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It Started About Three Weeks Ago, I Was At The
Question: It started about three weeks ago, I was at the gym and just settled into my first exercise (bench press) I was using my warm up weights (135lbs) which I usually do about 15 reps. But by the 4th rep I started to get pressure and headache at the back of the head (near the base of the skull on the left side). I stopped and after a few minutes the pressure and headache subsided. I continued and it was still there but mild. eventually I cut bench pressing short and went to cables and dumbells and no longer had any major issues (except very mild headaches/pressure). The following day at work my left ear started to hurt (near the drum area).had to take advil migraine and the ear pain went away, but every 6 hours the pain would return (even waking me up in the middle of the night). later I returned to the gym but this time working on arms with bar bell curls. using light weights again. after about the 3rd rep the pressure and headache returned. stopped once more and after a few minutes it subsided enough for me to continue with very minimal discomfort. The following day my earache continued so went to the doctor, and explained to him what was occuring, after looking in my ears and mouth (which he said was normal), he said the earache and the back of head pressure was not related. he suggest I take claritin D for the earaches and told me to monitor the pressure (as he didn't know what was causing it, after making me perform some neck exercise and asking some questions, during which the pressure did not occur) and if it continues we may have to do an MRI (which I'm trying to avoid the cost). Its been a couple of weeks and the earaches are gone but the back of head pressure is still the same. only seems to occur when my body is under pressure (lifting weights, sex etc) but like always greatly reduces after a few minutes then goes away completely after resting for about 30 minutes. it occurs at the back of the skull near the neck, which is why my neck muscles seems numb and stiff for a short period afterwards. Any ideas as to what you may think is causing this?
It started about three weeks ago, I was at the gym and just settled into my first exercise (bench press) I was using my warm up weights (135lbs) which I usually do about 15 reps. But by the 4th rep I started to get pressure and headache at the back of the head (near the base of the skull on the left side). I stopped and after a few minutes the pressure and headache subsided. I continued and it was still there but mild. eventually I cut bench pressing short and went to cables and dumbells and no longer had any major issues (except very mild headaches/pressure). The following day at work my left ear started to hurt (near the drum area).had to take advil migraine and the ear pain went away, but every 6 hours the pain would return (even waking me up in the middle of the night). later I returned to the gym but this time working on arms with bar bell curls. using light weights again. after about the 3rd rep the pressure and headache returned. stopped once more and after a few minutes it subsided enough for me to continue with very minimal discomfort. The following day my earache continued so went to the doctor, and explained to him what was occuring, after looking in my ears and mouth (which he said was normal), he said the earache and the back of head pressure was not related. he suggest I take claritin D for the earaches and told me to monitor the pressure (as he didn't know what was causing it, after making me perform some neck exercise and asking some questions, during which the pressure did not occur) and if it continues we may have to do an MRI (which I'm trying to avoid the cost). Its been a couple of weeks and the earaches are gone but the back of head pressure is still the same. only seems to occur when my body is under pressure (lifting weights, sex etc) but like always greatly reduces after a few minutes then goes away completely after resting for about 30 minutes. it occurs at the back of the skull near the neck, which is why my neck muscles seems numb and stiff for a short period afterwards. Any ideas as to what you may think is causing this?
Brief Answer:
Exercise Induced Headache (Also known as WEIGHTLIFTER'S HEADACHE)
Detailed Answer:
In fact, there is a connection between the earache and the headache which has to do with the rise in your INTRACRANIAL pressure that goes up during the course of the headache. Sex will do the same thing due to the physical exertional component which tends to increase intracranial pressure. Typically, one does not require an MRI to make the right diagnosis....just a history with all the consistent elements of history.
Now, let's look at EIH just a little more closely because I see this in my headache clinic frequently and I am mostly consoling, calming, and educating people who are afraid that something horrible is happening. There are 2 major classifications for EIH as given by the INTERNATIONAL CLASSIFICATION OF HEADACHE DISEASES (ICHD Version 3 beta). They are referred to as PRIMARY and SECONDARY. The vast majority of people (probably at least 98%) fit into the most benign category called PRIMARY EIH while <2% fit into SECONDARY category.
PRIMARY EIH which is what I believe you are describing come on simply as a consequence of doing the exercise or exertional activity and it is believed (though nobody really knows for sure) that it is related to a mix of RAISED INTRACRANIAL PRESSURE from the workouts themselves which would include changes to internal pressure that come about from breathing patterns that can sometimes be erratic...for example, don't many weightlifters BREATHE THE WRONG WAY? For example, while benching I see and have to yell at people on my rugby or wrestling team to EXHALE "for Heaven's Sake!!" LOL.....They're trying to bench 350lbs. by holding their frickin' breath as they sustain this bar above their chest. Geez....you know what kind of pressure that is exerting on the fluid and blood vessels in the brain? IT'S GARGANTUAN. But when you start exhaling and inhaling as you should rhythmically then, all of a sudden these pressures normalize and you LOOK BETTER to most people watching you and you feel better.
