BOSTON—The term “airplane headache,” a newly acknowledged clinical entity in the ICHD-3, refers to a recently described headache form whose attacks are strictly related to airplane travel, mostly to the landing phase. According to a report presented at the International Headache Congress 2013 meeting, airplane headache can coexist with a similar headache form associated with diving.
Using a detailed questionnaire, Giorgio Zanchin, MD, Director of the Headache Center, Department of Neurology at Padua University, Italy, and colleagues identified among 85 patients with airplane headache, nine patients with headache attacks also occurring during free or scuba diving. These patients (five females, four males, mean age 37), who complained of airplane headache attacks during landing in more than 50% of their flights, referred to the occasional onset of jabbing, severe, unilateral headaches in the frontotemporal region during free or scuba diving. They described this headache as presenting with the same features as that experienced during airplane landing. No accompanying symptoms were reported. Three patients free dove, attaining the maximum depth of five to eight meters, and six patients scuba dove, reaching an average depth of approximately 20 meters. According to the patient reports, the pain started shortly after the ascent, reaching its peak in a few minutes. No concomitant airway disturbance was reported during diving. In eight of the nine cases, the pain occurred in more than 30% of their dives; one patient complained of the headache occasionally.
Dr. Zanchin and colleagues reported that brain MRI, angio-MRI, and cranial CT-scan for sinuses were normal in these patients.
The coexistence of headache with peculiar, overlapping features triggered by these different situations—airplane landing and ascending after diving—supports the hypothesis of a shared pathophysiologic mechanism: the rapid change of external pressure, which occurs in both conditions, not accompanied by an adequate compensation inside the cranial sinuses.