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January 13, 2017

Exertional Headache

There is a specialty headache that needs some attention paid to it called an “Exertional Headache”. This is typically a sudden, extreme headache that comes on during exertion or physical strain.  For some, this can feel like a “Thunderclap”. Headaches that appear in the back of the head are of particular importance. For some, these headaches appear with straining, during a lift, during bowel movements, with orgasm, or even with extreme coughing or vomiting.

When the headache begins in the back of the head, sometimes it will  spread out over the musculature of the head, to the sides, temples and the front. This may feel like a headache “inside the head and out”, almost like two different headaches – one you can rub, and one you can not.  Some headaches can feel like they are behind or around the eyes. These are headaches we have to watch out for. You can read more here about cough headaches or exertional headaches.

Sentinel Headache

Some exertional headaches are problematic but uncomplicated. However, a subset of these suboccipital headaches could be what is called a “Sentinel Headache”, which occurs in a percentage of cases at some point just before or within two weeks before an inter-cranial bleed, or hemorrhage, called a Subarachnoid Hemorrhage. This headache can be sudden, extreme, is often pulsing, and may come with neurological signatures like sounds, numbness, visual disturbances, or dizziness. Occasionally, the victim will feel they are “blacking out”. Extreme or persistent vomiting is another warning sign. Pay attention to whether symptoms are on on one side or both.  Neck rigidity is another immediate concern.


An inter-cranial bleed is a big deal. Sometimes these “thunderclap” headaches occur because a small berry aneurysm is leaking into the spinal fluid. The brain is very sensitive to this. If this tiny blood seepage goes “all the way” and blows out, it becomes a subarachnoid hemorrhage and can possibly lead to a fatal stroke without immediate intervention.  You can read more here.

Headaches with some or all of these symptoms should be worked up. This is typically an ER referral rather than an Urgent or Zoom care. However, if there is any neurological issue, such as numbness, tingling, dizziness, vomiting, perhaps an Emergency Room, which is closer to a CT Scanner or the possibility of further intervention, is the best bet. As with almost all headaches, confusion, loss of alertness or slurring of words is an immediate referral for consultation. 

Your Medical workup may include a Diagnostic Ultrasound, a CT Scan, a CT-Angiogram, an MRI or even a spinal tap.

This issue is unfortunately not a Chiropractic adjustment correction; we can consider that afterwards. Our focus will be about making sure you are safe, starting to diagnose you properly and getting you to a facility where you could have all of your needs met. We will typically refer 100% of these headache cases to Urgent Care or the Emergency Room. The objective is to get you the care that you need, as directly as possible.  We can talk about all those easier headaches at a later date. 

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