Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S
Exertion Headache
Headaches which occur during or after strenuous physical activities like running, rowing, swimming, weightlifting, sexual intercourse etc are categorized under exertion headache which is also known as ‘exercise headache’. This headache may go away a few seconds or minutes later, after good rest or minimum intervention. Continuous exertion can keep the headache for a longer duration. It may be primary or secondary. Primary exertion headaches may not have any underlying disorder or cause and are least troublesome. Secondary headaches have an underlying disorder. Few cases need proper evaluation especially when they do not subside or go away easily, when they keep coming following strenuous activities, associated with additional symptoms or when they interfere in day-to-day activities.
Related Reading – Exertion Headache
Exertion Headache – Ayurveda Understanding
Exertion, Vata connect and Vataja Shiroroga / Shirashula
Excessive physical exertion or physical activity, as a rule, would cause vata increase. This increased vata would build up pressure and painful conditions at many places in the body, including headaches. Primary exertion headaches (PEH) or ‘Exercise Headache’ fall under the ‘Vataja Shiroroga’ or ‘Vataja Shirashula’.
Exercise headache / Exertion headache is caused by many activities done in excess i.e. running, swimming, weightlifting, rowing, sexual intercourse etc. All of these activities increase vata.
Any vata disorder or vata subtype of disorders would begin or worsen with strenuous activities, last for a few minutes and go away with rest. This includes an exertion headache also. When exertion or exercise is not practiced in balanced proportions in those having these types of headaches or in spite of having frequent episodes of the same, these headaches can run a chronic course.
If these headaches are primary in origin, they might not need any interventions other than rest and knowing the limits of one’s exercises or exertion saturation point. These people should follow the golden principle of nidana parivarjana i.e. keeping away the etiological factors.
If exertion headache is repetitive and has run a chronic course, then it requires interventions on the lines of ‘treatment of vataja shiroroga’. Comprehensive treatment including medicines, therapies, lifestyle changes and dietetic regimens which mitigate vata shall be included in treating exertion headaches of chronic type.
If other diseases or vataja disorders or vataja subtypes of disorders or any other chronic disease is causing exertion headache and presenting in the pattern of vataja shiroroga, it shall be considered as secondary exertion headache. The primary disease which causes exertion headache shall be properly treated in these cases.
The pulsatile or throbbing type of headache found in PEH are typical of vata type of pains.
Related Reading – Vataja Shiroroga / Vataja Shirashula
Exertion, Rakta and Raktaja Shiroroga / Shirashula link
Since exertion headache also happens due to problems in blood vessels in the brain and temporary increase in blood flow to the head and studies showing that about 70% of this type of headache is caused due to abnormal blood flow, it can also be compared to raktaja shirashhula. Raktaja Shiroroga or Raktaja Shirashula is a headache caused by blood.
The symptoms of raktaja shirashula are said to be similar to those of pittaja shirashula.
Raktaja Shirashula has the tenderness of the head. It is compared to many conditions like sinusitis, headache caused due to injury of bones of the head leading to swelling and congestion of these bones. It is also compared to constitutional headache which is found to be associated with diabetes mellitus, chronic alcoholism, severe cases of poisoning and increased blood pressure. Exertional headache following or associated with these conditions can be considered as secondary in nature.
Exercise in hot weather is a risk factor and people over the age of 40 years of age are at higher risk for exertional headache. Exertion headaches are common in hot and humid weather. The same factors are responsible for pittaja and raktaja headaches.
Related Reading –
Raktaja Shiroroga / Raktaja Shirashula
Pittaja Shiroroga / Pittaja Shirashula
Exertion and Ardhavabhedaka link
Those having history of migraine also are at risk of exertion headache. Migraine is compared to ardhavabhedaka shirashula in Ayurveda. Ardhavabhedaka vis-à-vis migraine has similar symptoms to those of vataja shirashula / shiroroga. It is seen that people having ardhavabhedaka will develop headaches after exposure to heat and after exercise.
Exertion headache is severe and has sudden onset and is associated with confusion, fainting or syncope. Such characteristic features of headache are most commonly found in vataja, pittaja or raktaja types of headaches.
Treatment of Exertion Headache through Ayurveda
Nidana Parivarjana
Inn exertion headache, exertion is the main causative factor. When the person clearly knows that the exercise is the aggravating, causative or trigger factor for his or her headache, it is better and wise to keep a monitor on the quality and quantity of exercise and decide the limitations and threshold of exercise or exertion. One should not go beyond one’s limits or the point of threshold which triggers a latent exertion headache. If certain activities cause exertion and they are time and again known to cause headaches as an end event, it is better to avoid those activities as far as possible. At the same time, since this headache has a vata link, any aggravating factor shall be avoided on a long term basis and should be made a habit of the same.
In secondary exertion headaches, the main disease-causing exertion and consequent headache shall be dealt with properly and any specific identified etiological factor or factors associated with such disease too shall be kept away.
Dealing with Vata
Most types of exertion headaches are due to vata aggravation, as already discussed. So, vata should be taken care of and pampered if aggravated. Vata alleviating foods, lifestyle changes including quality and quantity of exercise and exertion, medicines and therapies shall be included in the treatment protocol. Primary Exertion headaches may be treated just by advising rest in mild to moderate conditions. In severe, repetitive or chronic conditions, vata alleviating measures shall be adopted.
Important principles
Also, the treatment principles and medicines explained in the below mentioned contexts shall be brought into practice as and when needed –
– Treatment of Vataja Shiroroga / Shirashula
– Treatment of Raktaja / Pittaja Shiroroga / Shirashula
– Treatment of Ardhavabhedaka shiroroga / shirashula
Secondary Exertion Headache
If any other condition on the backdrop is responsible for exertion headache, that primary disease shall be dealt with promptly. Here, the vyadhi pratyanika i.e. disease specific approach and monitoring the quality and quantity of exercise and exertion should be adopted in the treatment strategy.