So think about how you BREATHE DURING YOUR CIRCUITS. Lower the weights as necessary to learn good breathing habits and techniques for the various weightlifting maneuvers. And so, if you are not breathing correctly or if you've CHANGED your style of respiratory patterns in your exercises then, you may be triggering these EIH's because of that reason alone. Still this is not a perfectly solid explanation because there are plenty of people who breathe exactly they should breathe and they STILL GET these headaches after working out heavily, or having sex, or mowing the lawn, taking out the trash, swimming a few laps, playing a little basketball, etc. What else could be going on? Well, when in doubt you can always blame almost everything going wrong in the body on HORMONES.....It's THEM DAMN HORMONES MARTHA!! THEY'RE AT IT AGAIN!! Heh..Heh...HAha! i AIN'T GOT NUTHIN' TO DO WITH IT...."It's my bleeding hormones!!" So there are those who believe that the sudden exuberant outpouring of hormones such as epinephrine, thyroxine, and calcium, as well as the SUGAR RUSH that some people get as a result of quickly converting your stored GLYCOGEN into GLUCOSE which tends to spike the sugar levels which in turn DRAWS FLUID into the blood vessels causing a swelling or engorgement of the blood vessels surrounding and feeding the brain.....Well, you can see where I'm going with this right? HEADACHEEEEEEE!
The earache is coming about quite probably as a result of this INCREASED INTRACRANIAL pressure which is transmitted into both the inner and middle ear systems as well as increasing pressures in the COCHLEA since there is DIRECT communication with the lymphatic and CSF flows OF THE BRAIN SO ANYTHING RAISING pressures in those systems will backflow and increase pressure in the cochleas transmitting forces into the MIDDLE EAR STRUCTURES which is the pain you are feeling.
You may tell me that the earache actually subsides right along with the headaches or even slightly before the headaches go away. But if you were to really chart out your headaches on a diary and throw in there exactly when you get your earaches along with exactly when they subside (both headaches and earaches) you'll likely notice a distinct correlation and pattern between them...it's no coincidence.
And so unfortunately, as much as I hate to say it, "I must disagree with your primary physician and tell you that your headaches following exertional activities and earaches are clearly related and NOT separate.
EIH are most often manifest in the back of the head (usually OCCIPITAL AREA) and there certainly can be PREMONITORY SYMPTOMS of shoulder, neck, and jaw tightness, prickliness, and even numbness PRIOR to or at the same time as when Headaches beginning manifesting. 30 minutes by the way is the average time for most people reporting relief from the headaches.
Now, what about the more OMINOUS CATEGORY of the SECONDARY forms of EIH...I don't think you've got that at all from the history you're presenting. But essentially secondary EIH comes about because of some architectural or structural abnormality that causing headaches but now there IS AN UNDERLYING CAUSE such as tumor, obstruction of some other form to the flow of cerebrospinal fluid (CSF), acute sinus congestion, and other causes. And so the SECONDARY FORM OF EIH is the more challenging of the 2 types to deal with since there is an identifiable CAUSE to the headaches. The problem is that the cause is not readily or easily able to be discovered so as a result studies do need to be done such as MRI/MRA and/or Lumbar Punctures, etc. But if it finally decided that you do need an MRI then, the cost should not be of consequence to you because you need to know what is actually at the root of these headaches (especially since they seem to have come out of nowhere, right?).
The reason I don't believe you've got SECONDARY EIH is because of the relative benign nature of the symptoms accompanying the headaches. You've not mentioned anything having to do with VOMITING, RIGIDITY of the neck...(but I mean REAL rigidity to the point where someone could pound nails with your head or feet...that's as stiff as you'd be.....), double vision, or passing out spells, ridiculously obstructed or blocked sinus passages resulting in a lot of pus and junk flowing down from the sinuses and/or up from the lungs...you've not said anything like that....so I'm assuming you don't have these symptoms.
There is a very good summary article that I'd like you to read from the Mayo Clinic's Patient Educational Library and I have all my patients read this article. It's very easy and quick to read and packs in a lot of great information. Here is the link:
https://www.mayoclinic.org/diseases-conditions/exercise-headaches/symptoms-causes/syc-0000
BTW, taking headache medication such as aspirin, ibuprofen, naproxen are not considered a reasonable way to treat these headaches because by the time you get the headache the horses are out of the barn so to speak...you need to be PRE-EMPTIVE and take something to PREVENT THEM from becoming so active. What you need to do is identify the associated ACTIVITIES triggering the headaches (i.e. HEAVY PHYSICAL ACTIVITIES) and then, AVOID these activities altogether or greatly reduce the WEIGHT LOAD of what you are doing or the types of exercise which could cause dramatic rises in the intracranial volumes and pressures, make sense? What you may be able to take to try and mitigate the pain or severity of these headaches would be something such as INDOMETHACIN (VERY HIGH RATE of GI upset as well as causing GI bleeding and darkening of the stool)...so I would start at a very low dose such as 25 mg. once daily and then, VERY SLOWLY ESCALATE to twice, 3x, and then, 4x daily. Actually, one of my favorites for these types of headaches would be the preventative medication, PROPRANOLOL. There I have another titration scheme that is based on the severity and age of onset of symptoms. For YOU, I would start with 10mg. daily and then, slowly escalate on a weekly basis to a TWICE DAILY REGIMEN followed another week later by a THRICE DAILY REGIMEN and in rare cases I even go 4x daily. The idea is to only use the amount of medication actually needed to control symptoms....nothing more, nothing less.
