Headache Due to Diving?

[DocVikingo]

Hi shakeybrainsurgeon,

You raise some excellent points and I agree that all diagnostic possibilities have yet to be eliminated. This is the reason I couched my last response as, "... glad it appears you've finally been properly diagnosed. Hope the treatment is effective." It is not my intent to argue the accuracy of this diagnosis in this poster.

I also agree that given the temporal parameters described, even remotely entertaining a diagnosis of C02 headache is simply nonsensical.

I would, however, take issue with your comment, "TMD is what you're left with when the serious possibilities are rejected." While it may be, I don't believe that TMD is necessarily a classical diagnosis of exclusion.

Leaving aside more non-specific features, such as headache, tinnitus, dizziness/vertigo and vague pain in and around the ear or face, there is a reasonable and defensible constellation of diagnostic criteria for TMD that includes:

- Pain or tenderness localizable the jaw
- Difficulty chewing or discomfort while chewing
- Discomfort while swallowing or smiling
- A clicking sound or grating sensation when opening the mouth or chewing
- Locking of the joint, making it difficult to open or close the mouth
- Limitation of movement of the jaw
- Uncomfortable bite and/or uneven bite

Given complaints of all or many of the above, it seems rather unlikely the constellation would be confused with the typical signs and symptoms of hypertension, cluster headache and some of the other possibilities you have raised.

Thanks for the food for thought.

Regards,

DocVikingo

 

[shakeybrainsurgeon]

doc

I guess what I meant to say was it is a difficult and exclusionary diagnosis given the information presented to us here. I agree that in many patients, the diagnosis is obvious and little time or money should be wasted searching out other causes. In others, it can be more problematic. But I stand corrected, it is not always an exclusionary consideration.

In the context of this particular presentation, we don't know the age of the person, the history is somewhat vague, the character of the headache poorly defined and, obviously, we have no clinical exam. Thus, TMD is possible, but many other more serious (medically serious --- TMD can be serious from a quality of life perspective) conditions would have to be ruled out first.

 

[El Cid]

....my problem comes up. Well, not precisely. I tend to get headaches after my dives too that last from within 10 minutes of surfacing to up to four hours or more afterwards. They aren't debilitating, but are certainly noticable. I'm curious to find if I might be taking on more Nitrogen than normal due to hemophelia (specifically von Willebrands). I don't fin on my ascent, so I can be nice and slow, and always observe the safety stop. My computer says I'm below nitrogen loading and O2 loading all the time, and I notice it mostly after 60'+ dives as opposed to an hour or more at 20'. All those factors get me curious about the solvency of a hemopheliac's blood as opposed to normal folks (I say normal without having had a beer with any of you, so take it gently!).

Sorry to thread jump, but as far as I know the DAN board might be a good place to bring it up.

 

[tc]

El Cid, try the link that Doc posted in the third post of this thread. It's a link to a good article DAN has on the topic.

 

[crispix]

Hi shakeybrainsurgeon,
You raise some excellent points and I agree that all diagnostic possibilities have yet to be eliminated.

I appreciate all the comments. I'll leave out the sordid details of my many medical visits, but here's some more info:

- I'm 34, bp is fine, otherwise healthy
- I had my eyes and vision checked.
- I had hearing tested.
- I had a dentist visit, and the xrays were ok.

While I don't grind or clench my teeth, I now realize I had developed a nasty habit of resting my chin in my hand while working at the computer, so that stops now. I have some tenderness in the appropriate places, too, so TMJ makes sense to me. There is no locking or clicking of the jaw, so hopefully this is mild and will resolve as I follow the treatment plan. I have a dive trip planned mid-month, but I won't be putting any regulators in my mouth until then.

If anyone is interested I'll post again in a few weeks, hopefully with a nice dive trip report (Caymans!) and headache-free.

 

[DocVikingo]

Hi crispix,

Sounds like you're well down the trail of rule out possibilities.

Please do keep us posted.

Regards,

DocVikingo