Dehydration Headache

[ft_critical]

Dear Dr BNA,

Recently, 3 times, after long rides, the day after, I have experienced the gradual onset of (self-diagnosed) a dehydration headache. The only other symptom is burning, dry lips.

Letting the same bad thing happen many times is insane. So yesterday, I drank lots. 133km ride with 750ml water, 500ml powerade. 2x750ml water on getting home. Then probably another 1.5l during the afternoon and evening. Today, around 12pm it started to drift into a headache. I have had 2l of water today.

I guess what I am somewhat surprised about is that I don't appear to be retaining the water (self-diagnosed). Anyone else experience this?

If I take two pain killers and more water I will be fine to ride tomorrow...

Cheers,

FT

[CKinnard]

Pre-hydrate
when you wake up in the morning, you are going to be down at least 500-1000mls.
that needs to be replaced before you go near the bike.

Event hydration
when on the bike, you want to be peeing every 1.5-2 hours. If you don't, then you are dry.
Check the color of your urine. Keep it lighter than chardonnay.

Post hydration
You want to keep your urine light in color, and continue to be every 1.5-2 hours.
This will help your kidneys dump metabolic waste and damaged cellular products from your big catabolic day out.

As for headaches, usually it is not the dehydration that is causing the headache, especially if it can be settled overnight. It is usually cervical spine facet joint irritation due to lack of lubrication. This leads to local inflammation which irritates the nerve roots of sensory nerves supplying the dermatomes over the head and behind the eye. Usually this headache is only on one side, or much worse on one side.

Get a good physio to mobilize the crap out of those cervical joints. They've probably got capsular thickening and shortening over years of road bike positioning. And get them to show you self exercises to keep them from stiffening up again.

[cyclotaur]

+1 for Pre-Hydration. And I'd say that a total of only 1.25l for 133km ride is on the low side.

Also, recent acquisition of accurate scales confirms I can lose up to 1kg overnight, if I don't wake up a have a drink at some point.

[TheWall]

Agree that pre and during ride hydration efforts look a little on the low side. One thing I read in lots of different places (and we all tend to adopt things if they suit our view on the world ) is that milk, and specifically full fat chocolate milk, is the best immediate post effort recovery drink. Much better than the Gatorades and like.

Could it also be diet related, more specifically not enough carbs? I have had that problem before...

[ValleyForge]

Sadly, dehydration does not produce headaches. It is commonly blamed but not responsible.
Exercise induced headache is much more common.

Pre-hydration has a lot of proponents but makes little sense as the metabolic response to exercise occurs after you have consumed extra water (assuming you start euvolemic) so the extra liquid ends up in your bladder. Logic would say trigger the exercise response first and then drink.

As to what you drink while you ride - here we go again

[trailgumby]

specifically full fat chocolate milk, is the best immediate post effort recovery drink. Much better than the Gatorades and like.

Not full fat. Otherwise, excellent advice that is supported by sports science literature. No need to pay for exxy specialist concoctions, which are often just freeze dried versions of this anyway.

Why no fat? The fat inhibits uptake of the protein. Skim milk sugar-sweetened chocolate (or strawberry or banana if you are like me and caffeine intolerant) milk is best. Needs to be taken in the first half-hour (some literature says up to an hour, but the earlier the better) so the sugar helps transport the protein to the muscles, according to my reading. Outside this wndow, the sugar just follows the normal metabolic pathways to the love handles.

On longer rides, my bidons towards the end of the session contain a 20% protein mix. I have found that helps recovery too.

On the mountain bike I am typically consuming one 750ml bidon per hour, more during summer. It seems to be less on the roadie, and I can get away with 2 bidons for the 100km. That may be because of the loooong coffee stop in the middle

Your pee should be a pale straw colour. Any darker and you are dehydrated,

[human909]

Sadly, dehydration does not produce headaches.

That goes against common medical knowledge.

Exercise induced headache is much more common.

Not sure about that medical assessment either.


I've experienced dehydration based headaches from too little salt.

