tsairis P. Warren RF eds. Sports Neurology. Rockville, Maryland, USA: Aspen, 1989
18. Thompson JK. Exercise-induced migraine prodrome symptoms.Headache 1987
19. Nadelson C. sports and exercise induced migraines. Curr Sports Med Rep 2006

20. Werener D, Thuman C, Maxwell J. Where There Is No Doctor: A Village Health Care Handbook, Hesperian Health Guides 1992

21. Prior MJ, Codispoti JR, Fu M. A randomized, placebo-controlled trial of acetaminophen for treatment of migraine headache. Headache. 2010
22. Lipton RB, et al. Aspirin is efficacious for the treatment of acute migraine. Headache. 2005
23. G, H., et al., Self-medication in migraines and tension headache: evidence-based recommendations of German Migraine and Headache Association (DMKG), German Neurological Society (DGN), the Autrian Headache Association (OKSG) and the Swiss Headache Association (SKG). Nervenheilkunde, 2009
24. Sawynok J. Caffeine and pain. Pain. 2011
25. Zhang WY, Po AL. Do codeine and caffeine enhance the analgesic effect of aspirin?–a systematic overview. J Clin Pharm Ther. 1997
26. Lipton RB, Diener H-C, Robbins MS, Garas SY, Patel K. Caffeine in the management of patients with headache. The Journal of Headache and Pain. 2017

Kevin Richardson
Kevin Richardsonhttps://www.naturallyintense.net
Featured everywhere from the Wall Street Journal to CBS News, celebrity Personal Trainer NYC and with over 2.6 million readers of his blog, Kevin Richardson is the creator of Naturally Intense High Intensity Training, one of the top lifetime drug free bodybuilders of his time, the first International Fitness & Nutrition Consultant for UNICEF, 2020 and 8 Time Winner of the Best of Manhattan Awards for Personal Training and a world recognized authority on high intensity training. Kevin has helped thousands, from celebrities to CEO's over the past 30 years achieve their fitness goals with his 10 minute high-intensity workouts done just three times a week in conjunction with his holistic nutrition approach. You can learn more about about his diet and training services at www.naturallyintense.net

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