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Reader's Mail: Exertional Headaches Require Professional Evaluation

Q. I get headaches whenever I lift any weight above my head or strain my shoulder muscles in any way with weight lifting. What do you recommend that I do?

A. Your headaches likely represent exertional headaches. These headaches are typically throbbing and last for five minutes to 24 hours after exertion. Usually these headaches are benign and are not associated with any underlying diseases. However, we typically order an MRI of the brain and MRA of the blood vessels of the brain to be absolutely certain that there are other causes for your headaches. The typical treatment for benign exertional headaches are non-steroidal anti-inflammatory agents (NSAIDS) or beta blockers administered before exercise. However, any decisions involving treatment should be discussed with your physician in order to consider the risks and benefits of each therapy.

Another possible cause would be thoracic outlet syndrome. This occurs when the muscles in your shoulders are contracted and tighten nerves or blood vessels in your shoulder. The most common symptoms are pain and numbness in your arms when you move them to different positions. Headaches have rarely been reported in this syndrome and typically occur in the back of the head. This can be diagnosed by your physician by putting your arms and shoulders in different positions. It can often be treated by physical therapy.

Vincent Martin, MD
Professor of Medicine
University of Cincinnati
Vice President, National Headache Foundation

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