Simulated airplane headache: a proxy towards identification of underlying mechanisms

Abstract

BackgroundAirplane Headache (AH) occurs during flights and often appears as an intense, short lasting headache during take-off or landing. Reports are limited on pathological mechanisms underlying the occurrence of this headache. Proper diagnosis and treatments would benefit from identification of potential pathways involved in AH pathogenesis. This study aimed at providing a simulated airplane headache condition as a proxy towards identification of its underlying mechanisms.MethodsFourteen participants including 7 volunteers suffering from AH and 7 healthy matched controls were recruited after meeting the diagnostic and safety criteria based on an approved study protocol. Simulation of AH was achieved by entering a pressure chamber with similar characteristics of an airplane flight. Selected potential biomarkers including salivary prostaglandin E2 (PGE2), cortisol, facial thermo-images, blood pressure, pulse, and saturation pulse oxygen (SPO) were defined and values were collected before, during and after flight simulation in the pressure chamber. Salivary samples were analyzed with ELISA techniques, while data analysis and statistical tests were handled with SPSS version 22.0.ResultsAll participants in the AH-group experienced a headache attack similar to AH experience during flight. The non-AH-group did not experience any headaches. Our data showed that the values for PGE2, cortisol and SPO were significantly different in the AH-group in comparison with the non-AH-group during the flight simulation in the pressure chamber.ConclusionThe pressure chamber proved useful not only to provoke AH-like attack but also to study potential biomarkers for AH in this study. PGE2, and cortisol levels together with SPO presented dysregulation during the simulated AH-attack in affected individuals compared with healthy controls. Based on these findings we propose to use pressure chamber as a model to induce AH, and thus assess new potential biomarkers for AH in future studies.

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].…”

“…After these two AH attacks, he contacted the GP as the headache pain was so severe that he decided not to fly anymore unless the doctor could find a solution for him. Afterwards, he requested a referral to a neurologist where he brought the AH papers by Bui et al [3][4][5] on possible treatments for AH for the consultation. The neurologist agreed to try triptans as a preventative treatment for him, one pill of rizatriptan (regular tablet), 10 mg, 30 min before a flight.…”

“…This may cause a sinus barotrauma and subsequently a local inflammation in the tissue [2-6, 8, 10, 12, 13, 16]. Prostaglandin E2 has been shown significantly elevated during the landing in a group of AH patients, which may indicate a local inflammation in the sinuses and thereby cause a potential vasodilation in the cerebral arteries followed by the characteristic symptoms of an AH attack [5], but it is still unknown if other substances are altered. It is known that calcitonin gene-related peptide (CGRP) is increased during migraine attacks where CGRP is also thought to induce vasodilation in the cerebral arteries [18].…”

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 …”

“…Although the previously described peculiar clinical features of AH have been confirmed, the exact physiopathology remains uncertain. An experimental model, reproducing the one performed by Marchoux and Nepper in 1919, in which the characteristics of an airplane flight was simulated by entering a pressure chamber, while confirming the fundamental role played by the imbalance between sinusal and external air pressure, did not provide convincing explanation of the consequent headache . The authors reported high concentrations of cortisol in a group of 7 AH sufferers in comparison to 7 healthy controls, and thus proposed a possible role of anxiety.…”