Headache in Divers

Abstract

The increasing popularity of scuba diving has added a new category to the differential diagnosis of headache. Headache in divers, while uncommon and generally benign, can occasionally signify serious consequences of hyperbaric exposure such as arterial gas embolism, decompression sickness, and otic or paranasal sinus barotrauma. Inadequate ventilation of compressed gases can lead to carbon dioxide accumulation, cerebral vasodilatation, and headache. Other types of headache encountered in divers include exertional headache, cold stimulus headache, migraine, tension-type headache, acute traumatic headache, cervicogenic headache, carbon monoxide poisoning headache, and headache associated with envenomation. Correct diagnosis and appropriate treatment require a careful history and neurologic examination as well as an understanding of the unique physiologic stresses of the subaquatic environment.

Visual aura in ice cream headache

“…Local cooling would also lead to a sequence of waning and subsequent waxing arterial flow. Thus the pain may appear as a consequence of a direct cold pressor effect, as it has been described during surfing in winter and in divers [6], although autoregulation that protects the brain from any systemic vascular changes should be overtaken in order to get to the painful aftermath. The exposure of the head to low temperatures triggers a headache not distinct from the cold stimulus variety.…”

Unexplained Extensive Skull Base and Atlas Pneumatization

“…Barotrauma to the middle ear of divers that is caused by a failure to equalize the pressure between the middle ear and the ambient pressure, with trapped air subjected to a pressure gradient, 11,12 even during free diving, has been well described in the literature. 13 To the best of our knowledge, only 6 previous cases of craniocervical pneumatization without a history of trauma have been reported.…”

Sports-related headache

“…Various non-contact sports such as swimming, running, or cycling can be associated with headache [5,[17][18][19][20]. These usually take the form of benign exertional headache or effort headache.…”

“…Cerebral involvement is common with AGE and spinal cord involvement is common with DCS, which may explain the increased incidence and severity of headache in the former. AGE is the second cause of mortality in divers, especially during rapid ascents [17]. Severe headache is a common manifestation of cerebral AGE and can be associated with cognitive deficits, focal neurological signs, and loss of consciousness.…”

“…Barotrauma headache or facial pain result from trapped air subjected to a pressure gradient, which injures tissues [17]. For example, negative pressure in the mask, which is commonly called mask squeeze, damages periorbital tissue and conjunctional vessels and precipitates facial and head pain.…”