Low blood pressure & headache after 1-2 hours of endurance exercise

Training
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As the title says, after 1-2 hours of any endurance exercise in any zone, my blood pressure drops and I get a migraine headache as a result in the frontal lobes, e.g. after 2 hours of walking, a few hours of mountain biking, etc. In the past I have been using caffeine, as it is a vasoconstrictor, and that works to get rid of the headache but then interferes with sleep and recovery (I get night terrors - waking up at 4am - and anxiety from caffeine), not to mention significantly increased recovery times.

I’d like to keep caffeine to a minimum and not rely on it as a remedy for my headaches. Reading through the forums, a few folks suggested

  • increasing sodium intake
  • ibuprofen before rides
  • taking preventative medication like MigreLief (mostly 400mg of both vit B2 and Magnesium Oxide)
  • getting enough sleep (hard with early morning training rides)
  • making sure I stretch the neck

Does anyone else have the same problem and found what works?

There are both preventative and treatment prescription med options (e.g. triptans as vasoconstrictors) via PCP, but all those drugs seem like too much - wondering if there is a simpler solution.

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Personally I’d go and see a Doctor rather than an internet forum!

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I have and most prescription options don’t look that great, which is why I’m asking on here.

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How do you take in your caffeine?

I get anxiety from too much coffee (full on panic attacks if I have even one cup too many), but not energy drinks that contain L-theanine. L-theanine has been studied in clinical trials and it helps reduce anxiety. My wife had to stop drinking coffee due to anxiety, but she can drink the same caffeinated sparkling waters as me (Ardor sparkling water contains caffeine, electrolytes, and L-theanine) without any issues.

I know that is not the answer you want, but it might be worth trying at least once to see if it helps.

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Describe your age, fitness, exercise regime and diet a bit more.

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Yes, tried l-theanine, hence caffeine from tea: this gives the least amount of panic, but anything over 100mg/day interferes with sleep and recovery and I need 300-400mg/day to get rid of headaches when exercising. I’ve completely quit caffeine for 4 months before and just kept taking Advil the whole time - not great - but sleep and recovery was fixed.

Nearing 40s, always kept active and in-shape with weights and biking; past 3 years got into competitive road, gravel and MTB - riding 4-5 times per week, gym 3 times per week. Good clean diet - mostly cook meals at home - eggs, beans, fish, meat… I either exercise first thing in the morning or after work - no difference in terms of headaches, but I usually wake up with a light headache already when cutting caffeine.

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TBH i’d go see a doctor first…

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Done:

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Do you drink alcohol? Alcohol gives me anxiety these days. Water intake? Protein before bed?

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Instead of coffee, you can try tea. I get tremors if I take in too much coffee but with tea I don’t.

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How about carbs?

Also this:

This can happen with caffeine withdrawl. Do you still get these light headaches after a week without caffeine?

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I actually had this same issue - post-exercise hypotension (PEH).

At that time, I was on high blood pressure meds. Post-workout, I’d check my BP every 30-minutes and it would often take more than 2 hours to get back to normal. Worked with my Doc and am no longer on any blood pressure meds (I also dropped a lot of weight).

This probably doesn’t help you but PEH was a thing for me.

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How low is low?

Static supine blood pressure low or postural hypotension? Big differences here.

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Have you had COVID-19 recently?

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Answering all questions here.

I stay away from alcohol because it worsens sleep. Beans (Fava) have enough carbs and I usually eat salmon before bed for protein - too much food makes sleep worse, no food also makes it worse - about 600-800kcal from Fava beans and salmon in total seems ideal before training rides the next morning.

I would get light headaches all the time when not drinking tea/coffee: sodium intake and keeping blood sugar high helps.

Blood pressure ~102/58 when I get bad headaches and ~118/70 when I don’t.

No COVID ever, usually don’t get sick - had this problem all my life but finally want to nip it in the butt since it interferes with training - masking this problem with caffeine is not good.

Decaf black tea seems to help with headaches for some reason… not sure what it has which helps (it’s really decaf because I don’t feel any sort of caffeine at all from it).

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That is because you are still getting caffeine, just a lower amount….decaf doesn’t mean caffeine free.

The downside of decaffeination is that if you are sensitive to caffeine and its side effects, you will still be consuming some caffeine. This is because it is virtually impossible to remove all the caffeine, often around 2.5% of the original caffeine content will remain

IIRC, a cup of decaf Starbucks coffee has more caffeine than a “normal” coffee.

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Have you considered whether the two symptoms - low blood pressure post exercise and headaches - may not be as related as you think? If you have not already, it may be worth playing around with fuelling with more carbs and increasing hydration.

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You and me both. I suspect this is quite common for endurance athletes who take some form of BP-reducing medication. For folks with this problem, drinking more, and consuming more sodium according to the increased fluid intakes, is often a workable solution.

Targeting complete fluid & sodium replacement during exercise instead of allowing up to ~2% body weight loss is a good idea for folks experiencing PEH.

When I read the title of this thread, I suspected PEH. Worth thinking about,

It’s the fluid volume. You could chug water and get a similar effect. It’s just more enjoyable to drink tea, so you probably end up drinking more of it. I know this is the case with me, at least.

The problem is, fluid consumption without sodium alongside it, is a short-term fix. If you want it to cure the low BP and associated headaches for longer than 1-2 hours, you’ll need sodium to get your body to retain the fluid volume in your blood stream, rather than pump it into urine via kidneys, completely negating the effect of the consumption in the first place.

Try 1000mg sodium per liter of water. Up to 1.2L per hour post-exercise, until BP is normalized and/or headache abates.

If it were me, I’d chug 1.2 L immediately post-training, with maybe closer to 1500mg sodium. Usually that does the trick within a few minutes.

PEH is caused primarily by dehydration, high fitness, BP med use, and genetics.

It’s most common among:

  1. Extremely high-fitness athletes.
  2. Heavy sweaters
  3. Folks taking BP-reducing meds.
  4. Folks whose parents or siblings have low blood pressure.
  5. People with any level of health anxiety who think they have ~115/70 BP but who really just have anxiety at the docs office and when tested at home have more like 100/65.

Add a bit of dehydration from training to 1, 3, 4, or 5, and boom: PEH.

It’s probably worth drinking more fluid and sodium during training.

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Sounds like the docs are failing him because of lack of knowledge in a specific sport-related experience.

Full disclosure: I’m not an MD. I’m a PhD in Sport Physiology and Performance, specializing in nutrition and hydration for endurance athletes.

These kinds of problems are often solvable by better salt and water strategy and implementation. I’m glad you asked, @itchyboii. I hope I can help. My wife and I have both experienced similar, from dramatically different mechanisms. (she’s crazy fit and has hypotensive genetic predisposition… and I’m the opposite of that, relatively speaking)

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This is an astute observation, @splash. Folks reporting “clean” diet are far more likely to be underfueling during training. It’s just a correlation, but it’s a pretty strong one.

@itchyboii, what does your intra-workout fueling / hydration regimen look like, in terms of hourly rate of consumption of carbs, fluid, and sodium, typically?