Exertion headaches (often called exercise headaches, or weightlifters migraine) usually occur during strenuous bouts of exercise.
I wanted to take some time to address this topic since myself, and several of our athletes have experienced these types of headaches over the course of our athletic careers. Delving into the literature reveals some insight, but none that I can find with a solid plan of action. Most sources provide very little insight into the root cause of the headaches.
Some say it could be the increase in intracranial pressure due to the valsalva maneuver and others say straining of the cervical muscles and tendons. And the main prescription that is offered in solving the problem is either:
2) Manage with medication.
If you are anything like me, both solutions are no bueno.Â
So after several personal bouts with these types of headaches I started to dig into the issue and started to identify some common movement faults and patterns along with some very helpful rehab and prevention strategies.
I began with looking at the first time each person I know of that has experienced these headaches first noticed them. For me it was during overhead squats, another during double unders, and another during pull ups, one during muscle ups, and a few during deadlifts.
I then asked everybody to explain the onset and intensity of the headaches. Everyone was very similar: The headaches were severe, throbbing, almost blinding and unrelenting. Some ranged from 10 mins up to (my personal worst) about 48 hours. Some were associated with nausea.
What we ultimately noticed was a breakdown in stability of the cervical spine over time. Like many injuries it does not stem from one specific instance (though it may feel like it) it actually is building up over time. We postulate: Once we begin hyper-extending the upper cervical spine, especially under load, we begin to put significant pressure on our cervical vertebrae which ultimately can create a nerve impingement eliciting a sympathetic response triggering vasodilation of the blood vessels in the head making it feel like some is beating you over the head with a Kettlebell in rhythm with your heart beat.
As coaches we all know we should teach a neutral head position. Â So a large chunk of this conversation lies within the concept of threshold training: Being able to train at a high-intensity while maintaining proper form and technique.
This threshold is easily ignored when in competition or chasing a PR. I understand this. The goal is to train smarter and scale load and/or intensity as needed. It is no good for the athlete to push his/her limits only to be sidelined for a month due to injury.Â
   Hyper-extended Cervical Spine = no good.Â
We identified 3 muscle groups that can play a significant role in this process. When an improper movement pattern or muscular imbalance goes untreated for long periods of time your muscles will adapt to the incorrect pattern or imbalance â meaning we then need a strategy to lengthen/mobilize and âre-wireâ the muscles involved in the movement pattern.
We started looking at the upper trapezius, scalenes and SternoCleidoMastoid (SCM) muscles. By mobilizing these 3 muscle groups on a DAILY basis, pre and post workout we found we were able to alleviate a lot of the pressure and tightness that is felt in association with these headaches. My personal opinion is that a lot of this issue stems from tight scalenes. I say this because many of the athletes, myself included, who focused mostly on scalene lengthening, noticed a significant decrease in frequency of the headaches.
Upper Trap stretch with head pull
Trap smash with Lacrosse Ball
Once we identified the mechanism of injury and started to target and mobilize what we feel were the main muscle groups involved we then needed a corrective strategy.
Here is what we implemented:
Overhead Kettlebell Walks
Slow Light Deads with good posture
We would also consciously focus on how much we were âshruggingâ during the WOD. What I mean here is as you get fatigued are you activating your upper traps in a shrug fashion? (we sometimes donât realize we are) If so, this could be playing a significant role in the process. Filming a workout or two can also provide some helpful insight.
 If you are experiencing these headaches here is our Plan of Action:
1.)Â Â Â Stop the training session (for some people this goes without saying, others will push through: Donât)
2.)Â Â Â Reduce volume of training for the next week, ease into workouts only if there is no neck/head pain
3.)Â Â Â Mobilize using the above methods prescribed above - everyday â pre and post WOD
4.)Â Â Â Implement corrective strategy as outlined above
5.)Â Â Â Find a chiropractor (preferably one that understands how you train) and get adjusted. Some soft tissue work around C-1 and C-2 can be helpful as well.Â