Dear Dr BNA,

Recently, 3 times, after long rides, the day after, I have experienced the gradual onset of (self-diagnosed) a dehydration headache. The only other symptom is burning, dry lips.

Letting the same bad thing happen many times is insane. So yesterday, I drank lots. 133km ride with 750ml water, 500ml powerade. 2x750ml water on getting home. Then probably another 1.5l during the afternoon and evening. Today, around 12pm it started to drift into a headache. I have had 2l of water today.

I guess what I am somewhat surprised about is that I don't appear to be retaining the water (self-diagnosed). Anyone else experience this?

If I take two pain killers and more water I will be fine to ride tomorrow...

Cheers,

FT

In my experience I've had headache issues from insufficient salt. Often happens after several days in the outdoors and a low sodium intake during that time. I'm now more concious to take in more salt when I'm sweating. It could be sports drink or a packet of crisps.

[cyclotaur]

....
Pre-hydration has a lot of proponents but makes little sense as the metabolic response to exercise occurs after you have consumed extra water (assuming you start euvolemic) so the extra liquid ends up in your bladder. Logic would say trigger the exercise response first and then drink.
.....

My comment supporting pre-hydration pretty was much based on the common habit of riders to leap out of bed early and shoot out the door and do a long ride. If I know I'm heading out early next morning (say ATB or AAC ride with an early start) I drink extra the night before - water that is.

It's pretty hard to re-hydrate from overnight de-hyrdation once you're out and riding.

[ValleyForge]

Sadly, dehydration does not produce headaches.

That goes against common medical knowledge.

Exercise induced headache is much more common.

Not sure about that medical assessment either.


I've experienced dehydration based headaches from too little salt.

I'm not going to get involved in this discussion, but please consider that I do know this topic well.

[ValleyForge]

specifically full fat chocolate milk, is the best immediate post effort recovery drink. Much better than the Gatorades and like.

Not full fat. Otherwise, excellent advice that is supported by sports science literature. No need to pay for exxy specialist concoctions, which are often just freeze dried versions of this anyway.

Actually, the research was on full-fat milk. And in the volumes consumed, we are talking about one to two grams of fat difference to low fat milk.

[g-boaf]

Pre-hydration has a lot of proponents but makes little sense

How would you approach a 160 lap event (approx. 240m laps) where you do not and cannot have a bidon on the bike? I know how to handle that myself, I'm just wondering what you'd suggest?

[Calvin27]

Sadly, dehydration does not produce headaches. It is commonly blamed but not responsible.
Exercise induced headache is much more common.

Pre-hydration has a lot of proponents but makes little sense as the metabolic response to exercise occurs after you have consumed extra water (assuming you start euvolemic) so the extra liquid ends up in your bladder. Logic would say trigger the exercise response first and then drink.

As to what you drink while you ride - here we go again

Interesting. I've always been a silent proponent of this, basically it just makes me pee more and lose precious sleep. your thoughts on the whole carb loading retains more fluid thing?

[ft_critical]

Okay, not sure what to think now. But, I am not a pre-hydrater you got me there, so I will do that.

The not related to dehydration is interesting - certainly something to ponder. I did stretch out pretty well afterwards, recovery ride next day... I am fine today after a medium ride.

Urine was okay throughout, the burning lips not relevant?

[CKinnard]

Pre-hydration has a lot of proponents but makes little sense as the metabolic response to exercise occurs after you have consumed extra water (assuming you start euvolemic) so the extra liquid ends up in your bladder. Logic would say trigger the exercise response first and then drink.

Euvolemia and dehydration mean very different things.

OP, regarding burning lips, it could be a combo of dry wind and dehydration.
I don't know where you live or how cold it was on your ride. Obviously you are not going to sweat as much in cooler weather, but your level of overnight fluid loss can be worse due to drier winter air or air conditioning.

Keep in mind most electrolyte drinks sold on supermarket shelves are not designed for endurance sport, unless they specifically say so.
The ones that are have over 800mg sodium per prepared liter. Potassium ratio can vary significantly but should be at least 15% of sodium. These formula make a difference to performance (according to the literature) and to dehydration headache and cramps (according to my involvement in multiple endurance charity and competitive events as a first aider, and elite cycling including Team Sky this year).

