Dive-Related Migraines: Symptoms and Solutions

Q: Dive-Related Migraines: Symptoms and Solutions

Hello, Zhi Yun： Headaches (migraines) caused by vascular factors are more common in individuals under 30 years of age. <br>To date, the exact causes of migraines remain unclear; however, certain triggering factors must be considered, such as neurogenic reflexes or stimuli that le

Migraine caused by diving?

Hello Dr.
Lin,
This summer, I went diving about 30 times, but I often experience symptoms of migraines and even nausea.
Here’s a description of my situation:
1.
It usually only occurs on the first dive.

2.
I feel uncomfortable underwater, and once I surface, I experience severe migraines accompanied by nausea.

3.
After resting on the shore for about 15 minutes, I can return to normal.

4.
If I dive again after feeling normal, I do not experience headaches.

5.
Typically, if the water temperature is below 26 degrees Celsius and I do not wear a hood, the likelihood of these symptoms occurring is very high, around 90%.

6.
This situation is unrelated to depth; sometimes it occurs even at only 10 meters.

7.
I also tend to have migraines when I am stressed.

Today, I came across a report, and I’ve excerpted the following: Symptoms such as nausea and severe headaches after diving may be caused by migraines.
However, if these two conditions are accompanied by other symptoms, it could indicate headaches caused by decompression sickness.
If a diver has a history of migraines, it may be directly related to the compression of the skull caused by diving.
Therefore, unless divers with a history of migraines have planned preventive measures, they should avoid diving.
If a diver experiences migraine symptoms along with blurred vision, they should seek professional evaluation, as these symptoms may also be caused by decompression sickness.

Thank you, Dr.
Lin...
Zhi Yun

Zhi Yun, 20~29 year old female. Ask Date: 2004/12/30

Dr. Lin Zhengyan reply Diving Medicine

Hello, Zhi Yun: Headaches (migraines) caused by vascular factors are more common in individuals under 30 years of age.
To date, the exact causes of migraines remain unclear; however, certain triggering factors must be considered, such as neurogenic reflexes or stimuli that lead to vasoconstriction of cerebral blood vessels, resulting in headaches.
In the early phase of a typical migraine, blood flow in specific areas of the brain may decrease by an average of about 36%, leading to vasoconstriction in those regions.
This outcome can cause cerebral hypoxia and acidosis, releasing various vasoactive substances, ultimately resulting in significant vasodilation of cerebral arteries.
The pathophysiology of decompression sickness (DCS) occurs when working in a high-pressure environment (greater than one atmosphere).
Prolonged exposure to high-pressure air causes the body tissues to dissolve a large amount of nitrogen.
If divers ascend too quickly without following proper decompression procedures, the nitrogen dissolved in body tissues can form bubbles, filling various tissues and organs.
This can lead to vascular embolism within blood vessels or stimulate the release of vasodilators in tissues, increasing microvascular permeability and causing tissue edema, ultimately resulting in ischemia and hypoxia, which can lead to a variety of clinical symptoms.
The clinical symptoms of decompression sickness can be classified into two types based on severity: Type I (mild) and Type II (severe).
Symptoms of both types may occur singularly or in combination.
Type I symptoms include fatigue, itching, skin rashes, localized edema, and joint and muscle pain.
Joint pain is the most common symptom in this type, which may present as aching or sharp pain and can be intermittent.
Type II refers to more severe symptoms that affect vital organs.
Symptoms may include headaches, blurred vision, loss of consciousness, and limb numbness or weakness if the brain is affected; cough, chest pain, and difficulty breathing if the lungs are involved; and dizziness, nausea, vomiting, and unsteady gait if the inner ear is affected.
Symptoms of Type II decompression sickness include: (1) Central nervous system: 1.
Headache, dizziness, nausea, vomiting, facial droop, slurred speech, altered consciousness, personality changes, stupor, coma, seizures, and death.
2.
Vision: Blurred vision, double vision, hemianopsia, blindness, and dilated pupils.
3.
Hearing and balance: Tinnitus, hearing loss, vertigo, vomiting, and nystagmus.
4.
Sensory nerves: Numbness or tingling in limbs, facial nerve paralysis.
5.
Motor nerves: Weakness in limbs, unsteady gait, hemiparesis, and coordination difficulties.
6.
Spinal nerves: Back pain, abdominal pain, diarrhea, lower limb paralysis, and incontinence.
7.
Other neurological symptoms.
(2) Respiratory system: Dry cough, shortness of breath, chest pain, tachycardia, and hyperventilation.
(3) Cardiovascular system: Chest tightness, chest pain, and shock due to myocardial hypoxia.
(4) Severe muscle and joint pain during ascent.
Diagnosis of decompression sickness primarily relies on the following points: (1) The likelihood of decompression sickness is low if the diving depth is less than 10 meters; most cases have a history of rapid ascent to the surface or failure to perform decompression stops.
(2) Any of the aforementioned clinical symptoms occurring within 48 hours post-dive, with approximately 85% of neurological symptoms appearing within one hour of surfacing.
Any of these symptoms occurring during or within 48 hours after diving should be considered as decompression sickness.
Based on your diving situation, experiencing migraines while diving may be related to low water temperature and cranial compression, as both can cause vasoconstriction in the brain.
If you are concerned whether your headache and vomiting symptoms are related to decompression sickness, you should seek medical evaluation at a hospital with a diving medicine department.

