Abstract
Headache occasionally occurs during or after scuba diving. Although its significance often is benign, headache may signal a serious neurological disorder in some circumstances. In addition to the usual causes of headache, the diagnostic evaluation should consider otic and paranasal sinus barotrauma, arterial gas embolism, decompression sickness, carbon dioxide retention, carbon monoxide toxicity, hyperbaric-triggered migraine, cervical and temporomandibular joint strain, supraorbital neuralgia, carotid artery dissection, and exertional and cold stimulus headache syndromes. Focal neurologic symptoms, even in the migraineur, should not be ignored, but rather treated with 100% oxygen acutely and referred without delay to a facility with a hyperbaric chamber.
Similar content being viewed by others
References and Recommended Reading
Divers Alert Network: Report on Decompression Illness and Diving Fatalities: DAN’s Annual Review of Recreational Scuba Diving Injuries and Fatalities Based on 1998 Data. Durham, NC: Divers Alert Network; 2000.
Spira A: Diving and marine medicine part II: diving diseases. J Travel Med 1999, 6:180–198.
Cheshire WP, Ott MC: Headache in divers. Headache 2001, 41:235–247. The authors comprehensively review the differential diagnosis of headache in divers and discuss pathophysiologic mechanisms and recommendations for management.
Fagan P, McKenzie B, Edmonds C: Sinus barotrauma in divers. Ann Otol Rhinol Laryngol 1976, 85:61–64.
Keller AP: A study of the relationship of air pressures to myringorupture. Laryngoscope 1958, 68:2015–2029.
Newton HB: Neurologic complications of scuba diving. Am Fam Physician 2001, 63:2211–2218, 2225–2226. This is a sentinel review of the neurologic aspects of diving medicine, including some discussion of headache.
Rivera JC: Decompression sickness among divers: an analysis of 935 cases. Mil Med 1964, 129:314–334.
Dick AP, Massey EW: Neurologic presentation of decompression sickness and air embolism in sport divers. Neurology 1985, 35:667–671.
Knauth M, Ries S, Pohimann S, et al.: Cohort study of multiple brain lesions in sport divers: role of a patent foramen ovale. BMJ 1997, 315:701–705.
Bove AA: Risk of decompression sickness with patent foramen ovale. Undersea Hyperb Med 1998, 25:175–178.
Wilmshurst PT, Byrne JC, Webb-Peploe MM: Relation between interatrial shunts and decompression sickness in divers. Lancet 1989, 2:1302–1306.
Dutka AJ, Francis TJ: Pathophysiology of decompression sickness. In Diving Medicine, edn 3. Edited by Bove AA. Philadelphia: WB Saunders; 1997:159–175.
Moon RE, Sheffield PJ: Guidelines for treatment of decompression illness. Aviat Space Environ Med 1997, 68:234–243.
Benton PJ, Woodfine JD, Westwood PR: Arterial gas embolism following a 1-meter ascent during helicopter escape training: a case report. Aviat Space Environ Med 1996, 67:63–64.
Neuman TS, Bove AA, O’Connor RD, Kelsen SG: Asthma and diving. Ann Allergy 1994, 73:344–350.
Elliott DH: Are Asthmatics Fit to Dive? Kensington, MD: Undersea and Hyperbaric Medical Society; 1996.
Edmonds C, Lowry C, Pennefather J: Diving and Subaquatic Medicine, edn 3. Oxford: Butterworth-Heinemann; 1992.
Sliwka U, Krasney JA, Simon SG, et al.: Effects of sustained low-level elevations of carbon dioxide on cerebral blood flow and autoregulation of the intracerebral arteries in humans. Aviat Space Environ Med 1998, 69:299–306.
Englund M, Risberg J: Self-reported headache during saturation diving. Aviat Space Environ Med 2003, 74:236–241. This paper is the first prospective study of headache in a cohort of professional divers.
Heckmann JG, Hilz MJ, Katalinic A, et al.: Myogenic cerebrovascular autoregulation in migraine measured by stress transcranial Doppler sonography. Cephalalgia 1998, 18:133–137.