And there you have it...as "Monty Python might say!" HAHA!
Now, as I said in the beginning we can often avoid getting imaging studies based on the clinical situation, age of the patient, severity, and evolution of the headaches. However, in YOUR case and because you are complaining of intermittent types of symptoms which cannot be 100% RULED OUT as being PRIMARY or SECONDARY and you're above the age of about 45 years I would get an MRI of the brain (and perhaps cervical spinal cord---looking for what's called a CHIARI MALFORMATION along with an MRA just to be as far on the safe side as possible. I can understand if cost is a factor but if there is some type of architectural anomaly you've had since birth or that you've acquired then, it may be perfectly FIXABLE if you act on it NOW instead of waiting until it either gets significantly worse or something else changes where you PASS OUT due to the severity of the pain, etc. Sound reasonable?
If I were the ordering physician for the MRI testing I would make sure you got BOTH an MRI and an MRA. I would direct the reading neuroradiologist to please evaluate the films for any aneurysms, fistulae, EXTRA-AXIAL FLUID OR EVEN BLOOD. I might also order a CTA of the carotid arteries in tandem with the MRA since the CT scan may pick up things otherwise, not known yet just based on the MRI.
The article's name is EXERCISE HEADACHES
https://www.mayoclinic.org/diseases-conditions/exercise-headaches/symptoms-causes/syc-0000
Well, time for this sailor to hit the hay.....got a full day of wrestling practice in the morning followed by a rugby scrimmage....I'll try not to get a CONCUSSION if you still need me to talk to!...been pretty good so far! HA!
You do not have anything weird...it's just a shame it chose to hit you AT THIS TIME but that's the way these headaches "roll" so to speak...so you just have to follow the proper steps to diagnosing and then, deciding what to do.
Lemme know what you find and how things go.
If I've provided useful and helpful information to your question could you do me a favor by CLOSING THE QUERY and taking a moment to provide some kind words of criticism and perhaps even stamp it with a 5 STAR rating if you feel so inclined?
Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.
This query has utilized a total of 60 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Exercise Induced Headache (Also known as WEIGHTLIFTER'S HEADACHE)
Detailed Answer:
In fact, there is a connection between the earache and the headache which has to do with the rise in your INTRACRANIAL pressure that goes up during the course of the headache. Sex will do the same thing due to the physical exertional component which tends to increase intracranial pressure. Typically, one does not require an MRI to make the right diagnosis....just a history with all the consistent elements of history.
Now, let's look at EIH just a little more closely because I see this in my headache clinic frequently and I am mostly consoling, calming, and educating people who are afraid that something horrible is happening. There are 2 major classifications for EIH as given by the INTERNATIONAL CLASSIFICATION OF HEADACHE DISEASES (ICHD Version 3 beta). They are referred to as PRIMARY and SECONDARY. The vast majority of people (probably at least 98%) fit into the most benign category called PRIMARY EIH while <2% fit into SECONDARY category.
PRIMARY EIH which is what I believe you are describing come on simply as a consequence of doing the exercise or exertional activity and it is believed (though nobody really knows for sure) that it is related to a mix of RAISED INTRACRANIAL PRESSURE from the workouts themselves which would include changes to internal pressure that come about from breathing patterns that can sometimes be erratic...for example, don't many weightlifters BREATHE THE WRONG WAY? For example, while benching I see and have to yell at people on my rugby or wrestling team to EXHALE "for Heaven's Sake!!" LOL.....They're trying to bench 350lbs. by holding their frickin' breath as they sustain this bar above their chest. Geez....you know what kind of pressure that is exerting on the fluid and blood vessels in the brain? IT'S GARGANTUAN. But when you start exhaling and inhaling as you should rhythmically then, all of a sudden these pressures normalize and you LOOK BETTER to most people watching you and you feel better.
So think about how you BREATHE DURING YOUR CIRCUITS. Lower the weights as necessary to learn good breathing habits and techniques for the various weightlifting maneuvers. And so, if you are not breathing correctly or if you've CHANGED your style of respiratory patterns in your exercises then, you may be triggering these EIH's because of that reason alone. Still this is not a perfectly solid explanation because there are plenty of people who breathe exactly they should breathe and they STILL GET these headaches after working out heavily, or having sex, or mowing the lawn, taking out the trash, swimming a few laps, playing a little basketball, etc. What else could be going on? Well, when in doubt you can always blame almost everything going wrong in the body on HORMONES.....It's THEM DAMN HORMONES MARTHA!! THEY'RE AT IT AGAIN!! Heh..Heh...HAha! i AIN'T GOT NUTHIN' TO DO WITH IT...."It's my bleeding hormones!!" So there are those who believe that the sudden exuberant outpouring of hormones such as epinephrine, thyroxine, and calcium, as well as the SUGAR RUSH that some people get as a result of quickly converting your stored GLYCOGEN into GLUCOSE which tends to spike the sugar levels which in turn DRAWS FLUID into the blood vessels causing a swelling or engorgement of the blood vessels surrounding and feeding the brain.....Well, you can see where I'm going with this right? HEADACHEEEEEEE!
