How I overcame primary exertion headaches

Posted on August 26, 2019


(Last Updated On: August 26, 2019)



How I trained for the steepest day climb in America

Something I noticed happening to me after those training sessions was headaches. I’d get home, feel tired but nothing crazy. Then, maybe a few hours later, a headache would slowly start, progressively worsening for a few hours. It would stay at a fairly manageable, though by no means enjoyable, level for about 24 hours. Maybe 36 hours. Then I’d be fine.

Since that time I’ve continued to get headaches from exercise, even when doing nothing remotely like those hiking sessions i.e. nothing like exercising for hours and hours. (More about this in a second.)

I do a little Googling; quickly finding out I suffer from primary exertional headaches aka headaches after physical activity.

It takes barely more Googling to find nobody has much of anything to offer as a remedy besides exercise less and or less intensely.

“Self-limiting. Usually goes away in 6 months”

is said. Which I imagine is because few of us ever intensely exercise for longer than that.

You’ll even get a dismissive feel. “It’s benign” they say. An interesting way of putting it. Try getting one of these headaches when you have two kids under two. Benign isn’t the word I use!

If you dig deeper, you might find things like,

Incompetence of internal jugular valve in patients with primary exertional headache: a risk factor?

Keep the preface in mind, but for me, I felt something like “my internal jugular valve is incompetent” was an incompetent cause for me to be considering.

Why would the vein suddenly now be incompetent after being fine for decades? This sounds much more like a congenital issue, not something that starts at 30 years old?

Most importantly though, I was quite confident there were obvious patterns to the headaches.

-> I’m well aware people have been active for years and years, only to drop dead one day in a race and the coroner’s report detailing they had a heart condition all that time.

A congenital issue is not impossible, it’s just I found it very unlikely. So that wasn’t where I was going to focus my intention, at least not until trying other avenues.

My headaches

While I don’t do anything close to 2-10 hour hikes like when this started, there are still clear similarities to the activities I do now and when I get the headaches-

  • It is always running oriented
  • It is always after running hard
    • Running and the hiking I did are both intense versions of bipedalism
  • It is always after the weather is at least decently warm
    • I live in a perpetually warm climate and always run (or hiked) inside (in a fairly warm gym) or outside
  • Thus, it is always after a lot of sweating

-> If you read the hiking link, you’ll see I had to stop wearing a farmer’s hat. The hat, while providing shade, made my head way hotter, and I noticed it was causing me headaches and I felt better forgoing it for sunblock.

You’ll find a lot of the stuff out there about exercise headaches says something like “after intense exercise.” Yeah, but I can bike my ass off and never get a headache. I do all my biking outside and when I bike I simply never get as hot as while running. (The wind cools me down more.)

Heavy lifting? Never causes a problem.

I felt quite confident my headaches were not so much exertion oriented as they were “I get too hot and probably dehydrated” oriented. Exertion was only a part of it in the context of that exertion leading to getting hot.

The solution

So I took the super cutting edge approach of writing a journal for my exercise and headaches. Tracking the exercise, what I did immediately after, and if a headache came on.

It became very clear- I had running days I basically didn’t drink water and fell back on my coffee-before-12pm-beer-after-12pm liquid consumption habits. Those were headache days.

I also started playing with immediately hopping into a cold shower after runs, and more or less chugging water after the running sessions. If I had to pee every 10 minutes for an hour after running? I was likely to be fine, though quite annoyed at being in the bathroom so much. If I only peed once or twice over the next few hours? Bad news for my head.

That’s it!

My headaches are nearly non-existent now, so long as I focus on (artificially) cooling down after hard runs, and drinking a lot of water, for probably 3-4 hours after I get done running.

But why did the headaches start now?

I’m not sure. Coffee doesn’t dehydrate you like many believe (the extra you pee is offset by the extra water you’re drinking), though alcohol does (I don’t actually drink that much; maybe a beer a day). At least, that’s on average. Maybe coffee does dehydrate me more than most?

I didn’t start drinking coffee much until my 20s, and I get awful caffeine withdrawal headaches if I don’t have it. The theory behind those is something like caffeine constricts your veins. If you don’t drink it, then the veins open more than usual, putting pressure on your brain / skull / whatever. That’s the WebMD explanation.

Part of me wondered if the caffeine constricts my veins, the exercise opens them up, and basically gives me a caffeine withdrawal headache sensation.

But biking should then be a problem too, and I really don’t drink much coffee. 12oz a day is typical. 18oz is high octane. And I didn’t need to stop drinking it to feel demonstrably better.

I do feel like drinking coffee has made me drink less water, because I’ll drink, say 6oz of coffee instead of 16oz of water. That’s particularly true in the mornings, and I do my runs in the morning. In that sense, coffee has likely made me dehydrated. In other words, I don’t drink as much water in the morning as I would if I didn’t drink coffee.

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