[Duck!]

So yesterday, I drank lots. 133km ride with 750ml water, 500ml powerade. 2x750ml water on getting home. Then probably another 1.5l during the afternoon and evening. Today, around 12pm it started to drift into a headache. I have had 2l of water today.

I'm seeing a lack of electrolyte replenishment. Water content is only one element of hydration, you also need to replace the mineral salts that you lose through sweat. These salts - the electrolytes - are important for helping getting water into the tissue cells, and for transmitting signals from the nerves into the muscle and other tissues. With depleted electrolytes, water isn't getting where it's needed and muscles become more prone to cramping (although there are other factors that contribute to cramping, not just electrolyte depletion).

Short version - increase the electrolytes in the fluid intake.

[trailgumby]

specifically full fat chocolate milk, is the best immediate post effort recovery drink. Much better than the Gatorades and like.

Not full fat. Otherwise, excellent advice that is supported by sports science literature. No need to pay for exxy specialist concoctions, which are often just freeze dried versions of this anyway.

Actually, the research was on full-fat milk. And in the volumes consumed, we are talking about one to two grams of fat difference to low fat milk.

Um, I think you may want to revisit the math.

Full fat milk is 3.5-4% fat. At 600ml that's 20-24g fat, compared with 3-3.5% protein. which is 18-20g for the same volume. I'm not sure how that can be construed as insignificant?

Skim milk (as opposed to "low fat", which is generally half the fat of full cream milk) by comparison typically has less than 0.3% fat. At 600ml that's 1.8g of fat, for a 22gram difference.

Seems to me you're out by a factor of x10?

[trailgumby]

So yesterday, I drank lots. 133km ride with 750ml water, 500ml powerade. 2x750ml water on getting home. Then probably another 1.5l during the afternoon and evening. Today, around 12pm it started to drift into a headache. I have had 2l of water today.

I'm seeing a lack of electrolyte replenishment. ... Short version - increase the electrolytes in the fluid intake.

I concur.

I'd also suggest using something other than those dreadful sugar-laden "sports" drinks. You would do just as well with lemon cordial and a teaspoon of salt.

Products like Endura Rehydration are much better, as they substitute a majority of the sugar for starch in the form of maltodextrin, which has a much more sustained burn, avoiding the excessive insulin spike and subsequent hole that will put you in a not very pleasant place. The blending of potassium and magnesium salts instead of simple (sodium chloride) table salt is also a better balance, and while you need to let your stomach adapt to it, the magnesium helps with cramping.

No I don't have shares in the company Although, I wouldn't mind. My personal preference is Hi5 based on price and performance. It lacks magnesium, which I sometimes add separately for races and high intensity workouts.

[TheWall]

Not full fat. Otherwise, excellent advice that is supported by sports science literature. No need to pay for exxy specialist concoctions, which are often just freeze dried versions of this anyway.

Actually, the research was on full-fat milk. And in the volumes consumed, we are talking about one to two grams of fat difference to low fat milk.

Um, I think you may want to revisit the math.

Full fat milk is 3.5-4% fat. At 600ml that's 20-24g fat, compared with 3-3.5% protein. which is 18-20g for the same volume. I'm not sure how that can be construed as insignificant?

Skim milk (as opposed to "low fat", which is generally half the fat of full cream milk) by comparison typically has less than 0.3% fat. At 600ml that's 1.8g of fat, for a 22gram difference.

Seems to me you're out by a factor of x10?

Ok you two...off to the New Thread for you both. Let's save this thread for this topic eh?

Introducing the Chocolate Milk is the Best Recovery Drink Thread: viewtopic.php?f=49&t=91188&p=1362307#p1362307

[Derny Driver]

My take:
Its not dehydration.
Look elsewhere.

[Duck!]

