Feeling a sudden, intense headache during or immediately after strenuous exercise, like push-ups, is a common experience. This reaction is known as an Exercise-Induced Headache, or exertional headache. These headaches are defined as pain brought on by sustained or vigorous physical exertion. Although typically temporary and harmless, understanding the mechanisms behind this pain is important for safely continuing your fitness routine.
Why Push-Ups Trigger Head Pain
The primary reason push-ups and similar resistance exercises trigger head pain relates to pressure changes within the torso and head. When performing a difficult push-up, many people instinctively hold their breath and bear down, an action known as the Valsalva maneuver. This involves exhaling forcefully against a closed airway, dramatically increasing pressure in the chest and abdomen.
This spike in intrathoracic pressure restricts the return of venous blood flow from the head and neck to the heart. This momentary blockage causes a quick backup of blood in the head’s veins, leading to a rapid increase in intracranial venous pressure. The resulting distension of blood vessels around the brain is perceived as a throbbing or bursting headache.
Poor form during the exercise also contributes to pain by creating significant muscle tension. If the neck is strained or improperly aligned, such as by letting the head sag, the muscles in the cervical spine and shoulders tighten excessively. This muscle overactivity can lead to a cervicogenic component, where tension-related pain is referred up to the skull, compounding the pressure discomfort.
Classifying Exertional Headaches
Medical professionals categorize exertional headaches into two main types based on their underlying cause: primary and secondary. The most common type is the Primary Exertional Headache (PEH), which is not caused by any underlying medical condition. Symptoms of PEH often start during or shortly after the activity.
A typical PEH is described as a pulsating or throbbing pain that frequently affects both sides of the head. These headaches tend to be short-lived, often resolving within minutes, though they can persist for up to 48 hours. Individuals who experience this form of headache often have a family history of similar exercise-related head pain.
In contrast, Secondary Exertional Headaches are caused by a serious, identifiable structural or vascular problem. This type of headache occurs because of an underlying condition, such as a brain aneurysm or a structural abnormality. Secondary headaches tend to last longer, often persisting for several days, and may change in character over time. Differentiating between the two types is important, as the secondary form requires immediate medical investigation.
Critical Warning Signs Requiring Medical Evaluation
While most exertional headaches are harmless, certain accompanying symptoms indicate that a medical evaluation is required. The most serious warning sign is a sudden, severe onset, often described as a “thunderclap” headache. This pain reaches its peak intensity within seconds and can signal a life-threatening event like a subarachnoid hemorrhage.
Any exertional headache accompanied by neurological symptoms also warrants immediate attention. These symptoms include double vision, blurred vision, numbness, weakness, or difficulty with speech or coordination. These are significant red flags suggesting a potential issue with the brain’s structure or blood supply.
A headache accompanied by vomiting or a stiff neck not attributable to muscle strain should be evaluated promptly. Furthermore, medical investigation is needed if a headache lasts longer than two days or changes in its typical location or severity. Individuals over the age of 40 who experience their very first exertional headache should also seek a professional assessment.
Practical Strategies for Prevention and Relief
Preventing exertional headaches involves simple modifications to your exercise routine and technique. Starting your workout with an extended warm-up period is effective, allowing blood vessels to dilate gradually and preparing the body for increased demand. A 10 to 15-minute warm-up, including light cardiovascular activity, helps smooth the transition to strenuous exertion.
Maintaining proper hydration throughout the day is another proactive step, as dehydration and electrolyte imbalances contribute to headaches. Sipping water before, during, and after exercise helps maintain blood volume and minimizes the risk of a dehydration-related headache. Paying close attention to your breathing technique during the exercise itself is also important.
Actively avoid the Valsalva maneuver by ensuring you do not hold your breath while straining. Focus on exhaling forcefully during the exertion phase, such as when pushing away from the floor, and inhaling as you lower your body. Correcting your form to keep your head and neck aligned with your spine minimizes unnecessary muscle tension. If primary exertional headaches are frequent, a doctor may recommend taking a non-prescription anti-inflammatory or a specific prophylactic medication, such as Indomethacin, 30 to 60 minutes before exercise.