Why You Get a Tension Headache After Working Out and How to Prevent It

We all love the look and feel of toned arms. Plus, muscle strength is so important for overall longevity and allows you to thrive in life.

But what happens when arm day, lifting overhead, or working out leaves you with a tension headache the next day? Or if not a tension headache, you feel tightness in the neck and shoulders that is super uncomfortable?

This is a common occurrence, but it does not have to be normal. The key is first recognizing that your upper body workouts are triggering a tension headache. Then you need to implement strategies to optimize your movement and prevent those neck and shoulder muscles from getting so angry afterwards. 

This is one of our absolute favorite things to treat in our office! It’s something I’ve struggled with personally, so I have first-hand experience with the debilitating pain that comes with this kind of neck pain and headache, as well as how to fix it. 

In this blog we are going to talk about:

• What is a tension headache?

• Why tension headaches can occur after a workout

• How to prevent post-workout tension headaches

• How physical therapy can help

What is a tension headache?

Tension headaches are quite common and are characterized by their name- tension. Tension headaches feel like dull, achy, painful pressure or tightness in the head or face. Tension headaches typically start at the base of the head and can wrap up the back of the head. 

Sometimes, tension headaches are felt in the forehead, temples, behind the eyes, or around the ear. It is common to feel tightness in the jaw and/or neck when a tension headache is present. 

Tension headaches can be felt either on one side of the head and face or can be felt on both sides.

Tension headaches usually build gradually and may be associated with stress, repetitive overhead activity, or lifting heavy objects. They often improve or go away after a night’s sleep, then build throughout the next day. In this post we are focusing on tension headaches caused by exercise, repetitive overhead lifting, and lifting heavy objects. For more information on other causes of tension headaches, check out our blog post How To Fix Tension Headaches: Top 5 Physical Therapy Exercises. (**INSERT LINK**)

Why tension headaches can occur after a workout

Tension headaches can occur after a workout for several reasons, but it all comes down to how you are stabilizing your body throughout the workout. 

There are two main places we need to focus on for stabilization: the core and the shoulder blades. 

Think of the core as a pop can. The diaphragm is the top, pelvic floor is the bottom, and the abdominal and back muscles are the sides. When pressure is created inside the can, as in a carbonated beverage, it gives the can stability.

The core is where the vast majority of stabilization comes from. Through a series of compensations, your core can be put at a mechanical disadvantage to work. This is primarily driven by altered breathing mechanics and not using your diaphragm to its full potential for both breathing and core stabilization.

Here are signs that you’re not using your diaphragm optimally:

• You tend to take shallow breaths

• You primarily breathe through your mouth

• Your shoulders lift upwards when you inhale

• You feel like you can’t breathe enough to keep up with exertional activities

Remember, the diaphragm is the top part of your core. If it isn’t working well for breathing, it isn’t working well for stabilization.

The body will always find a way to stabilize itself. If it’s not getting enough stabilization through it’s #1 strategy- the core- then it will turn to subsequent stabilization strategies. The next most common way to stabilize is by gripping through the neck.

Here are signs that you grip through your neck for stabilization:

• You hold your breath while you do an exercise

• You try to breathe through an exercise but can’t and also keep proper form

• Crunches make your neck super tired

• Core exercises don’t make your core fatigued

• You can see your neck muscles popping up when exercising

• You experience neck tightness or tension headaches the day after a workout

Neck muscles are not designed to be big stabilizers. When they are relied upon for stability during a workout, they are doing much more work than they would like to. Over time, this leads to neck tension, pain, and tension headaches.

The next place you need stability is in the shoulder blades. Think of the shoulder blades as the core of your shoulder. They are the foundation from which your shoulders move. 

The shoulder blades are primarily stabilized by muscles. There is one tiny joint that connects the shoulder blade to the shoulder, the acromioclavicular joint, and the rest is all muscle. These muscles stabilize, slide, and rotate the shoulder blades on the ribcage as you move your arm.

There is a massive amount of shoulder blade movement that needs to happen to raise your arm overhead. In fact, one third of overhead mobility comes from the shoulder blade rotating upwards- the rest is from the ball and socket shoulder joint itself. I hope this all highlights how critically important shoulder blade mobility and stability is!

