Headache attributed to airplane travel: diagnosis, pathophysiology, and treatment – a systematic review

Abstract

BackgroundHeadache attributed to airplane travel, also named "airplane headache" (AH) is a headache that occurs during take-off and landing. Today, there are still uncertainties about the pathophysiology and treatment of AH. This systematic review was performed to facilitate identification of the existing literature on AH in order to discuss the current evidence and areas that remain to be investigated in AH.MethodsThe systematic literature search was performed in 3 relevant medical databases; PubMed, Scopus, and Embase. The search yielded 220 papers and the papers were sorted based on inclusion and exclusion criteria established for this study.ResultsThis systematic review included 39 papers. Main findings revealed that AH attacks are clinically stereotyped and appear mostly during landing phases. The headache presents as a severe painful headache that often disappears within 30 min. The pain is unilateral and localized in the fronto-orbital region. Sinus barotrauma has been considered as the main cause of AH. Nonsteroidal anti-inflammatory drugs and triptans have been taken by passengers with AH, to relieve the headache.ConclusionsBased on this systematic review, further studies seem required to investigate underlying mechanisms in AH and also to investigate the biological effects of nonsteroidal anti-inflammatory drugs and triptans for alleviating of AH. These studies would advance our understanding of AH pathogenesis and potential use of treatments that are not yet established.

An Anecdotal Case of Treatment of Headache Attributed to Airplane Travel: Are Triptans an Option?

“…Headache attributed to airplane travel (airplane headache (AH)) is a painful headache that occurs during the takeoff and/ or landing; however, the headache mostly appears during the landing [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. There is still uncertainty about the treatment of AH, but the current literature indicates that pharmacological treatments such as triptans might be effective for AH [4]. We present a patient in Denmark who has used triptans with beneficial effects on AH.…”

Headache Attributed to Aeroplane Travel: An Historical Outline

“…The official insertion of AH in the international classification attracted the attention of the scientific community; subsequently and up until publication of this article, 45 publications in English on the topic have been published …”

Ocular problems associated air traveling

“…It has been considered that barotrauma associated with trigeminal nerve endings in the ethmoid sinuses causes the frontoorbital pain in this clinical entity. [14][15][16] It has been speculated that the vasodilation in the cerebral arteries which developed during an AHAattack may be induced by prostaglandin E2. 14,17 Although there is no specific treatment or prophylaxis for AHA, it has been demonstrated that several medications including analgesics, nonsteroidal antiinflammatory drugs or triptans may have beneficial effects as prophylactic therapy.…”

“…[14][15][16] It has been speculated that the vasodilation in the cerebral arteries which developed during an AHAattack may be induced by prostaglandin E2. 14,17 Although there is no specific treatment or prophylaxis for AHA, it has been demonstrated that several medications including analgesics, nonsteroidal antiinflammatory drugs or triptans may have beneficial effects as prophylactic therapy. However, drugs and nasal spray decongestants should be taken prophylactically approximately 30 minutes and 30-60 minutes, respectively before the expected triggering phase (ascending or descending phase) of the flightto obtain optimal results.…”

“…Some maneuvers including compression on pain region, Valsalva maneuver, extension of the earlobe, chewing, or yawning can provide a relief of %25 in pain intensity. [14][15][16][17] Dry-eye is the most common problem in the air travelers. As air humidity in the cabin of the aircraft is often lower than 20% of humidity rate and the air in the pressurized cabin is dehydrated, dryness in both skin and ocular surfaces usually occur.…”