The earache is coming about quite probably as a result of this INCREASED INTRACRANIAL pressure which is transmitted into both the inner and middle ear systems as well as increasing pressures in the COCHLEA since there is DIRECT communication with the lymphatic and CSF flows OF THE BRAIN SO ANYTHING RAISING pressures in those systems will backflow and increase pressure in the cochleas transmitting forces into the MIDDLE EAR STRUCTURES which is the pain you are feeling.
You may tell me that the earache actually subsides right along with the headaches or even slightly before the headaches go away. But if you were to really chart out your headaches on a diary and throw in there exactly when you get your earaches along with exactly when they subside (both headaches and earaches) you'll likely notice a distinct correlation and pattern between them...it's no coincidence.
And so unfortunately, as much as I hate to say it, "I must disagree with your primary physician and tell you that your headaches following exertional activities and earaches are clearly related and NOT separate.
EIH are most often manifest in the back of the head (usually OCCIPITAL AREA) and there certainly can be PREMONITORY SYMPTOMS of shoulder, neck, and jaw tightness, prickliness, and even numbness PRIOR to or at the same time as when Headaches beginning manifesting. 30 minutes by the way is the average time for most people reporting relief from the headaches.
Now, what about the more OMINOUS CATEGORY of the SECONDARY forms of EIH...I don't think you've got that at all from the history you're presenting. But essentially secondary EIH comes about because of some architectural or structural abnormality that causing headaches but now there IS AN UNDERLYING CAUSE such as tumor, obstruction of some other form to the flow of cerebrospinal fluid (CSF), acute sinus congestion, and other causes. And so the SECONDARY FORM OF EIH is the more challenging of the 2 types to deal with since there is an identifiable CAUSE to the headaches. The problem is that the cause is not readily or easily able to be discovered so as a result studies do need to be done such as MRI/MRA and/or Lumbar Punctures, etc. But if it finally decided that you do need an MRI then, the cost should not be of consequence to you because you need to know what is actually at the root of these headaches (especially since they seem to have come out of nowhere, right?).
The reason I don't believe you've got SECONDARY EIH is because of the relative benign nature of the symptoms accompanying the headaches. You've not mentioned anything having to do with VOMITING, RIGIDITY of the neck...(but I mean REAL rigidity to the point where someone could pound nails with your head or feet...that's as stiff as you'd be.....), double vision, or passing out spells, ridiculously obstructed or blocked sinus passages resulting in a lot of pus and junk flowing down from the sinuses and/or up from the lungs...you've not said anything like that....so I'm assuming you don't have these symptoms.
There is a very good summary article that I'd like you to read from the Mayo Clinic's Patient Educational Library and I have all my patients read this article. It's very easy and quick to read and packs in a lot of great information. Here is the link:
https://www.mayoclinic.org/diseases-conditions/exercise-headaches/symptoms-causes/syc-0000
BTW, taking headache medication such as aspirin, ibuprofen, naproxen are not considered a reasonable way to treat these headaches because by the time you get the headache the horses are out of the barn so to speak...you need to be PRE-EMPTIVE and take something to PREVENT THEM from becoming so active. What you need to do is identify the associated ACTIVITIES triggering the headaches (i.e. HEAVY PHYSICAL ACTIVITIES) and then, AVOID these activities altogether or greatly reduce the WEIGHT LOAD of what you are doing or the types of exercise which could cause dramatic rises in the intracranial volumes and pressures, make sense? What you may be able to take to try and mitigate the pain or severity of these headaches would be something such as INDOMETHACIN (VERY HIGH RATE of GI upset as well as causing GI bleeding and darkening of the stool)...so I would start at a very low dose such as 25 mg. once daily and then, VERY SLOWLY ESCALATE to twice, 3x, and then, 4x daily. Actually, one of my favorites for these types of headaches would be the preventative medication, PROPRANOLOL. There I have another titration scheme that is based on the severity and age of onset of symptoms. For YOU, I would start with 10mg. daily and then, slowly escalate on a weekly basis to a TWICE DAILY REGIMEN followed another week later by a THRICE DAILY REGIMEN and in rare cases I even go 4x daily. The idea is to only use the amount of medication actually needed to control symptoms....nothing more, nothing less.
And there you have it...as "Monty Python might say!" HAHA!
