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     Fitness Tips For 4/2/2008
Avoiding Exercise Induced Headaches (EIH)
By Andrew Baye
Reprinted with permission of Exercise Protocol Magazine.
If, during an exercise, you ever feel as though you are beginning to 
get a headache, stop the exercise immediately. Relax for a few minutes, 
close your eyes and breathe deeply. Then, if you can no longer sense 
any trace of the headache, continue. If, however, you still feel even 
a slight head pain, then do not finish the workout. Take a few days 
off before attempting to train again. If you attempt to work through 
this head pain, it may develop into an exercise induced headache (EIH). 

EIH can be twice as severe as a migraine, and can last anywhere from 
a few days to two weeks. It was previously believed that EIH was 
related to tension in the muscles of the neck, similar to tension 
headaches, and was often addressed by performing a neck extension 
and/or flexion exercise at the beginning of the workout, to produce 
fatigue induced relaxation of the neck muscles. This was done to 
minimize tension in the neck muscles during the more intense 
exercises involving greater body masses, such as the leg press.

Recent observations by Doug McGuff, MD suggest that EIH may be caused 
by stretching of the dura mater (outermost of the three membranes 
covering the brain and spinal cord) as a result of increased BP in 
the cerebral veins caused by retrograde venous flow towards the brain. 
The onset of EIH is usually experienced during intense exercises for 
the legs, hips, and trunk, during which there is a large amount of 
venous congestion in the pelvis and abdomen. In an article entitled 
The Mystery of Exercise Induced Headache, in Vol. 5, Issue 3 of The 
Super Slow Exercise Standard, Dr. McGuff writes,

"This congestion is a result of soft tissue compression, Val Salva 
and massive venous return from the legs stimulated by intense 
muscular contraction. This massive venous congestion can create a 
strong enough force to drive venous flow in a cephalad direction 
(towards the head). Perhaps, in some subjects, the force is great 
enough to reverse the gradient of cerebral venous drainage so that 
venous blood is pushed up through the jugular veins into the 
confluence of sinuses...
...Theoretically, a threshold level of venodilation and pressure 
transmission would have to occur before the dura could be stimulated. 
Once this threshold is reached, look out! Dural stimulation produces 
severe, sudden onset pain that can persist for days."

In other words, during exercises for the lower body, increased 
pressure in the abdomen may cause venous blood to be forced back into 
the cerebral veins, increasing BP in the brain to the point where the 
dura mater is stretched. If this happens, it's going to feel like a 
bolt of lightening shot through the back of your skull, cracked it 
wide open, and exited through one or both of your eyes.

If this theory is correct, the reason that performing exercises 
for the neck at the beginning of a workout tends to reduce or prevent 
the onset of EIH would not be due to fatigue induced relaxation of 
those muscles, and the resulting decrease in tension. Instead, it 
appears that the increased pressure exerted on the jugular veins 
caused by edema (the "pump" ) in the surrounding neck muscles 
decreases retrograde blood flow. This would reduce BP in the
cerebral veins, which would reduce the pressure exerted on the 
dura mater.

It is best not to develop EIH in the first place, but if you do 
there are measures which can be taken to minimize the possibility 
of it recurring. 

1. Do not hold or force your breath during an exercise. As 
previously stated, this causes BP to quickly increase to 
dangerously high levels. 

2. Perform neck extension and flexion exercises at the beginning of 
the workout. Always move extremely slowly when performing neck 
exercises. A 10/10 movement speed is recommended. 
3. If you are performing a full body workout, perform it in reverse 
order, with exercises for the trunk and lower body last.

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