Headaches after Elevated Heartrate

[stromi]

I am a 28 year old female in excellent shape, living in Denver, CO.  (I work out 6-7 days per week, including running (anywhere from 4-10 miles), spinning (60 minute classes), weight training, skiing, tennis, etc.)  I have normal blood pressure, and am of normal weight for my height and build (155 lbs – 5’ 11”), eat very healthily, and am always properly hydrated.  The only medication I take is the birth control pill.  My family history is good – although my grandfather on my father’s side died of an aneurysm in his early 50s.

For about 5 years, I have been getting very bad headaches after exercising.  I used to think that they were heat and humidity-induced, as when I first started getting them I was living in Austin, TX.  So I made sure that I was properly hydrating (including electrolyte drinks), but that still did not prevent my headaches.  I noticed that these headaches came on after exercising after getting my heart rate up pretty high (around 165-170).  

After having moved to Denver about two years ago, I am still getting these headaches, mainly if I get my heart rate high – both indoors and outdoors.  I have noticed that if I keep my heart rate lower, I generally do not get the headaches, or if I do, they are not as severe.

The headaches start out very gradually – dull at first – and usually last about 12 hours.  The pain is felt toward my forehead – and nothing I can do will make the pain subside even slightly.  (No amount of water, electrolyte drinks, ibuprofen, acetaminophen, food, rest, etc. will do the trick).

I am worried about these headaches because I have been getting them for so many years, and I have not found anything I can do to stop them.  They interfere with my daily life, as the headaches last an entire day, and I also feel lethargic and sometimes dizzy – almost “out of it” for the entire day.  I am worried that since they usually happen after I get my heart rate up pretty high, that they might be heart-related . . . or even a precursor to an aneurysm since that is in my family history?

I will gladly welcome any help you may be able to give me!!!!

[Vanessa Lacuesta]

Hi,

An internist will be able to give you a complete assessment.He/she may refer you to a specialist if indicated.You mentioned several factors that may contribute to your symptoms.Your internist will be able to make a full evaluation so that management will be focused on the most possible underlying cause.

[stromi]

Hi Vanessa,

Thank you for your response.  

What type of doctor would you recommend that I see for these assessments?

Thank you!

[Vanessa Lacuesta]

Hi,

This has been present for a long time you say? Have you had a baseline assessment done by a physician? If not I suggest that you do. A family history of aneurysm is significant and should warrant further evaluation in your case. Do understand that I do not mean to say this is an aneurysm but in trying to assess a given case all probable risk factors including any significant family history of diabetes, cardiac problems and previous trauma have to be considered. Presence of any of these requires further evaluation.

Exercise induced headaches are mostly benign but the diagnosis is only given once all other possible conditions have been ruled out. A baseline CT scan or MRI may be able to help. Also a complete blood test and assessment of cardiac function will be able to shed some light.

The best way to prevent the headaches is to avoid the triggers. In your case, you may not want to give up your exercises. Warm up prior to exercising. Also, avoid taking too much caffeine, do not skip meals and try engaging on low impact sports like swimming . Certain exercises seem to entail a higher risk of developing the headaches (e.g. running, weight lifting).

Discuss with your physician the advantages of indomethacin and propranolol in preventing the headaches.