The Case of the Woman Who Did Never Dare to Fly: Headache Attributed to Imbalance Between Intrasinusal and External Air Pressure

Abstract

Background: A new form of headache, Headache attributed to aeroplane travel (AH), has been recognized within the International Classification of Headache Disorders 3 beta (ICHD-3beta). In 8 out of 85 AH cases we identified the coexistence of a headache with identical features of AH, but appearing during the rapid descent by car from a high mountain. Pain began shortly after the rapid descent from a medium altitude of 1920 m above sea level, the maximum peak of intensity developing within a few minutes. All of the patients reported the disappearance of pain within 20 minutes of the rapid descent.

Case: We recently observed a 36-year-old woman who experienced recurrent headache attacks that were constantly triggered by rapid descent from high altitude by car. Negatively shaped by this experience, the patient never dared to fly.

Conclusion: Headache attacks sharing the same features and occurring in three distinct conditions of pressure variations (aeroplane travel, rapid altitude mountain descent, snorkelling, or scuba diving) have already been reported, although the last two only anecdotally. If confirmed by further case series, they could be gathered together in a unique heading: Headache attributed to imbalance between intrasinusal and external air pressure within the 10th chapter: Headache attributed to disorders of the homoeostasis.

Keywords: airplane headache; free or scuba diving headache; rapid descent from altitude headache.