Totaro R, Marini C, De Matteis G, et al.: Cerebrovascular reactivity in migraine during headache-free intervals. Cephalalgia 1997, 17:191–194.
Greer HD: Neurologic consequences. In Diving Medicine, edn 3. Edited by Bove AA. Philadelphia: WB Saunders; 1997:266.
Harer C, von Kummer R: Cerebrovascular CO 2 reactivity in migraine: assessment by transcranial Doppler ultrasound. J Neurology 1991, 238:23–26.
Hannerz J, Jogestrand T: Provocation of unilateral pain in cluster headache patients by breathing CO 2. Headache 1995, 335:38–43.
Clark JM, Thom SR: Toxicity of oxygen, carbon dioxide, and carbon monoxide. In Diving Medicine, edn 3. Edited by Bove AA. Philadelphia: WB Saunders; 1997:131–145.
Gold D, Geater A, Aiyarak S, Juengpraert W: The indigenous Sea Gypsy divers of Thailand’s west coast: measurement of carbon monoxide in the breathing air. Appl Occup Environ Hygiene 1999, 14:488–495.
Austin CC, Ecobichon DJ, Dussault G, Tirado C: Carbon monoxide and water vapor contamination of compressed breathing air for firefighters and divers. J Toxicol Environ Health 1997, 52:403–423.
Hobson RS: Temporomandibular dysfunction syndrome associated with scuba diving mouthpieces. Br J Sports Med 1991, 25:49–51.
Roydhouse N: 1001 disorders of the ear, nose, and sinuses in scuba divers. Can J Appl Sport Sci 1985, 10:99–103.
Balestra C, Germonpre P, Marroni A, Snoeck T: Scuba diving can induce stress of the temporomandibular joint leading to headache. Br J Sports Med 2004, 38:102.
Ingervall B, Warfvinge J: Activity of orofacial musculature during use of mouthpieces for diving. J Oral Rehabil 1978, 5:269–277.
Jacobson RI: More "goggle headache:" supraorbital neuralgia. N Engl J Med 1983, 308:1363.
Pestronk A, Pestronk S: Goggle migraine. N Engl J Med 1983, 308:226–227.
Sjaastad O, Fredriksen TA, Pfaffenrath V: Cervicogenic headache: diagnostic criteria. Headache 1998, 38:442–445.
Gibbs JW 3rd, Piantadosi CA, Massey EW: Internal carotid artery dissection in stroke from scuba diving: case report. Undersea Hyperb Med 2002, 29:167–171.
Nelson EE: Internal carotid artery dissection associated with scuba diving. Ann Emerg Med 1995, 25:103–106.
Sands GH, Newman L, Lipton R: Cough, exertional, and other miscellaneous headaches. Med Clin North Am 1991, 75:733–747.
Neuman TS: Near drowning. In Diving Medicine, edn 3. Edited by Bove AA. Philadelphia: WB Saunders; 1997:218.
Bove AA: Medical Examination of Sport Scuba Divers, edn 3. San Antonio: Medical Seminars Inc.; 1998.
Anderson B Jr, Heyman A, Whalen RE, Saltzman HA: Migrainelike phenomena after decompression from hyperbaric environment. Neurology 1965, 15:1035–1040.
Harries M: Ice cream headache: ice cream headache occurred during surfing in winter. BMJ 1997, 315:609.
Williamson JA, Fenner PJ, Burnett JW, Rifikin JF: Venomous and Poisonous Marine Animals: A Medical and Biological Handbook. Fortitude Valley: University of New South Wales Press; 1996.
Barss PG: Penetrating wounds caused by needle-fish in Oceania. Med J Aust 1985, 143:617–622.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Cheshire, W.P. Headache and facial pain in scuba divers. Current Science Inc 8, 315–320 (2004). https://doi.org/10.1007/s11916-004-0015-y
Issue Date:
DOI: https://doi.org/10.1007/s11916-004-0015-y