Diving and Migraine

[barb]

...I have the migraine with aura, onset was post-hysterectomy so I suspect that hormone levels have something to do with this, at least in my case.
The relationship of migraine with aura to increased likelyhood of having a PFO worries me as I'm about to begin my Adv.Nitrox/Decompression Proced. course and this will likely take me to depths/pressures I have not yet experienced.
I'm not so concerned about this triggering a headache (although an unchecked visual disturbance with a significant deco obligation could be challenging) I'm more worried about the impact of possibly having a PFO and deep diving.
Is this contraindcated?


A side note: My aunt made a wonderful recommendation when I first started these migraines (she had suffered them for many years).
She said: as soon as I had the visual distortion I should go into a darkened room, sit in a comfy chair - NEVER LIE DOWN, take two Aspirin (not Tylenol), apply a cold pack to my head (back of neck and upper forehead).
When I follow her advice I'm good to go in about 1/2 hour - I never get the headache and just feel a bit more tired than usual.

I am worried about the deeper diving though - I currently dive to within recreational depths with no problems but would like to visit some of the deeper wrecks in my area.
Barb

 

[kelpdiver]

There really isn't a lot of information on these issues. Check out
http://www.scuba-doc.com/pfo.htm with a link at the end to migraines w/ aura and PFO. (Also http://www.diversalertnetwork.org/medical/articles/article.asp?articleid=50). The Italian study in Neurology is the only one I've seen relating these two, and numbers for PFO were fairly high in all groups: Control was 20%, migraine w/o aura 23%, and migraine w/ aura 48%, a significant difference. Bove estimates a threefold increase in risk for DCS in divers with PFO (but it's three times a very small number).

So what do you do? 20% of divers without migraine still have PFO, yet have very small risk of DCS. Unless you've got very generous insurance (or family/friends, or plenty of disposable income), getting a bubble contrast or doppler echo isn't cheap, and you should have an idea of what you'll do with the information. (And to answer a prior question, the study isn't dangerous. Not difficult, unless they decide it would be better to do a transesophageal echo, in which the ultrasound transducer doesn't go on your chest, but down your gullet.) If you have PFO, will you dive differently? If so, you might want to spring for the test. If not, why go to the expense? And would your instructors feel differently? That might be a factor. You might want to call DAN directly and see if they'd be willing to give some specific advice.

Usual disclaimer: This is meant as general discussion, not specific medical advice. No doctor-patient relationship implied.

Good luck

 

[barb]

...

 

[WarmWaterDiver]

I am a diver and also a migraine sufferer. I definitely think the primary component is genetic - my father was also a migraine sufferer, and was never able to find the right medications during his lifetime - but neither of my siblings have migraines. I was properly diagnosed at age 30 (12 years ago) - and things like Imitrex and Zomig are absolutely wonder drugs in my opinion. Mine tend to center behind one eye or the other, and my best analogies center around feeling like someone is trying to extract that eye with a dull grapefruit spoon, or an evil gnome inside my head trying to push my eye out with a rusty railroad spike from the back side. Needless to say, if I am in the throes of a migraine, I don't feel like diving (and don't dive) - but neither do I feel like running, driving a vehicle, going to a rock concert, etc. so I don't do those things until I'm feeling better either.

I have suffered migraine while on my most recent dive trip, as well as on other dive trips - but I do not think the diving was the trigger at all. Bright light, lots of gear (my first Tech training dive), fair surface swim, etc. that day (Turtle Reef in Grand Cayman - when the west end was 'choppy" and Cobalt Coast was a surf - not dive - resort if one was invincible enough to surf up to ironshore). The very next day I did 3 dives at Turtle Reef wearing all the same gear with absolutely no symptoms of migraine. I'm wondering if I should invent "clip-on" sunglasses for scuba masks, or see if someone can make a Transitions lens mask, for use during the surface swims . . . I always have my cap 7 shades while on the boat 9unless it's a night dive).

I have tried to get a more definitive ruling on use of medications like Imitrex and Zomig (triptans) either before or after diving. I have had PADI instructors tell me that I should never go diving the same day i have a migraine period, whether I take such medication that day or not. I have had others let me know it was up to my judgement (I have performed a fair bit of literature search on such a near & dear subject). I have seen articles in scuba magazines - one where taking such medications before, but not after a dive was thought to be OK, others who had just the reverse. I do think using Nitrox does reduce risk of migraine in my experience though.

