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What is an Exertional Headache?

An exertional headache (AKA thunderclap headache, exercise headache or sex headache) delivers the abrupt sensation of giving birth through the head.  They strike at moments of high exertion such as when lifting heavy objects, while having an orgasm, or while doing both.  They are often accompanied with the thought: “Am I having a stroke?”

The pain of a primary exertion headache is the result of compromised biomechanics in the neck leading to a spasm of the suboccipital muscles that attach the base of your skull to your neck.  This results in increased blood pressure in the vessels in the brain and causes a benign but exquisitely intense wave of throbbing pain that can last between 5 minutes and 24 hours.

There are two classes of exertion headaches:  Primary and Secondary. 

1) Primary Exertion Headaches are the direct result of high exertion and simple biomechanical factors without an underlying pathology.    Approximately 3% of the population suffers from benign primary exertional headaches.  (Neurology. 1996;46:1520-1524)

2)  Secondary Exertion Headaches are exertion headaches that crop up because of an underlying lesion such as a brain tumor or brain hemorrhage.  While the vast majority of exertion headaches are of the primary benign variety, sufferers of exertion headaches have an increased rate of intracranial lesions when compared to the general population according to numerous published studies.
If you are having exertion headaches, you would be well advised to have your medical doctor give you a physical to rule out signs of the worst case scenario.  Ideally, this would be a physician with a sports medicine background so as to avoid the irritating questions of “why do you lift heavy things?”  “Don’t you know that squatting below parallel is bad for your knees?”  or “who told you that is how people procreate?”

How to Address Primary Exertional Headaches

When someone presents in my office with an exertional headache I address the biomechanics of the neck with cervical traction, Graston Technique for deep soft tissue work, and a chiropractic adjustment called an occiput lift.  Due largely in part to the Crossfit Games Open wod #4, I have had many opportunities to work on exertional headaches lately and this combination gets results.

K-Starr has some handy self care techniques that will keep your symptoms in check long enough to get an appointment with someone who can do some corrective work for you.

Is it safe to continue training with exertional headaches?
To get back to normal training, it is typically the case that you have to lower your intensity levels and go 1-2 weeks without inducing the headache before you can return to normal levels of pain free exertion.
Primary exertional headaches are benign.  After getting confirmation from your MD that there’s no underlying cause, it is safe to train with or through the pain.  It is however not always possible to continue to train as it feels as though you have been punched in the brain and Trent Reznor has built a nest behind your eyes. 



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    Dr. Skylar Pond is a sports medicine chiropractor in Seattle, Washington. sportsmednw.com

    3 Comments

    1. seaDads on April 27, 2011 at 5:48 pm

      Thanks for the article Sky. It may also be helpful to know that for temporary relief, an NSAID such as Aleve can be taken 1 hour prior to your workout, if you are experiencing exertion headaches longer than 24 hours.

      Eric Renn



    2. Skylar Pond, D.C. on April 27, 2011 at 5:56 pm

      NSAIDs aren't vitamins but desperate times call for desperate measures.



    3. GogO on May 8, 2011 at 5:41 pm

      so my massive traps are pulling on my 1st vertebrae which makes me feel like chipmunks are eating at the back of my eyes? also something about a pissed off cobra. i love kstar