Exertional Headaches while Cycling: Understanding and Overcoming the Pain by Exploring the Causes, Symptoms, and Solutions
There’s no doubt about the exhilarating rush of an endurance high. That brief rush of euphoria or relaxation after a long bike ride or race is hard to beat. You can’t help but babble incoherently in the manic moments during your post-mortem race report.
Yet, for some cyclists, this euphoria is replaced by something far less pleasant—Exertional Headaches.
These headaches, which are quite literally a pain in the head, can disrupt your performance and hamper your overall cycling experience. No cyclist has time for that! So, let’s delve deeper into exertional headaches, their causes, and how to avoid them.
Exertional Headaches While Cycling: A Brief Overview
Researchers first described exercise or exertional headaches in 1968, identifying them as a phenomenon that occurs during or after intense, strenuous physical activity. Exertion headaches can arise from various activities – from heavy lifting and vigorous exercise to sneezing and gardening.
Exertional Headaches While Cycling: Symptoms
In a retrospective study published in the Journal of Headache and Pain, researchers discovered that about one-third of patients initially reported neck pain when the headache began. This particular symptom is more prevalent with exercise-induced headaches than standard migraines, particularly among males.
While the symptoms vary, they typically present as a pulsating sensation on both sides of the head, somewhat akin to migraines. These discomforting sensations can last anywhere from a few minutes to a couple of days, with some individuals experiencing multiple episodes.
In a study published in the British Journal of Sports Medicine exploring sports-related headaches, the researchers surveyed 129 participants. Those experiencing nontraumatic exertional headaches reported durations ranging from a brief 5 minutes to a full 24 hours.
Interestingly, the trigger played a role in the duration. For instance, headaches that began soon after intense activities such as sprinting or heavy weightlifting tended to resolve faster than those triggered by factors that take more time to develop, like dehydration or prolonged endurance exercises. Additionally, the scientists discovered that sustained aerobic activity predominantly caused headaches lasting beyond 1 hour.
Exertional Headaches While Cycling: Prevalence
While it’s difficult to pinpoint the prevalence of exertional headaches due to overlapping symptoms with other headaches (such as migraines), they affect between 1 and 26 percent of adults and up to 30 percent of adolescents. However, underreporting could make these headaches more common than we currently believe. After all, the pain typically ceases when the activity stops, and it may not be severe enough to prevent the continuation of exercise.
Most studies on this subject indicate that exertion headaches are more common in people aged 22 to 40 and often begin before the age of 30. Intriguingly, these studies also show men are more likely to experience them, accounting for approximately 80 percent of the participant pool. The reasons behind this gender disparity remain unclear and warrant further research.
The Mechanism Behind Exertional Headaches While Cycling
The exact pathophysiology behind exertional headaches while cycling has yet to be fully understood. However, several explanations exist for the pain athletes experience only during or after exercise.
During exercise, blood flow to the brain increases to ensure it receives enough oxygen to keep us moving and thinking straight. Alongside this, there’s also a surge in the amount of CO2 and heat our brains need to eliminate. The rapid expansion of our blood vessels to cope with this change can potentially cause pain.
Other experts believe exertional headaches result from increased pressure within the skull, which in turn affects the blood vessels in the brain. Short-lived spikes in this intracranial pressure brought on by physical exertion cause the enlargement or expansion of veins or arteries. This distention can then activate pain-inducing neurotransmitter pathways and bring about headache symptoms.
Research involving weightlifters has shown that blood pressure can skyrocket during maximal lifts, with systolic readings surpassing 400 mm Hg and diastolic readings exceeding 300 mm Hg. High-intensity cycling sprints place similar demands on our bodies.
Physical activity can lead to increased blood pressure and intracranial pressure of varying degrees, which is why athletes may experience headaches of differing intensity and duration depending on the sport they engage in and the amount of time they perform.
What Should You Do If You Get An Exertional Headache While Cycling?
Primary exercise headache isn’t the result of an underlying condition or disorder. If exercising leads to a headache, it’s crucial to consult your doctor to eliminate the possibility of severe latent problems—especially if these symptoms are new and if your healthcare provider hasn’t previously evaluated for an exertional headache while cycling.
Your doctor will carry out a clinical examination and may conduct tests to rule out potential underlying causes. The analysis could involve brain and blood vessel imaging to rule out conditions like a brain tumor, a lesion obstructing the flow of spinal fluid, a brain hemorrhage, or an issue with the blood vessels in and around the brain.
Those suffering from exercise-induced headaches may also undergo an evaluation for cardiovascular risk factors to exclude heart disease (cardiac cephalalgia) as a cause for their headaches. Ruling out this cause becomes particularly important if the pain from the exercise-induced headache spreads to or originates from the neck or jaw. Potential cardiovascular risk factors include a history of heart attacks, coronary artery disease, diabetes, hypertension, high cholesterol, obesity, and smoking.
Exertional Headaches While Cycling: Causes
Every individual has a unique anatomy and physiology. Hence, for some, exercise’s additional demands on their circulatory system might be enough to trigger a headache. For others, certain conditions or environments may contribute to exertional headaches while cycling.
Here are a few key factors:
Exercising in hot weather:
The brain naturally operates at a higher temperature than the rest of the body, and it can’t dissipate heat through sweating. Its primary method of heat elimination is dilating blood vessels to increase blood flow through the brain. During hot and humid weather, the brain’s temperature rises. Adding exercise to the mix can exacerbate this to troublesome levels. The result is an even more significant expansion of blood vessels, potentially triggering exertional headaches.
Training at altitude:
Exertional headaches are more likely at high altitudes due to the reduced oxygen-carrying capacity of the blood. More blood circulates to supply the brain with the needed oxygen, leading to vascular swelling and consequent pain.
