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EricT · 05-05-2006, 02:57 PM

This is not necessarily for Frankie or to beat a dead horse. Just info. I would like to point out that things like this should be taken seriously.

Thomas Souza, DC, DACBSP

Athletic Headaches

The athlete may present with a complaint of headaches in three ways: (1) headaches unrelated to athletic activity; (2) headaches that are exertion/activity related; and (3) posttraumatic. The first category of presentation is evaluated and managed like non-athletic presentations. Exertional and post-traumatic headaches are often acute events which require immediate triage. On-the-field evaluation is limited but can provide a reasonable basis for decision making with regard to return-to-play or referral for further evaluation.

Exertional/Activity Related Headaches

One of the major concerns with exertion related headache is the possibility of an underlying tumor or vascular weakness which may lead to sudden death. Although 50-60 percent of patients with brain tumors have headaches, only 2-25 percent experienced exertion-related headaches.1 When aneurysms rupture, a quick onset of headache followed by loss of consciousness and death is the usual scenario. However, in patients with an aneurysm that is slowly hemorrhaging, a severe headache may appear over several days or weeks. This "sentinel" headache appears in 30- 60 percent of patients with eventual rupture.2 Associated symptoms may include nausea, vomiting, visual disturbances and photophobia, aphasia, nuchal rigidity (without fever), and weakness. Immediate referral is necessary. Evaluation will include a CT for structural brain lesions and a lumbar puncture to detect a subarachnoid bleed.

It is important to screen athletes regarding some common culprits of benign exertional headaches including dehydration, hyperventilation, hypoglycemia and/or poor diet, alcohol use, caffeine withdrawal, and heat intolerance. These are more likely to be triggering mechanisms in the poorly conditioned athlete. When headache is associated with a specific activity, clues may be found with regard to the mechanism is some cases.

For example, one common presentation is "weightlifter's" headache.3 There are probably two possible explanations for this occurrence; (1) increased intracranial pressure is caused by the Valsalva-like maneuver with lifting, and (2) stretching or strain of cervical musculature/tendons.
Valsalva maneuvers increase intracranial venous sinus pressure. This in turn leads to a general increase in intracranial pressure which reduces cerebral blood flow. This effect is generally short lived and benign. If persistent or severe, further evaluation with CT or MRI may be necessary.

Overstrain due to maximum lift effort or abnormal posturing of the neck during activity may lead to a primarily subluxation/soft-tissue caused headache. Historical review of the mechanism of onset with regard to neck position and the onset of symptoms is valuable. Confirmation by physical examination, spinal palpation, and resolution with chiropractic care are likely with this etiology. Migraine headaches occur with some athletes involved in short, strenuous activities including weightlifting, and short distance running or swimming.4 Although the mechanism is not clear, it has been proposed that hyperventilation leads to a decrease in Pco2 with resulting vasoconstriction. This leads to a migraine aura followed by vasodilation leading to the headache.