Headaches & Diving

Allow me to start off by saying that in most instances, diving related headaches are of minimal consequence.

There is a myriad of potential causes very much determined by where in the diving profile the headaches begin or intensify. The causes of headaches can be divided up in to physical (pressure induced) and physiological (normal human functioning). For ease of classification, divide the dive profile into the three core phases namely, the descent, bottom time and ascent.

Descent

These headaches are almost by definition pressure related sinus headaches. There are a few different sinuses and so the pain may be felt above the eye (in the forehead), or below the eye (in the cheekbone). This pain is due to an inability for the pressure in the sinus to be equalised with the ever-increasing water pressure. The end result is swelling of the tissues, bleeding and pain. Ascending till the pain relieves and gentle equalisation might help, otherwise it may be wise to terminate the dive. Ear problems can also cause headaches on descent, given the origin of the pain; it is usually quite clear where the pain comes from. Dental pain can be referred and result in a vague "sinus-like" pain and is often misdiagnosed as a result. Lastly, migraine or 'vascular' headaches can also start on the descent if they are triggered by exertion.

Bottom Time

By the time the diver has reached the desired depth, new headaches are not that likely to be due to pressure changes unless the diver is swimming over reef at different depths or has endured the pain of inadequate equalisation of the sinuses. Common causes include more of the 'physiological' headaches referred to earlier, CO2 headaches being the most common. As a result of trying to conserve air, divers skip breathe and levels of CO2 build up in the blood causing excruciating headaches that often persist till well after the dive. Carbon monoxide from contaminated air also now starts playing a role in headache origin, but hopefully a reputable dive charter has addressed that… Migraine headaches still continue to provide their two cents worth and may be debilitating, for this reason, migraine sufferers who have transient neurological signs should not dive.

Tension headaches, especially in those 'teeth-clenching' diver types will now also start to feel a dull throbbing ache due to the constant straining of the muscles in their jaws. All those divers who suffer from motion sickness won't need reminding of the headache that often accompanies the nausea. Lastly, divers who suffer from uncontrolled hypertension may also suffer headaches throughout the dive. These headaches are not diving induced, but may be noticed while relaxing on a dive. Medical attention is needed to manage the hypertension.

Ascent

This phase of the dive is often where the already established headache continues and is often unfairly blamed for the woes of the unimpressed diver. Headaches beginning in this phase of the dive may be either physical or physiological. Reverse block of sinuses, ears and teeth cause a sudden sharp pain that worsens with continued ascent (this is often the realm of the congested diver diving on decongestants that wear off!!). CO2 headaches intensify on the ascent and are also often associated with nausea on the surface. Decompression sickness (DCS) may manifest on the ascent and also present with headaches. This is often associated with neurological signs and symptoms (such as loss of muscle power, sensation and even loss of consciousness). All headaches should be avoidable, visits to your diving doctor and a healthy dose of common sense should stand you in good stead. Happy diving.

 

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