Now, as I said in the beginning we can often avoid getting imaging studies based on the clinical situation, age of the patient, severity, and evolution of the headaches. However, in YOUR case and because you are complaining of intermittent types of symptoms which cannot be 100% RULED OUT as being PRIMARY or SECONDARY and you're above the age of about 45 years I would get an MRI of the brain (and perhaps cervical spinal cord---looking for what's called a CHIARI MALFORMATION along with an MRA just to be as far on the safe side as possible. I can understand if cost is a factor but if there is some type of architectural anomaly you've had since birth or that you've acquired then, it may be perfectly FIXABLE if you act on it NOW instead of waiting until it either gets significantly worse or something else changes where you PASS OUT due to the severity of the pain, etc. Sound reasonable?
If I were the ordering physician for the MRI testing I would make sure you got BOTH an MRI and an MRA. I would direct the reading neuroradiologist to please evaluate the films for any aneurysms, fistulae, EXTRA-AXIAL FLUID OR EVEN BLOOD. I might also order a CTA of the carotid arteries in tandem with the MRA since the CT scan may pick up things otherwise, not known yet just based on the MRI.
The article's name is EXERCISE HEADACHES
https://www.mayoclinic.org/diseases-conditions/exercise-headaches/symptoms-causes/syc-0000
Well, time for this sailor to hit the hay.....got a full day of wrestling practice in the morning followed by a rugby scrimmage....I'll try not to get a CONCUSSION if you still need me to talk to!...been pretty good so far! HA!
You do not have anything weird...it's just a shame it chose to hit you AT THIS TIME but that's the way these headaches "roll" so to speak...so you just have to follow the proper steps to diagnosing and then, deciding what to do.
Lemme know what you find and how things go.
If I've provided useful and helpful information to your question could you do me a favor by CLOSING THE QUERY and taking a moment to provide some kind words of criticism and perhaps even stamp it with a 5 STAR rating if you feel so inclined?
Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.
This query has utilized a total of 60 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Exercise Induced Headache (Also known as WEIGHTLIFTER'S HEADACHE)
Detailed Answer:
In fact, there is a connection between the earache and the headache which has to do with the rise in your INTRACRANIAL pressure that goes up during the course of the headache. Sex will do the same thing due to the physical exertional component which tends to increase intracranial pressure. Typically, one does not require an MRI to make the right diagnosis....just a history with all the consistent elements of history.
Now, let's look at EIH just a little more closely because I see this in my headache clinic frequently and I am mostly consoling, calming, and educating people who are afraid that something horrible is happening. There are 2 major classifications for EIH as given by the INTERNATIONAL CLASSIFICATION OF HEADACHE DISEASES (ICHD Version 3 beta). They are referred to as PRIMARY and SECONDARY. The vast majority of people (probably at least 98%) fit into the most benign category called PRIMARY EIH while <2% fit into SECONDARY category.
PRIMARY EIH which is what I believe you are describing come on simply as a consequence of doing the exercise or exertional activity and it is believed (though nobody really knows for sure) that it is related to a mix of RAISED INTRACRANIAL PRESSURE from the workouts themselves which would include changes to internal pressure that come about from breathing patterns that can sometimes be erratic...for example, don't many weightlifters BREATHE THE WRONG WAY? For example, while benching I see and have to yell at people on my rugby or wrestling team to EXHALE "for Heaven's Sake!!" LOL.....They're trying to bench 350lbs. by holding their frickin' breath as they sustain this bar above their chest. Geez....you know what kind of pressure that is exerting on the fluid and blood vessels in the brain? IT'S GARGANTUAN. But when you start exhaling and inhaling as you should rhythmically then, all of a sudden these pressures normalize and you LOOK BETTER to most people watching you and you feel better.
So think about how you BREATHE DURING YOUR CIRCUITS. Lower the weights as necessary to learn good breathing habits and techniques for the various weightlifting maneuvers. And so, if you are not breathing correctly or if you've CHANGED your style of respiratory patterns in your exercises then, you may be triggering these EIH's because of that reason alone. Still this is not a perfectly solid explanation because there are plenty of people who breathe exactly they should breathe and they STILL GET these headaches after working out heavily, or having sex, or mowing the lawn, taking out the trash, swimming a few laps, playing a little basketball, etc. What else could be going on? Well, when in doubt you can always blame almost everything going wrong in the body on HORMONES.....It's THEM DAMN HORMONES MARTHA!! THEY'RE AT IT AGAIN!! Heh..Heh...HAha! i AIN'T GOT NUTHIN' TO DO WITH IT...."It's my bleeding hormones!!" So there are those who believe that the sudden exuberant outpouring of hormones such as epinephrine, thyroxine, and calcium, as well as the SUGAR RUSH that some people get as a result of quickly converting your stored GLYCOGEN into GLUCOSE which tends to spike the sugar levels which in turn DRAWS FLUID into the blood vessels causing a swelling or engorgement of the blood vessels surrounding and feeding the brain.....Well, you can see where I'm going with this right? HEADACHEEEEEEE!
The earache is coming about quite probably as a result of this INCREASED INTRACRANIAL pressure which is transmitted into both the inner and middle ear systems as well as increasing pressures in the COCHLEA since there is DIRECT communication with the lymphatic and CSF flows OF THE BRAIN SO ANYTHING RAISING pressures in those systems will backflow and increase pressure in the cochleas transmitting forces into the MIDDLE EAR STRUCTURES which is the pain you are feeling.
