Flying is a headache for most people, but for some that figure of speech becomes literal, researchers say.
In 2004, doctors reported the first case of "airplane headache" in the medical literature. Three dozen more cases were documented in the following years.
The unusual head pain is specific: severe pain, usually on one side of the head and near the eye that flares up during an airplane landing. Whether "airplane headache" is a distinct condition is still up for debate. But Italian researchers are arguing that it should be considered a new subtype of headache.
In a recent article in Cephalalgia, they report on another 75 people with complaints that fit the signs of airplane headache. And they suggest a list of criteria for diagnosing it.
Is it unique?
Whether airplane headache will someday be officially recognised in the International Classification of Headache Disorders is anyone's guess.
"Is (airplane headache) a unique disorder? I think it is. But others might disagree," said Dr R. Allan Purdy, a neurologist and professor at Dalhousie Medical School in Halifax, Canada.
Classifying airplane headache as a distinct disorder would allow it to be studied more directly, according to Dr Purdy, who wrote an editorial on the report.
"Nobody knows what causes it," Purdy said. "Nobody knows how many people have it. Nobody knows what treatments work."
In this most recent report, researchers led by Dr Federico Mainardi, of Giovanni e Paolo Hospital in Venice, describe 75 people with symptoms suggestive of airplane headache.
Headache short lived
Those individuals had contacted the doctors – mostly by email – after reading a case report of airplane headache Dr Mainardi's team had published in 2007. The researchers had all these people complete detailed questionnaires to delve deeper into their symptoms.
Overall, respondents' symptoms fit the features of past cases of airplane headache – severe pain on one side of the head that was usually limited to the time when the plane was landing.
The headache was almost always short-lived – less than 30 minutes for 96% of people. Only a minority consistently had headaches during airplane landings; for most, it happened on some flights but not others.
There are limitations to the report, Dr Mainardi and his colleagues acknowledge.
Except for three individuals who had physical exams, the rest were assessed long-distance.
Pain related to sinus cavities
Dr Purdy agreed that's a shortcoming – and said that some people in the group may well have had other reasons for their head pain.
But taken along with earlier case reports, Dr Purdy said he thinks there's enough evidence to suggest that airplane headache may be a "new and unique disorder."
It's not clear what, precisely, might trigger headaches during airplane landings. But one theory is that the pain may be related to pressure changes in the sinus cavities.
Another question is why only some passengers would succumb to airplane headaches. But Dr Purdy pointed out that just over half of the people in the current report also had a history of other headache problems – including migraines and frequent tension headaches. So people who are already vulnerable to headaches may be at greater risk.
Two headache attacks during flight
But Dr Mainardi's team says airplane headache is distinct from migraines and other well-known headache types. In fact, one of their diagnostic criteria is that the pain can't be linked to other causes.
They also say a person should have had at least two attacks of severe head pain during flight, with the symptoms lasting no more than 30 minutes. And there should not be any other symptoms – like nausea or sensitivity to light or noise, which may be signs of migraine.
No one, however, is sure how to prevent airplane headaches.
Of the 75 people in this report, 29 said they'd tried taking medication to head off their pain. The tactic was a success for 11 of them – with over-the-counter painkillers, like aspirin, naproxen and ibuprofen, being the most common choice.
(Amy Norton, Reuters Health, June 2012)
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