The Pressure of Air Travel: Headaches on the Plane

Abstract & Commentary

By Dara G. Jamieson, MD, Associate Professor, Clinical Neurology, Weill Medical College, Cornell University. Dr. Jamieson is a consultant for Boehringer Ingelheim and Merck, and is on the speaker's bureau for Boehringer Ingelheim, Merck, Ortho-McNeil, and Pfizer.

Synopsis: Barotrauma to the paranasal sinuses may cause sudden and severe headache during airplane travel.

Source: Berilgen MS, Mungen B. Headache Associated with Airplane Travel: Report of Six Cases. Cephalalgia. 2006:26:707-711.

This summer, most headaches caused by airplane travel will be due to long security lines and delayed take-offs. But once the plane is in the air, more than just cramped seats and lack of food may cause headaches. Berilgen and colleagues describe 6 men in their 30s and 40s who suffer from intermittent but recurrent, severe, short lasting, unilateral, periocular headaches thought to be related to sinus barotrauma, caused by changes in cabin pressure. The most severe pain lasted from 15-20 minutes. Five of the men described the headaches as occurring during landing, especially at seaside airports. Only one man had an occasional headache of the same description while a plane was gaining altitude. Most of the men did not have any accompanying symptoms, and only half had any other headache type. None suffered from cluster-like headaches. Three of the men had a long smoking history. No abnormalities were found on a thorough evaluation of the men, including brain and sinus imaging, performed soon after a headache.

Commentary

Subclinical congestion and inflammation in the ethmoid sinus and middle turbinate mucosa, with a vacuum effect triggering ethmoid nerve branches of the trigeminal nerve and nociceptors on the anterior ethmoid artery, is a possible explanation for the attacks. The name barotrauma-related headache was suggested to identify the mechanism of these brief but severe, travel-related headaches. Prevention of these headaches may be possible with the use of a potent nasal and sinus decongestant (oxymetazoline) prior to boarding the airplane and just before the approach to landing.