Exercise-Induced Headaches
On Wednesday, January 6, 2010, while doing a set of V-squats to failure (ultimately 30 reps at ~225 lbs), I developed a headache worse than any head pain I’ve ever experienced. The onset came at about the 15th rep, but it didn’t seem too terrible, even though even at that point it was reminiscent of a similar headache of the same nature that I’ve had in the past (although this time, it’s intensity and duration was much, much worse). After the 30th rep, I had to sit down and hold my head in pain, and it felt like the back of my head was going to explode (imagine something from an alien movie). After 15-20 minutes of agony, including dizziness and nausea (from the pain), I took 2 Advil (which I’ve never done for pain before). Walking and any other exertion caused the pain to worsen–I had to avoid the bounce in my step, bending over, and even turning my head from side to side. The pain pulsated with my hear beat. I tried to eat within about 30 minutes of my workout, but it wasn’t until about an hour after the onset of the headache that I was finally able to eat and the pain subsided. (Perhaps the Advil kicked in.)
Although I felt better as the evening progressed, when I awoke after about 8 hours of sleep on Thursday morning, my headache returned. I wasn’t dizzy, and I didn’t have any nausea, but the pain was still there–dull and pulsating, becoming more pronounced with any exertion (even standing up out of bed). If I didn’t do anything to exacerbate it, the pain level was at about 40% of Wednesday. I had to take a 4-hour nap after class that afternoon.
I felt substantially better on Friday, and thus decided to try a workout. Unfortunately, after only a handful of reps of the first exercise (floor presses at 185 lbs–floor presses are like bench presses, but on the floor instead of on a bench) (albeit after a few warmup sets on light weight), I felt the more excruciating pain returning, and I immediately stopped my workout. I was in pain that was about 75% of the initial pain I felt on Wednesday for the next hour.
Since then, my headache had subsided tremendously, though I still felt inklings of it when running too fast or jumping too much, but because it felt much more on its way out than Friday, I decided to try going to the gym again.
On Monday, January 11, I felt fine through my warmup set of 8 reps at 25 lbs dumbbell curls (although I did them together instead of alternating), and fine through the first 12 reps of 35-lbs dumbbell curls, and then quite suddenly, a flood gate of pain opened on the 13th rep, and I immediately stopped. As I write this, about 30 minutes after that last rep, I’m still at 75% of the Wednesday pain, with my head pulsating, feeling like it’s going to explode. I’m very slightly dizzy, and I’m having just the slightest trouble focusing my vision when I look from one thing to another. I should note that I tried especially hard to not tense up any part of my head or neck while performing the exercise, in case that contributed to the onset of the pain–obviously, that wasn’t relevant. My layman suspicion is that it’s correlated with blood pressure and/or heart rate.
My dad picked me up, and we went to the UCLA ER. The triage nurse saw me, and my blood pressure was okay (on the higher side of normal), and my heart rate and temperature were fine. I didn’t actually get admitted until about 11pm, during which time I had an opportunity to eat dinner (my appetite was fine), and my headache subsided to about 65% of the Wednesday pain. However, between 10pm and 11pm, it increased to about 85%. Also, the headache spread–first to just above my temples, then to the front of my head, and then just to my temples again.
The various superficial neurological test that the doctor performed were fine–I had no difficulty with balance, following her finger, exercising excellent motor control over everything. My blood sugar and hemoglobin was normal. They gave me about 1000mg Tylenol, which is probably the first time in my life that I took it. After about 20-30 minutes, it helped the headache (down to about 30% pain), but I started getting severely dehydrated. I drank well over a liter of water in about 15 minutes, and my mouth was extremely dry. My urine sample revealed that I was slightly ketonic, but my layman guess is that has to do with the fact that I was so dehydrated, although it’s quite possible that it’s related to my extremely low-carb diet (although I do eat a fruit a day and there’s the lactose in milk). The doctor tried to give me crackers and juice, but I refused. (After reading several accounts of people whose lives were saved by steadfast allegiance to their diet under medical emergency circumstances, I figure eating the types of foods closer to what humans evolved to eat and avoiding other stuff is probably a good idea–or at least safe.)
I also don’t think that my avoiding carbs is related, since I’ve been doing that for almost 6 months without incident (and instead, realized quite a few benefits, including a visible drop in body fat, the complete disappearance of my allergies, the disappearance of any lactose-sensitivity I had, better sleep, etc.). Also, I’ve had head pain like this before (see below).
The doctor occasionally mentioned the word “migraine”, but I don’t know enough about it to know whether that was actually my problem. On the plus side, I’m not particularly photo-sensitive. The doctor ordered an MRI, which I will be pursuing, as well as a prescription for Motrin, which I think I’ll avoid unless the pain gets unbearable again. Around 12 midnight, as they were getting ready to discharge me, my stomach started hurting, but I figured it was just due to lack of sleep. (Especially in the last several weeks, I’ve been getting excellent sleep (probably 8-10 hours nightly), typically going to bed at 7pm and waking up at 4am.) I drove home, and got into bed, and suddenly I had extreme stomach pain and became extremely nauseous. I barely made it to the bathroom in time, and I vomited a huge volume of fluid, including much of my dinner. I also tried sitting on the toilet periodically through the night, and that helped a little. After getting a few hours of sleep, I woke up again around 4, and managed to get to the bathroom in time to voimit, and it was even more than the first time I had vomited that night. I remember being astounded that my stomach could hold such a volume of liquid. I drank some water, but I was extremely dehydrated throughout the night, even until I woke up at 10am. I tried to get up, but I was so exhausted that I went back to bed, and woke up at about noon. (This is Tuesday, January 12, now.) I tried to get some reading done, but I just passed out again. It seems that no matter how much water I drink, I’m still terribly dehydrated. I’ve been urinating a normal amount, but slightly less than I would have expected for the close-to-2-liters of water I had had by about 1pm.
That brings us to the time of this writing: I’ve been awake and lucid since about 1pm, although I do feel a little foggy. I’m able to be somewhat functional, but I suspect that if I were to lay down again, I would fall asleep. My head pain is at about 20-30%, and my stomach pain is at about 30-40% of the worst stomach pain that I can imagine (which actually occurred in July 2000: the gastritis I was diagnosed with was my stomach feeling like it was being cut up by knives, thanks to chronic sleep deprivation and stress.) Although I’m a little hungry, I feel like if I were to eat anything, it would hurt my stomach. At this point, I will be contacting a general physician to get a regular checkup and scheduling an MRI with a specialist.
As for some background information:
Throughout this entire ordeal, and in general, I’ve been extremely well hydrated, and I get plenty of salt in my diet (sometimes I worry it’s too much!), and I make sure to eat a banana before my workouts (since I am prone to cramps).
I don’t typically do any cardio exercise, aside from just being generally active. From September to December, I went to the gym about 4-5 times per week to lift weights. My new routine consists of only 3 days of lifting per week. Last academic year, I was on the UCLA Triathlon team.
The most notable previous occurrence of a headache of this nature was after doing “jumpies” in Fall 2005 as part of a warmup for rowing. Jumpies are like a squat, but without added weight, and one jumps in the air. After a set of about 20, I had this type of headache, but the pain was much less, and after laying down for about an hour, it subsided completely and didn’t return, even with subsequent ordinary exertion. This is typical of all the other past occurrences.