You may tell me that the earache actually subsides right along with the headaches or even slightly before the headaches go away. But if you were to really chart out your headaches on a diary and throw in there exactly when you get your earaches along with exactly when they subside (both headaches and earaches) you'll likely notice a distinct correlation and pattern between them...it's no coincidence.
And so unfortunately, as much as I hate to say it, "I must disagree with your primary physician and tell you that your headaches following exertional activities and earaches are clearly related and NOT separate.
EIH are most often manifest in the back of the head (usually OCCIPITAL AREA) and there certainly can be PREMONITORY SYMPTOMS of shoulder, neck, and jaw tightness, prickliness, and even numbness PRIOR to or at the same time as when Headaches beginning manifesting. 30 minutes by the way is the average time for most people reporting relief from the headaches.
Now, what about the more OMINOUS CATEGORY of the SECONDARY forms of EIH...I don't think you've got that at all from the history you're presenting. But essentially secondary EIH comes about because of some architectural or structural abnormality that causing headaches but now there IS AN UNDERLYING CAUSE such as tumor, obstruction of some other form to the flow of cerebrospinal fluid (CSF), acute sinus congestion, and other causes. And so the SECONDARY FORM OF EIH is the more challenging of the 2 types to deal with since there is an identifiable CAUSE to the headaches. The problem is that the cause is not readily or easily able to be discovered so as a result studies do need to be done such as MRI/MRA and/or Lumbar Punctures, etc. But if it finally decided that you do need an MRI then, the cost should not be of consequence to you because you need to know what is actually at the root of these headaches (especially since they seem to have come out of nowhere, right?).
The reason I don't believe you've got SECONDARY EIH is because of the relative benign nature of the symptoms accompanying the headaches. You've not mentioned anything having to do with VOMITING, RIGIDITY of the neck...(but I mean REAL rigidity to the point where someone could pound nails with your head or feet...that's as stiff as you'd be.....), double vision, or passing out spells, ridiculously obstructed or blocked sinus passages resulting in a lot of pus and junk flowing down from the sinuses and/or up from the lungs...you've not said anything like that....so I'm assuming you don't have these symptoms.
There is a very good summary article that I'd like you to read from the Mayo Clinic's Patient Educational Library and I have all my patients read this article. It's very easy and quick to read and packs in a lot of great information. Here is the link:
https://www.mayoclinic.org/diseases-conditions/exercise-headaches/symptoms-causes/syc-0000
BTW, taking headache medication such as aspirin, ibuprofen, naproxen are not considered a reasonable way to treat these headaches because by the time you get the headache the horses are out of the barn so to speak...you need to be PRE-EMPTIVE and take something to PREVENT THEM from becoming so active. What you need to do is identify the associated ACTIVITIES triggering the headaches (i.e. HEAVY PHYSICAL ACTIVITIES) and then, AVOID these activities altogether or greatly reduce the WEIGHT LOAD of what you are doing or the types of exercise which could cause dramatic rises in the intracranial volumes and pressures, make sense? What you may be able to take to try and mitigate the pain or severity of these headaches would be something such as INDOMETHACIN (VERY HIGH RATE of GI upset as well as causing GI bleeding and darkening of the stool)...so I would start at a very low dose such as 25 mg. once daily and then, VERY SLOWLY ESCALATE to twice, 3x, and then, 4x daily. Actually, one of my favorites for these types of headaches would be the preventative medication, PROPRANOLOL. There I have another titration scheme that is based on the severity and age of onset of symptoms. For YOU, I would start with 10mg. daily and then, slowly escalate on a weekly basis to a TWICE DAILY REGIMEN followed another week later by a THRICE DAILY REGIMEN and in rare cases I even go 4x daily. The idea is to only use the amount of medication actually needed to control symptoms....nothing more, nothing less.
And there you have it...as "Monty Python might say!" HAHA!
Now, as I said in the beginning we can often avoid getting imaging studies based on the clinical situation, age of the patient, severity, and evolution of the headaches. However, in YOUR case and because you are complaining of intermittent types of symptoms which cannot be 100% RULED OUT as being PRIMARY or SECONDARY and you're above the age of about 45 years I would get an MRI of the brain (and perhaps cervical spinal cord---looking for what's called a CHIARI MALFORMATION along with an MRA just to be as far on the safe side as possible. I can understand if cost is a factor but if there is some type of architectural anomaly you've had since birth or that you've acquired then, it may be perfectly FIXABLE if you act on it NOW instead of waiting until it either gets significantly worse or something else changes where you PASS OUT due to the severity of the pain, etc. Sound reasonable?
If I were the ordering physician for the MRI testing I would make sure you got BOTH an MRI and an MRA. I would direct the reading neuroradiologist to please evaluate the films for any aneurysms, fistulae, EXTRA-AXIAL FLUID OR EVEN BLOOD. I might also order a CTA of the carotid arteries in tandem with the MRA since the CT scan may pick up things otherwise, not known yet just based on the MRI.