What I have empirically done with no sign of ill effects or damage is this - if I have a migraine after a dive (and realize, this could be HOURS after a dive), I take the appropriate medication, let it do its thing, and get on with life. If I wake up with a migraine, whether middle of the night or first thing in the morning, I take my medication (these are often the worst - as when they come on in your sleep, you don't catch them in the early stages and they are well and truly full-blown by the time you become awake). These medicines are supposed to let you get back to having a more normal life - and so that is what i do wth them. I don't use the ergotamine / caffiene medicines on dive trips, and I found they make one ride a "cresting wave' of nausea on top of the migraine neausea in the first 30 minutes to one hour after swallowing, before I start feeling better. The Imitrex self-administered injections are generally the fastest to give relief, and best for those that come on in one's sleep, and I found the Zomig to be the best oral medication for this condition.

The long & short is there has not been specific research I can find on migraine, triptans, and diving. Conflicting opinions (just that - opinions) exist in the literature I have seen. I do mark this in the RTSC forms when needed. The MD who properly diagnosed me was also a migraine sufferer, and he always signed my RTSC forms as OK for diving (and he was also a diver, and also a chemical engineer, but that's another story . . .), but we have since moved from that area and no one has required me to submit a completed RTSC form to dive since we moved. I will continue to use these medicines to help restore control & quality of life for me, and that includes when I go diving. If such a medical study is ever performed, I would gladly review the data and frame it within my own life experience.

I hope that sharing my experiences can be of help to any other migraine sufferers out there, especially other divers. The best point in my migraine history was finding a MD who recognized the potential and tested to make an accurate diagnosis.

 

[DocVikingo]

The original inquiry was posted over 7 months ago, and the most recent post was over 5 months ago.

As such, you may wish to e-mail these members directly in case they are no longer following the thread.

Best regards.

DocVikingo

 

[WarmWaterDiver]

Doc,

I just thought I'd post this for others like me who might use the word "migraine" in the "search" function. This is what I did after gaining access to this board, to see what I could learn from others - so hopefully my contribution will be archived for common use.

If you have any data to share, I'd appreciate it - feel free to PM me.

 

[underwater daphne]

hmm, please post if there is any new information. especially about triptans (sumatriptan) and diving.

 

[Sylvie]

HI - I mean Greeutzi Neighbour. I'm also from the Limmatthal, but in canton Zurich

I was subscribed triptans last month, but didn't start taking them because I was about to go on a dive holiday and my doctor advised against taking anything new before diving. My dive holiday was canceled due to this summer flew that's going around. So three days ago I deceide to start taking the Tritans. I don't expect to feel any effects for a few weeks. I've been told by my doctors not to dive after just starting to take them. However, it's ok once you've been using them for a while and your body is adjusted to them, because at that point it would be worse for your system to stop taking them (i.e. during a two week dive holiday) than to dive while taking them. Of course it's always best to check with your own doctor.

You can send me a private message if you want. I see that you're on line too.

Tschüseli

Sylvie

Hope this help

 

[underwater daphne]

hoi sylvie
danke.
i'm actually from Fricktal, but i like living in baden.
i'll send you a pm, as i have a few q's.
i do not take imigran daily, only when i have an attack, which lol actually has been several times daily.

 

[beachdivequeenbelam]

I get migraine's now and then. Really quite mild, they typically last 4 hours or so, and I feel "hungover" for another 8-12 hours.

I get mild visual distortion that builds up to the point where I could not drive a car. This takes about 10-20 minutes from first signs. I can still read text, but I have to really look. That clears, then I'm fine for about 30 minutes then the headache kicks in.

Anyhow, I've never had a migraine during a dive. Is there anyone out there who has ? Was is any different from a migraine on the surface ?

BTW before anyone tells me I shouldn't dive... I've been dealing with this for many years. They are predictable I have LOTS of warning time, and I have every confidence that I can surface safely at first signs. I can be on the surface long long before it becomes a problem.

Yes DECO diving is OUT for me. As is Caves etc.

I have severe severe migraines. I dive. Weather, that time of the month, and Stress cause them.
I actually find being under water helps mine!! I don't know why. But if I feel one coming especially from weather if I dive it goes away. Diving takes away my stress so that could be a reason too. THere is less light, and less noise. Those are the things that bother me when I have headaches. I also take migraine meds and Excedrin Migraine(stops the hungover feeling)