Endura is a good product, but a word of caution: the magnesium content gives it a flavour and consistency that does not agree with some people, so get a single-serve sachet - available at Endura stockists - before lashing out on a big tub of the stuff just in case you don't like it. A good alternative is Torq; like Endura it contains its energy component in a slower-burn form than basic sugar, and has a good electrolyte balance that includes magnesium, in a much more palatable consistency. It is my preferred mix.

Disclosure: I work in a shop that sells Torq, Endura, Hammer and Isowhey sports nutrition products. I choose Torq out of all of them because I like them the most.

[ft_critical]

Thanks all. I will get some better quality sports drink - I only use Powerade because it can arrive in my weekly Coles online order; probably says it all right there. I will have a glass of milk when I get home too.

I do lean towards the conclusion that although I was dehydrated, the source of the headache was more probably skeleto-muscular.

[g-boaf]

Torq is very, very good. Skratch labs is okay too, but Torq is more agreeable (for me at least). Endura okay, but Torq is the best I've found - it doesn't cause the stomach upsets that some of the others can do.

Gatorade is also decent, mainly because it is readily available and I find it is easy to consume without the risk of stomach upset.

I've had the same sort of headache you describe, it was after a 175km ride which I'd done very fast - I felt tired, had something to eat and drink when I went home, then went to sleep for a while and woke up feeling absolutely dreadful, headache, etc.

It shifted only after eating an enormous bowl of pasta and a couple of glasses of coke...

[CKinnard]

I do lean towards the conclusion that although I was dehydrated, the source of the headache was more probably skeleto-muscular.

It's usually a combination. If it was just musculoskeletal, you'd get a headache most times you do long rides.
When you combine a long ride on a roadie with head down and neck muscles contracting for hours, with a lack of fluid turnover through the neck joints, inflammation of the joints is more likely....and that inflammation will irritate the nerve roots of nerves that receive signals from your scalp and behind your eyes. I've had these headaches myself and have treated thousands over 20 years (and at least 200 cyclists), and have discussed at length with one of my old uni lecturers and a world's leading expert in headache (google gwen jull headache).

The other cause of dehydration associated headache is reduced fluid cushioning the brain (cerebrospinal fluid). When this occurs, the weight of the brain can pull on the lining of the brain (duramater and meninges) and lead to irritation of pain receptors.

The two types of headaches have very different presentations though, and ime the more common is neck joint irritation causing cervicogenic headache.

As for electrolytes, the ones that are used by professionals today are based on reverse engineering sweat. That doesn't include high magnesium formula.

[ft_critical]

Thanks. Don't hate me for using pain killers. I took high strength paracetamol and codine tablets and though I felt somewhat euphoric, I still had the headache. Later I took a single ibuprofen and it went away and hasn't returned.

So the inflammation plus dehydration stacks up. All rides where I have had this headache were long and included a race - so high on intensity.

I used to to put Magnesium supplement in my drink bottles for cramp. But it didn't work because it was that my muscles were not used to the high intensity for a long distance. Improved training fixed the cramp. I really don't much care for it now.

[CKinnard]

Yep, these kinds of headaches respond pretty much to anti-inflammatory meds only.... like ibuprofen, but better to diclofenac (voltaren)...though a much higher dose than over the counter is often necessary. i.e. 50-75mg every 2-3 hours for 6-9 hours. The best treatment for more severe cases is
- the meds
- at least a liter of electrolyte every hour until symptoms get down to 4/10
- a healthy balanced meal.
- resting in bed to take the load off the neck joints, and ice therapy for the 3 upper neck joints (don't use an ice pack. it's got to be a wet ice application using crushed ice in a wet wrung tea towel. lay down a bath towel underneath to keep everything dry.)
- gentle manual traction of your neck by a friend can also give enormous relief. they sit behind you and cradle your head and pull your head gently away from your spine, oscillating slowly.

Now you know!

Regarding sweat, a sample from sub tropical heat looks like this:
Sodium 800mg/L
Potassium 150mg/L
Calcium 25mg
Magnesium 12mg
zinc 0.6mg

So large amounts of magnesium in a formula has nothing to do with sweat losses, and more to do with the wrong old wive's tail that magnesium causes cramps.