The article's name is EXERCISE HEADACHES
https://www.mayoclinic.org/diseases-conditions/exercise-headaches/symptoms-causes/syc-0000
Well, time for this sailor to hit the hay.....got a full day of wrestling practice in the morning followed by a rugby scrimmage....I'll try not to get a CONCUSSION if you still need me to talk to!...been pretty good so far! HA!
You do not have anything weird...it's just a shame it chose to hit you AT THIS TIME but that's the way these headaches "roll" so to speak...so you just have to follow the proper steps to diagnosing and then, deciding what to do.
Lemme know what you find and how things go.
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Exercise Induced Headache (Also known as WEIGHTLIFTER'S HEADACHE)
Detailed Answer:
In fact, there is a connection between the earache and the headache which has to do with the rise in your INTRACRANIAL pressure that goes up during the course of the headache. Sex will do the same thing due to the physical exertional component which tends to increase intracranial pressure. Typically, one does not require an MRI to make the right diagnosis....just a history with all the consistent elements of history.
Now, let's look at EIH just a little more closely because I see this in my headache clinic frequently and I am mostly consoling, calming, and educating people who are afraid that something horrible is happening. There are 2 major classifications for EIH as given by the INTERNATIONAL CLASSIFICATION OF HEADACHE DISEASES (ICHD Version 3 beta). They are referred to as PRIMARY and SECONDARY. The vast majority of people (probably at least 98%) fit into the most benign category called PRIMARY EIH while <2% fit into SECONDARY category.
PRIMARY EIH which is what I believe you are describing come on simply as a consequence of doing the exercise or exertional activity and it is believed (though nobody really knows for sure) that it is related to a mix of RAISED INTRACRANIAL PRESSURE from the workouts themselves which would include changes to internal pressure that come about from breathing patterns that can sometimes be erratic...for example, don't many weightlifters BREATHE THE WRONG WAY? For example, while benching I see and have to yell at people on my rugby or wrestling team to EXHALE "for Heaven's Sake!!" LOL.....They're trying to bench 350lbs. by holding their frickin' breath as they sustain this bar above their chest. Geez....you know what kind of pressure that is exerting on the fluid and blood vessels in the brain? IT'S GARGANTUAN. But when you start exhaling and inhaling as you should rhythmically then, all of a sudden these pressures normalize and you LOOK BETTER to most people watching you and you feel better.
So think about how you BREATHE DURING YOUR CIRCUITS. Lower the weights as necessary to learn good breathing habits and techniques for the various weightlifting maneuvers. And so, if you are not breathing correctly or if you've CHANGED your style of respiratory patterns in your exercises then, you may be triggering these EIH's because of that reason alone. Still this is not a perfectly solid explanation because there are plenty of people who breathe exactly they should breathe and they STILL GET these headaches after working out heavily, or having sex, or mowing the lawn, taking out the trash, swimming a few laps, playing a little basketball, etc. What else could be going on? Well, when in doubt you can always blame almost everything going wrong in the body on HORMONES.....It's THEM DAMN HORMONES MARTHA!! THEY'RE AT IT AGAIN!! Heh..Heh...HAha! i AIN'T GOT NUTHIN' TO DO WITH IT...."It's my bleeding hormones!!" So there are those who believe that the sudden exuberant outpouring of hormones such as epinephrine, thyroxine, and calcium, as well as the SUGAR RUSH that some people get as a result of quickly converting your stored GLYCOGEN into GLUCOSE which tends to spike the sugar levels which in turn DRAWS FLUID into the blood vessels causing a swelling or engorgement of the blood vessels surrounding and feeding the brain.....Well, you can see where I'm going with this right? HEADACHEEEEEEE!
The earache is coming about quite probably as a result of this INCREASED INTRACRANIAL pressure which is transmitted into both the inner and middle ear systems as well as increasing pressures in the COCHLEA since there is DIRECT communication with the lymphatic and CSF flows OF THE BRAIN SO ANYTHING RAISING pressures in those systems will backflow and increase pressure in the cochleas transmitting forces into the MIDDLE EAR STRUCTURES which is the pain you are feeling.
You may tell me that the earache actually subsides right along with the headaches or even slightly before the headaches go away. But if you were to really chart out your headaches on a diary and throw in there exactly when you get your earaches along with exactly when they subside (both headaches and earaches) you'll likely notice a distinct correlation and pattern between them...it's no coincidence.
And so unfortunately, as much as I hate to say it, "I must disagree with your primary physician and tell you that your headaches following exertional activities and earaches are clearly related and NOT separate.
EIH are most often manifest in the back of the head (usually OCCIPITAL AREA) and there certainly can be PREMONITORY SYMPTOMS of shoulder, neck, and jaw tightness, prickliness, and even numbness PRIOR to or at the same time as when Headaches beginning manifesting. 30 minutes by the way is the average time for most people reporting relief from the headaches.