Personal or family history of migraines:
Cyclists with a personal or family history of migraines may be more prone to exertional headaches. It’s likely due to the same physiological changes, such as alterations in blood vessel size, that trigger migraines, but some have a genetic predisposition.
Practical Steps to Prevent Exertional Headaches While Cycling
Now that we understand the mechanisms behind exertional headaches let’s look at strategies for prevention and treatment:
Rest and Rehydrate:
After exercise, these headaches typically resolve within an hour or two once your heart rate decreases and there’s less brain oxygen demand. However, if dehydration is also a factor, it will likely take longer—around three hours—to replenish your fluid levels and for the headache to subside.
Over-the-counter pain medications can be helpful if the headache is particularly painful, and your healthcare provider or pharmacist will advise you. If these headaches are a recurrent problem, consult your healthcare provider. They may recommend certain prescription medications to reduce symptoms or even prevent these headaches.
Consistent Exercise and Warming Up:
Jumping into strenuous exercise after a long period of inactivity can trigger exertional headaches, as your cardiovascular system might not be fit enough to cope with the sudden demands. It’s essential to reintroduce exercise gradually and to warm up before each session consistently.
Check out the article below for warm-up routines elite cyclists and top-tier coaches recommend.
Hydration is critical. It ensures the brain’s blood vessels function correctly, which can help reduce the chances of an exertional headache.
Staying hydrated during long exercises like bike rides seems obvious. We all get it—we need to drink water for our health and to do our best during a workout.
But even though our coaches and cycling buddies tell us to drink water, and we read about it everywhere, figuring out exactly how much water to drink can be tricky. We know we need to drink, but it’s hard to know how much is correct, how to figure it out, and why it’s so important.
Not many of us realize that not drinking enough water or too much can be risky. Yes, if we don’t drink enough water, we might get dehydrated. While it’s unclear how this affects our performance, getting dehydrated can be dangerous to our health and cause exertional headaches while cycling.
Check out the following article to create your hydration strategy.
Don't Overlook a Proper Cool-Down
An effective active cool-down is instrumental in avoiding exertional headaches while cycling. It facilitates recovery and enables your body to gradually and systematically return to its baseline pre-exercise state.
Besides allowing you to mentally decompress following a rigorous workout or race, an active cool-down also safeguards against the shock that can ensue from the abrupt halt of high-intensity activity.
Engaging in a relaxed, brief recovery post-ride, paired with some light stretching and rolling, will pave the way for a swift bounce-back. This approach minimizes the mental and physical distress that might otherwise make remounting the saddle the following day an intimidating prospect.
Read the article below with tips for a proper cycling cool-down.
Make sure you’re getting enough sleep and rest. It helps the brain function optimally and reduces sensitivity to pain.
Why is a Proper Warm-Up Critical for Exertional Headaches While Cycling?
When a cyclist begins riding, our muscles significantly increase their metabolic requirements, and our entire body escalates its oxygen demand. The critical factor in this equation is our heart, which must drastically ramp up its cardiac output—the amount of blood it pumps throughout the body.
We calculate cardiac output by multiplying the heart rate with the stroke volume, where the stroke volume is the quantity of blood that the heart pumps with each beat. Therefore, Cardiac Output = Heart Rate x Stroke Volume.
In the initial stages of a cycling session, your body experiences a jolt as your heart rushes to fulfill your aerobic requirements—Heart rate and stroke volume surge to adapt to the increase in cardiac output and to satisfy the increased demand for oxygen.
You experience an exhilarating sensation due to the sudden uptick in your respiratory rate. This increased breathing permits more gas exchange in your lungs and, coupled with the rise in stroke volume, allows more oxygen to reach your muscles. However, this redirection of blood flow from other organs, such as your digestive tract, makes the initial five minutes of the ride particularly strenuous.
Your heart, lungs, blood vessels, and muscles must work extra to balance this mismatch and meet your exercise needs.However, there is good news for the seasoned athlete: your heart rate and stroke volume swiftly adapt to the cardiac output demanded by your muscles and internal organs. As soon as you move past this intense phase and achieve a stable state, your perceived level of exertion normalizes, allowing you to continue your warm-up more comfortably.
Despite the annoyance of exertional headaches, they shouldn’t prevent you from pursuing your passion for cycling, even in warmer weather.
Conclusion-Exertional Headaches While Cycling
Remember, gradual warm-ups, adequate hydration, and avoiding extreme conditions may help reduce your risk of developing these headaches.
In addition, diversifying your exercise routine by incorporating activities that don’t sustain peak heart rate levels—such as yoga or resistance training—might be beneficial. Keep exploring, keep cycling, and, most importantly, listen to your body.
Ultimately, the key is to strike a balance between pushing your limits and respecting your body’s signals. Cycling is an endurance adventure, and with the right approach, you can ensure that headaches are one less obstacle on your journey.
Semi-retired as owner and director of his private Orthopedic Physical Therapy practice after over 20 years, Chris is blessed with the freedom to pursue his passion for virtual cycling and writing. On a continual quest to give back to his bike for all the rewarding experiences and relationships it has provided him, he created a non-profit. Chris is committed to helping others with his bike through its work and the pages of his site.
In the summer of 2022, he rode 3,900 miles from San Francisco to New York to support the charity he founded, TheDIRTDadFund. His “Gain Cave” resides on the North Fork of Long Island, where he lives with his beautiful wife and is proud of his two independent children.
You will read him promoting his passion on the pages of Cycling Weekly, Cycling News, road.cc, Zwift Insider, Endurance.biz, and Bicycling. Chris is co-host of The Virtual Velo Podcast, too!