Pilates enthusiasts turn to the 80-year-old exercise technique to help strengthen their core, improve flexibility, and increase joint mobility. Some Pilates teachers even recommend what’s known as NeuroPilates to help with migraine relief. A report published in the Journal of Medical Case Reports highlights the case of a 42-year-old woman from the UK who started suffering from persistent and debilitating headaches due to her Pilates classes.

Doctors at King’s College Hospital in London were presented with a woman who had been suffering from a headache that gradually worsened over the course of four weeks after she attended a Pilates “reformer” class. The woman reported feeling a sudden “pop” in her neck while performing a certain exercise and experiencing her initial headache an hour after the class ended. Although she was able to relieve her initial headache by lying down, it got progressively worse throughout the next couple of days.

When the woman finally made an appointment with her physician, she was diagnosed with a neck muscle injury and prescribed painkillers and a muscle relaxant. Even after physiotherapy sessions, which included intensive neck manipulation, the woman continued to suffer from a headache that was only worsening over time. The woman arrived at King’s College Hospital four weeks after the initial event.

A computed tomography (CT) scan found blood pooling in two spots outside of her brain and a follow-up magnetic resonance imaging (MRI) scan revealed pockets of fluid outside the spine. Using the results of both scans, doctors concluded that a tear in the lining of her neck’s spinal cord was causing fluid to leak out. Doctors were unable to identify the origin of the leak; however, the woman recovered after bed rest and taking nonsteroidal anti-inflammatory medication.

“We present the case of a 42-year-old Caucasian woman who developed a low-pressure headache following a pilates class,” the research team explained. “A computed tomography scan of her head demonstrated bilateral chronic subdural hematomas and cerebellar descent. Magnetic resonance imaging of her spine revealed the presence of extensive extradural cerebrospinal fluid collections. She responded to conservative management and repeat neuroimaging after symptom resolution revealed no abnormalities.”

According to The American Council on Exercise, at the foundation of Pilates lies the Reformer, a wooden piece of machinery that consists of cables, pulleys, springs, and a sliding board. Pilates exercises are designed to be low impact. While this case is the first reported cerebrospinal fluid leak caused by Pilates, this type of injury is often associated with trauma, tumors, and botched sinus surgeries.

Source: Moran N, Hayee B, Dubois P, ChATU s, Yanny I, Davis J. Spontaneous cerebrospinal fluid leak following a pilates class: a case report. Journal of Medical Case Reports. 2015.