Now, what about the more OMINOUS CATEGORY of the SECONDARY forms of EIH...I don't think you've got that at all from the history you're presenting. But essentially secondary EIH comes about because of some architectural or structural abnormality that causing headaches but now there IS AN UNDERLYING CAUSE such as tumor, obstruction of some other form to the flow of cerebrospinal fluid (CSF), acute sinus congestion, and other causes. And so the SECONDARY FORM OF EIH is the more challenging of the 2 types to deal with since there is an identifiable CAUSE to the headaches. The problem is that the cause is not readily or easily able to be discovered so as a result studies do need to be done such as MRI/MRA and/or Lumbar Punctures, etc. But if it finally decided that you do need an MRI then, the cost should not be of consequence to you because you need to know what is actually at the root of these headaches (especially since they seem to have come out of nowhere, right?).
The reason I don't believe you've got SECONDARY EIH is because of the relative benign nature of the symptoms accompanying the headaches. You've not mentioned anything having to do with VOMITING, RIGIDITY of the neck...(but I mean REAL rigidity to the point where someone could pound nails with your head or feet...that's as stiff as you'd be.....), double vision, or passing out spells, ridiculously obstructed or blocked sinus passages resulting in a lot of pus and junk flowing down from the sinuses and/or up from the lungs...you've not said anything like that....so I'm assuming you don't have these symptoms.
There is a very good summary article that I'd like you to read from the Mayo Clinic's Patient Educational Library and I have all my patients read this article. It's very easy and quick to read and packs in a lot of great information. Here is the link:
https://www.mayoclinic.org/diseases-conditions/exercise-headaches/symptoms-causes/syc-0000
BTW, taking headache medication such as aspirin, ibuprofen, naproxen are not considered a reasonable way to treat these headaches because by the time you get the headache the horses are out of the barn so to speak...you need to be PRE-EMPTIVE and take something to PREVENT THEM from becoming so active. What you need to do is identify the associated ACTIVITIES triggering the headaches (i.e. HEAVY PHYSICAL ACTIVITIES) and then, AVOID these activities altogether or greatly reduce the WEIGHT LOAD of what you are doing or the types of exercise which could cause dramatic rises in the intracranial volumes and pressures, make sense? What you may be able to take to try and mitigate the pain or severity of these headaches would be something such as INDOMETHACIN (VERY HIGH RATE of GI upset as well as causing GI bleeding and darkening of the stool)...so I would start at a very low dose such as 25 mg. once daily and then, VERY SLOWLY ESCALATE to twice, 3x, and then, 4x daily. Actually, one of my favorites for these types of headaches would be the preventative medication, PROPRANOLOL. There I have another titration scheme that is based on the severity and age of onset of symptoms. For YOU, I would start with 10mg. daily and then, slowly escalate on a weekly basis to a TWICE DAILY REGIMEN followed another week later by a THRICE DAILY REGIMEN and in rare cases I even go 4x daily. The idea is to only use the amount of medication actually needed to control symptoms....nothing more, nothing less.
And there you have it...as "Monty Python might say!" HAHA!
Now, as I said in the beginning we can often avoid getting imaging studies based on the clinical situation, age of the patient, severity, and evolution of the headaches. However, in YOUR case and because you are complaining of intermittent types of symptoms which cannot be 100% RULED OUT as being PRIMARY or SECONDARY and you're above the age of about 45 years I would get an MRI of the brain (and perhaps cervical spinal cord---looking for what's called a CHIARI MALFORMATION along with an MRA just to be as far on the safe side as possible. I can understand if cost is a factor but if there is some type of architectural anomaly you've had since birth or that you've acquired then, it may be perfectly FIXABLE if you act on it NOW instead of waiting until it either gets significantly worse or something else changes where you PASS OUT due to the severity of the pain, etc. Sound reasonable?
If I were the ordering physician for the MRI testing I would make sure you got BOTH an MRI and an MRA. I would direct the reading neuroradiologist to please evaluate the films for any aneurysms, fistulae, EXTRA-AXIAL FLUID OR EVEN BLOOD. I might also order a CTA of the carotid arteries in tandem with the MRA since the CT scan may pick up things otherwise, not known yet just based on the MRI.
The article's name is EXERCISE HEADACHES
https://www.mayoclinic.org/diseases-conditions/exercise-headaches/symptoms-causes/syc-0000
Well, time for this sailor to hit the hay.....got a full day of wrestling practice in the morning followed by a rugby scrimmage....I'll try not to get a CONCUSSION if you still need me to talk to!...been pretty good so far! HA!
You do not have anything weird...it's just a shame it chose to hit you AT THIS TIME but that's the way these headaches "roll" so to speak...so you just have to follow the proper steps to diagnosing and then, deciding what to do.
Lemme know what you find and how things go.
If I've provided useful and helpful information to your question could you do me a favor by CLOSING THE QUERY and taking a moment to provide some kind words of criticism and perhaps even stamp it with a 5 STAR rating if you feel so inclined?
Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.
This query has utilized a total of 60 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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