Reply Date: 2004/12/30

More Info

Understanding dive-related migraines is crucial for divers who experience headaches and nausea during or after diving. Based on your description, it seems that you are experiencing a specific type of headache that could be related to your diving activities. Let's break down the symptoms and potential solutions.

Symptoms
1. Timing of Symptoms: You mentioned that the headaches typically occur after your first dive. This is significant because it suggests a possible trigger related to the initial descent or the conditions of that particular dive.

2. Location of Pain: The fact that you experience severe migraines upon surfacing indicates that the headache is likely linked to changes in pressure or other physiological responses to diving.

3. Nausea: The nausea accompanying your headaches is also a common symptom in migraine sufferers and can be exacerbated by the physical exertion and stress of diving.

4. Recovery Time: Notably, you recover after resting on the surface for about 15 minutes, which suggests that the symptoms may be related to the physiological changes your body undergoes while diving.

5. Temperature Sensitivity: Your observation that lower water temperatures (below 26 degrees Celsius) increase the likelihood of headaches is interesting. Cold water can cause muscle tension and may also affect blood flow, potentially triggering migraines.

6. Depth Independence: The fact that these symptoms can occur even at shallow depths (like 10 meters) indicates that the issue may not be solely related to pressure changes but could also involve other factors such as stress or environmental conditions.

7. Pre-existing Conditions: You noted that you experience migraines when stressed, which suggests that your overall health and mental state may play a role in your diving experience.

Potential Causes
Based on the symptoms you've described, several factors could contribute to your dive-related migraines:
- Barometric Pressure Changes: Diving involves significant changes in pressure, which can affect the sinuses and lead to headaches. If you have a history of migraines, these pressure changes could exacerbate your condition.

- Dehydration: Diving can lead to dehydration, especially if you're not drinking enough fluids before and after your dives. Dehydration is a known trigger for migraines.

- Cold Water Exposure: As you mentioned, diving in colder water without proper headgear can lead to muscle tension and headaches. The body’s response to cold can also trigger migraines in susceptible individuals.

- Stress and Anxiety: If you are feeling anxious or stressed about diving, this could also contribute to your migraine episodes. The mental strain of diving, especially if you are worried about your performance or safety, can lead to tension headaches.

Solutions
1. Hydration: Ensure you are well-hydrated before and after diving. Drink plenty of water and consider electrolyte solutions if you are diving in warmer conditions.

2. Temperature Management: Use appropriate thermal protection, such as a wetsuit or drysuit, to maintain body temperature and reduce the risk of headaches.

3. Gradual Descent: Consider practicing slower descents and ascents to allow your body to adjust to pressure changes more gradually.

4. Pre-Dive Preparation: If you have a history of migraines, consult with a healthcare professional before diving. They may recommend preventative medications or strategies tailored to your specific needs.

5. Rest and Recovery: If you experience symptoms, take adequate time to rest on the surface before diving again. Listen to your body and avoid pushing through discomfort.

6. Consult a Specialist: If your symptoms persist or worsen, it may be beneficial to consult a neurologist or a dive medicine specialist. They can provide a thorough evaluation and may suggest specific treatments or preventive measures.

In conclusion, dive-related migraines can be complex, involving various physiological and psychological factors. By understanding your symptoms and implementing preventive strategies, you can enhance your diving experience while minimizing the risk of headaches. Always prioritize your health and safety while enjoying your diving adventures.

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