Head pounding with exercise

[em1981]

I'm a 26 year old female, 5'9", 160lbs. For months (at least) I've been getting pounding in the back of my head and neck/throat when I exercise, even if the exercise is only moderate. If I do 15 mins on an elliptical machine it gets pretty bad, and I can feel it even after 5 mins. There is no pain, just hard pounding like I can feel my pulse. Previously I didn't concern myself with it. I never noticed that happening when I used to have dance classes 2 years ago, I really only noticed it when I started working out on a stationary bike, and it's not as bad on there as it is on the elliptical which I find much more difficult to do.

Now that this is bothering me, I realize I can feel my pulse in my head pretty much all the time. It's making me nervous to work out, which is unfortunate because I really want to get in shape.

I would say I'm pretty deconditioned right now. I have an office job where I sit all day. Other history: several times I've been on the border-line of iron deficiency anemia. I have lots of benign heart palps: PVCs, PACs, atrial runs. A year ago I had a stress test as an additional heart test, and wasn't contacted for anything abnormal, although the nurse asked me if I normally have low blood pressure when she took it before the test started. I've had a non-contrast CT scan about a year and a half ago for short, sharp headaches, with normal results.

I also occasionally get short bouts of pounding in the head when I first stand up.

I'll likely go see my doc next week about this, but since she tends to dismiss everything I wanted an opinion before I go. I'm wondering if this could be caused by deconditioning or another minor issue, or if I should be getting it checked out. Thanks!

[Enoch Choi, MD]

I'm glad you'll go see your doc next week, don't let her dismiss it.

Deconditioning is one possibility, but i'd be concerned about causes of headache resulting from decreased blood pressure.

The reason why that could be the case is that when you stand up suddenly, your blood pressure can drop from vagus nerve stimulation.  And when you exercise your veins dilate and can decrease blood pressure.

The normal CT is reassuring, but a lot can happen in a year and a half.

Ask about atypical migraine as well.

[Enoch Choi, MD]

perhaps ask the next doctor you see (for the 2nd opinion) to take your blood pressure when you experience this, after your first stand up.  see if it's elevated.

[em1981]

Like I said, it's not pain, it's just like I can feel a heavy pulse in the back of my head when I exercise or occasionally when I first stand up for the first few seconds. Neither doctor seemed to think it was much to concern myself with. I'm down to one or two more opportunities for another opinion, then I'm out of luck, or I can retry going to the same places and hope to get a different doctor. I am booked for a full physical with my regular doctor, and I can bring it up to her again.

[Enoch Choi, MD]

cervical spine xray for pain when you exercise?  i'd say that's a stretch that this could be cervical disc disease.

get a second opinion...

[em1981]

Went to a clinic. Doc there took my blood pressure - said it was fine, and ordered me a cervical spine x-ray. Does that sound like appropriate workup?

[Enoch Choi, MD]

i would get a second opinion

[em1981]

So, as usual, despite anything I said, my doctor dismissed it as a tension headache. She didn't take my blood pressure, wouldn't even test my iron levels when I asked. The first day I met my doc a few years ago she diagnosed me with anxiety without doing any physical tests and since then she comes up with any anxiety related explanation for any symptom I have. It's not reassuring at all.

[Enoch Choi, MD]

yes, depending on the reason:
- sodium supplementation
- medication to decrease diuresis (urination)
- slowing/strengthening the heart

it all depends on why the blood pressure is low.  it could be totally normal

[em1981]

Thank you doctor. Is there anything that could be done for low blood pressure? I'll make an appointment with my doc tomorrow.