If the shoulder blade doesn’t have the mobility or stability it needs from surrounding muscles, including the serratus anterior, mid trap, low trap, and rhomboids, it is going to be very difficult to raise your arm overhead. 

The compensation that bypasses this is hiking the shoulder upwards towards the ears. Muscles including the upper trap and levator scapulae lift the whole shoulder/shoulder blade complex upwards in an effort to raise the arm higher. But this movement isn’t genuine and when repeated over and over again, is an underlying cause of neck and shoulder tension, as well as tension headaches.

How to prevent post-workout tension headaches

Mobility and stability training are both critical to preventing a tension headache after working out. This is a multi-layered process that must address overhead shoulder/shoulder blade mobility, core stabilization, and shoulder blade stabilization.

The first place to start is giving your shoulder the mobility to get overhead. If you don’t have the required mobility, you’re 100% going to compensate when trying to reach or lift overhead. If there are mobility limitations here, you must address this first. 

One of my favorite moves to improve overhead shoulder mobility is called inverted breathing. You can check it out here. [https://youtu.be/b1gs3THTQ7g] 

Next, you need to teach your shoulder blade how to move and stabilize while moving the arm, especially if the movement is overhead. This is important for exercises like a front or side raise, overhead press, reverse fly, etc. Basically exercise where you’re moving your arms away from your body requires shoulder blade mobility and stability.

My favorite exercise to start this type of training is the child’s pose rockback.

The next thing to consider is core stabilization. You can layer this in with the previous two steps because they will complement one another. 

Core stabilization is NOT doing crunches. I’ve never prescribed a crunch to a client in my career. I recommend strengthening the core from a neutral position (as in a plank) and setting the exercise up in a way to focus on core stabilization while keeping the neck relaxed.

My favorite exercise for this core isolation is a 90-90 heel drop.

These exercises are fantastic places to start, and are initial exercises I give most of my clients to undo the compensations that lead to a tension headache after working out. Give them a try!

How physical therapy can help

Physical therapy plays a crucial role in getting rid of your tension headaches, as well as neck and shoulder pain or tension from exercise. Physical therapists are movement experts and are specifically trained to address and fix compensations that lead to pain and injury.

If you’ve been experiencing pain or tension in the neck and shoulders, or tension headaches, after a workout for months or years, you are likely holding on to a lot of muscle tension in this area. To effectively optimize your movement, that muscle tension needs to be addressed first.

When muscles like the upper trap and levator scapulae are overworked and tense, they will inhibit the stabilizing muscles from activating and working properly. Techniques like dry needling, cupping, and trigger point release are very effective at reducing muscle tension. This will alleviate pain and allow for optimal muscle activation. 

Depending on the severity of muscle tension and how long it has been going on, it could take weeks to achieve an adequate amount of muscle release. 

In conjunction with the muscle release work, a well-trained physical therapist will prescribe mobility and strength exercises to address your specific compensations. These exercises are crucial for maintaining the benefit from the dry needling, cupping, or trigger point release. As you release tension from tight muscles, you have to teach those muscles as well as the surrounding ones how to work properly. Otherwise, they will go back to their same tight state the next time you reach, lift, or work out. 

It is so important to focus on re-training the way your body moves. Any type of pain or tightness you experience over and over again after a workout is because of compensations. If you fail to properly address the compensations, your pain and tightness will continue to be a problem.

As you fix compensations and move more optimally, your physical therapist will keep progressing your exercises to challenge you in more advanced ways. Building solid strength at this point in the recovery process is very important. Strength training will allow you to maintain and advance the progress you’ve made thus far. 

This whole recovery process is very individualized and should be tailored to you and your goals! I see so many clients with the same type of issue, but each of their treatment plans looks slightly different. 

Conclusion:

That’s a wrap! Thanks for allowing me to unpack all this information with you. I hope you’ve gained great insight about why you get a tension headache after a workout, the importance of core and shoulder blade stabilization, exercises you can do to optimize your movement, and how physical therapy can help you move and feel your best. 

If you’d like more individualized help or have specific questions, please contact us! We would love to talk in more detail, hear your story, and see how we can help.