During organized exercise or other physical exertion, some people will have a sudden, severe pain at the occipital area (headache at the top of the neck and base of the skull). Some people refer to this occipital headache during exercise as exertion headache or weightlifting headache. The pain may be isolated to the occipital area or may also radiate across the top of the head and into the eye. The occipital area is rich with postural muscles and nerves that control slight changes in our head position. Additionally, the large trapezius muscles and cervical extensor muscles attach to the bony, horizontal ridge at the occiput. Problematic tension of the large trapezius muscles and/or postural fatigue of the smaller upper cervical stabilizing muscles, results in exercise related occipital headache. Often times, occipital headache during exercise is very frustrating because they keep coming back. The headache responds to rest only temporarily.
How do you diagnose occipital headache during exercise?
A professional evaluation of headaches should start with a detailed history, looking for clues to differentiate your type of headache from other types. Often times, headaches will be triggered by a variety of predisposing factors. Examination and discussion of your overall health, examination of the nervous system, and examination of the muscles and joints around the shoulders, spine, head and jaw are all important to leading to an accurate diagnosis for exertional headaches. A doctor can determined if the occipital headache is coming from joint and muscle problems at the neck (cervicogenic). Other headache disorders, such as migraine and occipital neuralgia, may mimic occipital, cervicogenic headaches. A professional evaluation can determine which factors are producing the head pain.
How is exercise headache or exertional headache treated?
Occipital headache during exercise, with pain being generated by the muscles and joints of the upper neck, should completely resolve with rehabilitation of the upper cervical muscle and joint function. Mechanical problems need mechanical solutions. This could involve anything from manual therapy, myofascial release, chiropractic manipulation therapy, cervical spine mobilization, trigger point dry needling, and/or therapeutic exercises. When the large muscles which move the neck and shoulders are working in a more efficient way, and the deep stabilizing muscles and joints of the neck are balanced, then the person has more capacity for activity without reproducing pain.