Posterior Occipital Pain Following Strenuous Exercise

Case at a Glance

A 34-year-old male athlete presents with persistent posterior occipital headache and motion-sensitive pain following strenuous bodyweight exercises, with symptoms lasting over one week.

Patient's Story

The patient, a 34-year-old male (height 193 cm, weight 105 kg), presented with complaints of posterior occipital pain that began during a workout session approximately 10 days prior to consultation. He was returning to bodyweight exercises following shoulder surgery rehabilitation. During his workout, which included pull-ups and dips, he reported performing exercises at maximum exertion, noting he could only complete two proper repetitions with significant strain. During the dip exercises, he described creating intra-cranial pressure by holding his breath and straining intensely. Immediately following the workout, he developed a severe throbbing headache localized to the posterior-inferior region of his skull, distinct from neck pain.

Initial Assessment

The patient reported no current medications, no known medical conditions, and denied tobacco use. He has a history of recreational ice hockey participation with previous minor head impacts resulting in transient confusion and temporary neck stiffness, both of which resolved completely without sequelae. Current symptoms include persistent posterior occipital discomfort exacerbated by rapid head movements or gentle head oscillations.

The Diagnostic Journey

Physical examination focused on neurological assessment, cervical spine evaluation, and palpation of the occipital region. The patient's symptoms suggested possible muscular strain of the upper cervical musculature or occipital muscle groups. Differential diagnosis included exercise-induced headache, cervical muscle strain, or exertional headache syndrome.

Final Diagnosis

Exercise-induced posterior occipital muscle strain, likely involving the upper cervical musculature and occipital muscle attachments, secondary to excessive Valsalva maneuver during strenuous exercise.

Treatment Plan

Conservative management including rest from strenuous exercise, gentle neck stretching, application of heat therapy, and over-the-counter anti-inflammatory medications as needed. Patient education regarding proper breathing techniques during resistance training to avoid excessive intra-cranial pressure buildup.

Outcome and Follow-up

Patient advised to gradually return to exercise with proper breathing techniques and to seek further evaluation if symptoms persist beyond two weeks or worsen. Emphasis placed on avoiding breath-holding during exertion and maintaining proper form during bodyweight exercises.