“Cardio Makes My Head Hurt”
Last month, I had the opportunity to assist a fitness client during a Saturday Solutions session. I have found exercise induced head pain is becoming a more common problem and I wish to share this success story in an effort to help others.
Susan was making good progress in her fitness program when she suddenly developed head pain after every session of exercise. She tried non-steroidal anti-inflammatory and migraine medications, but the head pain did not change. She noticed that the pain was worse on the days she performed more demanding cardiovascular training. Susan worked at a computer for six plus hours a day and she spent at least an hour in the car. She enjoyed her gym sessions and was frustrated by the limitations this pain was placing on her exercise program.
Susan reported the head pain would begin behind her right ear and radiate to the right side of her forehead. The pain was present for two or three hours after an exercise session and would resolve more readily if she would lay supine. Susan had limited cervical spine extension and right rotation. Her right sternocleidomastoid muscle was tender to palpation. She had a forward head and rounded upper back. Posture correction was possible, but she reported it was difficult for her to maintain. She reported that her deskwork kept her in a seated position, gazing to the right, for long periods. She slept on her right side and stated that she was unable to sleep on her left side secondary to waking with neck pain. Susan had poor rib cage expansion and difficulty with diaphragmatic respiration.
If we lose the capacity to expand the rib cage, the efficiency of respiration is diminished. During an exercise session, our brain is going to use every means possible to get air in and out of the lungs by using the accessory respiratory muscles. The sternocleidomastoid is an accessory muscle travels from the back of the skull–just behind the ear (mastoid bone), to the clavicle and sternum. Muscles start to complain when they are asked to do more than their fair share of the daily biomotor activity. An overworked sternocleidomastoid muscle will register its complaint by referring pain to the back of the ear and forehead.
Susan was sent home with instructions on work site posture modification and a three times a day program of positional relaxation for the right sternocleidomastoid muscle. She was given a program of exercise to restore rib cage expansion and diaphragmatic respiration. We forbid holding a cell phone to her right ear and reading in bed. Fast forward two weeks and the head pain was abolished. Susan misses reading in bed, but not as much as she hated those headaches.
Postural restrictions in the neck, thoracic spine, and rib cage are becoming more common drivers of pain. We start gazing into screens at younger ages and this makes it easier for pain related problems to develop when a physical demand is placed on the body. As fundamental as this sounds, many fitness clients need to work intensely on their posture and proper respiration.
Michael S. O’Hara, PT, OCS, CSCS