EUGENIZATION.

A comment by a reader over the weekend reminded me of a topic that is little understood but comes up with surprising frequency: exertional or exercise-induced headache (EIH). 

I previously blogged about EIH here but here’s the skinny on it: EIHs occur due to either increased pressure in the venous sinuses around your brain, excessive tension in your head and neck muscles, or a combination of both (it is possible that another mechanism may be at work, but those are the best explanations for exertional headaches as of rigth now).  Before you get images of blood spurting out of your ears and worry about sustaining a stroke while performing an overhead press, don’t worry.  Most EIHs are mild and transient - they cause some degree of pain acutely, and tend to leave a dull ache/pressure for a day or two afterwards, but as far as I know most cases aren’t causing any long-term damage.

What is problematic is that if the trainee doesn’t resolve the form issues that cause EIH, they may give up on strength training (or intense exercise, as any activity requiring high level of effort can result in EIH) altogether.

There are three main causes of EIH (as far as strength training is concerned), and the first is overwhelmingly the biggest factor:

1. Valsalva:

Valsalva is simply extertion against a closed glottis, i.e., holding your breath and bearing down (think #2 in the bathroom).   It’s not hard to imagine how bearing down in this manner causes blood pressure to increase, which in turn causes the pressure in the sensitive venous sinuses to increase…

The easiest “cure” for EIH is to overbreathe while lifting.  I’ll often instruct clients to hyperventilate while performing a set; that during their most intense efforts, their breathing should resemble Lamaze.  This helps by preventing blood pressure increase during a set, since trainees are unable to sustain pressure inside their abdominal cavity if they’re constantly taking breaths.  Some clients argue that it feels silly or that they feel a little light-headed afterwards, to which I normally respond, “It’s better to be a little light-headed than to have a headache.”

No, this isn’t the best method for attaining one-rep maxes, but if you’re getting EIHs then you’re not ready to try maxing out anyway.

2. Excessive neck tension:

Hand in hand with breath-holding is scrunching up the face and excessively tightening the muscles of the neck.  This creates tension in the neck and head muscles, which can contribute to a headache.  While breathing in the above manner (see #1) helps to ameliorate this somewhat, consciously relaxing the face and neck areas helps as well.

3. Incorrect posture:

Whenever possible, the spine should be kept in anatomical neutral, which is a fancy way of saying that the natural curves of the spine should be maintained and the head should be kept forward.  There’s a strong tendency (for novices, at least) to whip the head around when giving your best efforts on an exercise.  This kind of behavior should be kept to a minimum, since the more stable your torso (read: spine) is, the easier it’ll be for you to lift a weight with max effort.  A good rule of thumb is to imagine yourself holding an extra large egg underneath your chin; think of neither dropping the egg nor cracking its shell.

Most trainers have never heard of EIH but I can bet you they’re worked with someone that had one.  It’s important to note that while they’re uncomfortable, EIH are not life-threatening and highly preventable.  If you or someone you know gets these kinds of headaches, you now know how to deal with them.