Dr. Allan Horowitz, published newspaper article, The Liberal, Copyright Wednesday June 8, 1988


QUESTION: I am a soccer player who competes at quite a competitive level. I do a thorough warm-up before each game and practise, including stretching and cardiovascular warm-ups. I have no history of any physical problems which I feel might relate to the problem which I am going to discuss with you.

That problem is one of headaches. I only get these headaches after a soccer game or practice. The headache only lasts a couple of hours, but is quite severe when it is present. I don’t feel that aspirin or any other medication is beneficial, and the only thing that seems to help me is when I lie down and relax for a couple of hours. This does eliminate my headaches, however I would still like to find out their cause.

They have been present since I was 16, and always occur after some form of vigorous activity. I am now 22 years old and hope that you can help me.

ANSWER: Every headache must be thoroughly investigated before a proper plan of treatment might be instituted. Headaches which have been present for six years and especially those that only occur after vigorous activity are most likely related to your level of exertion and are probably benign headaches which do not have any serious consequences.

However, I emphasize strongly that you must see your physician to have him evaluate your headaches so that he might confirm my suspicion or so that he might proceed with further testing.

If your physician finds that your headaches are related to your exertion level, then I do have a couple of tips for you.

The cause of these ‘exertion headaches’ is really an unknown entity in the headache literature, except in those patients where a pathology is demonstrated through neurological or vascular studies. Only theories exist to explain why some people get headaches after exerting themselves.

One theory is that these headaches are caused by a vasodilation of cerebral vessels caused by a release of a chemical known as ‘prostaglandin.” Most people who have exertion headaches find that the pain is quite excruciating and they would do anything to get some pain relief.

LESS ACTIVITY

One of the best ways to prevent these headaches is simply by decreasing the amount of activity, as it is just the activity which causes the headache in the first place.

The person who suffers these headaches should be relieved to know that despite the severity of the headache, most studies indicate that fewer than one percent of all headaches have a serious underlying disease which is causing the headache. Some studies show that certain medications (which your doctor can discuss with you) are beneficial in treating these headaches.

However, because of the nature of your headaches and the fact that you get the headaches immediately after a soccer game or practice, it is not really practical for you to rush home from a game and take medication. The best advice I could give you is to decrease the level of exertion you put your body through, or to decrease the length of time your body is exerting itself.

In other words, you may continue to play soccer at practices and games, however, you might consider a change in position so that you are not running as fast or as far, or you might consider asking your coach to limit your playing time so that your headache will not come on after the game.

You will eventually find a level of activity which is right for you and which does not cause a headache. If this level of activity is still compatible with you being an important member of the team (assuming you ever were), then you may continue playing soccer. If, however, you find that you must curtail your time on the field so much that you are a burden to the team, you might seriously consider getting into another sport which does not demand such constant activity.

These sports include tennis, swimming, jogging and bicycling, because these are all sports where you may pace yourself and work at your own comfortable speed.

In soccer, which is a team sport, you must usually go ‘full out” for the time you are on the field, and pacing yourself usually means that your team will suffer.

SEE A DOCTOR

So remember, it sounds as though your headaches are what are referred to as “exertional headaches”, however, before you listen to any of my advice I insist you obtain a diagnosis from your physician and listen to his advice if he wishes to give you any follow-up tests or examinations. Good luck.