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Travel on Airplanes Brings Painful Headaches

Researchers from two hospitals in Italy have been studying what they call “airplane headache” (AH) and recommend that the disorder be included in the next update to the International Headache Society classification. Such a move, the authors say, would bring more studies and better understanding of AH and how it might be prevented.

In recent years, these authors have followed 75 people who contacted them about experiencing AH and have developed a profile of the painful disorder.

Men (61%) are more likely to experience the headaches than women; most typically, the headaches appear when people are in their 30s. While the headaches can occur in any portion of a flight, most people (87%) reported them only during landing. In more than 85% of the cases, the headaches are unilateral and most frequently located in the frontal areas of the head. All 75 study participants classified the pain as severe. In most AH episodes, the pain escalates within seconds then subsides within 30 minutes.

None of the study participants had clinical evidence of an active sinus disorder during their attacks, and more than 50% of the participants experienced at least one other kind of primary headache. The pain of this disorder is so severe that roughly 75% of the patients said the headaches cause a significant emotional impact and affect their decisions about flying.

Roughly 30% of the participants took medications to treat the pain. Most effective were nonsteroidal anti-inflammatory agents (NSAIDs) taken 30 to 60 minutes before the expected problem portion of the flight. The authors note some studies have also shown triptans to be beneficial.

The researchers, led by Frederic Mainardi, MD, from the SS Giovanni e Paolo Hospital in Venice, believe that several factors are responsible for the headaches, including abnormalities of the sinus outlet; environmental factors, such as cabin pressure and speed of the aircraft, and other factors that affect the sinuses, such as mucosal edema.

“Each year approximately 1 billion people travel by air on domestic and international airlines, and it has been predicted that in the next two decades, the number of passengers will double. Therefore, AH will increasingly become a more common and relevant condition,” the authors wrote. “Its formal validation would favor further studies aimed at improving the understanding of the pathophysiology and implementing preventative measures.”

At the National Headache Foundation, founder and Executive Chairman Seymour Diamond, MD, noted that altitude headaches have been described extensively throughout medical literature for a number of years. The decreased oxygen in present-day pressurized cabins makes it difficult to differentiate “airplane headache” from “altitude headache,” he said, and believes further study is necessary in order to facilitate a more definitive classification.

The article appeared in the April 5 issue of Cephalalgia.

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