Migraines and diving

[lulubelle]

Saturation,

The OP mentioned triptans are counter-indicated if diving. I take Maxalt for occuring migraines which is, I presume, a triptan. I didn't see anything on the DAN site regarding this drug being counter-indicated. Could someone elaborate? lulubelle, what have you found that confirms this?

I also suffer from migraines, and have also had the occassional CO2 post-dive headache. There is a difference! In addition CO2 headaches respond to narcotic pain relievers, but migraines won't. (as migraine sufferers know).

cdolphin, the doc I saw said that because the triptans work by constricting the blood vessels that they could interfere with offgassing. I don't know if that is theoretical or data based, but it does make sense. But if I have a true migraine not in close proximity to diving, I will be in bed and not diving anyway. I use triptans on land for all of my headaches that need medicating. But I will probably use high dose Ibuprofen in lieu of a triptan if one occurs near a dive. lMy post dive headaches go away on their own.

 

[lulubelle]

What is known about Maxalt and Imitrex reveals no theoretical issues with recreational diving.

There are no reports to date, of any issues with such drugs in any type of diving.

Both drugs typically have 1/2 lives of ~ 2 hours or less. In 12 hours 98% is gone, in a day 99.99% of the drug is gone. So if a doc is completely conservative just don't dive for a day or less.

In practice, I've seen a number of real divers dive with all kinds of drugs, including Imitrex. As expected, nothing to report, so I'm not sure what this dive doc is considering.

That was my understanding as well. I'll probably avoid them while I am diving if I can.

Any medical visit that begins with "just what is it that you want from me today" was probably not going to be a good one.

On a happier note, my internist said that my cholesterol panel looked better than 99.75% of the ones he sees and that he has no concern about my CV health which is really why I went to see the dive doc.

 

[cdolphin]

cdolphin, the doc I saw said that because the triptans work by constricting the blood vessels that they could interfere with offgassing. I don't know if that is theoretical or data based, but it does make sense. But if I have a true migraine not in close proximity to diving, I will be in bed and not diving anyway. I use triptans on land for all of my headaches that need medicating. But I will probably use high dose Ibuprofen in lieu of a triptan if one occurs near a dive. lMy post dive headaches go away on their own.

I understand the vasodilation. An interesting thing to note: when I exercise to 80% or better of my maximum heart rate for any length of time, the left side of my face gets flushed, and the right side stays normal. There is a distinct line right down the middle of my face. Those little blood vessels are very active on the left side. I get only left-side migraines.
And yeah, if I had a migraine there would be no diving. I'd be in bed and with a cool cloth on my head in a quiet room. No other drugs touch my migraines - only the triptans. Immitrex is too potent in injection form and the pills take too long. Maxalt is a tab that melts on my tongue and works in 10-20 minutes.

 

[cdolphin]

One interesting hypothesis is that 5HT-1B/D agonists pre-synaptically inhibit neurotransmitter release from trigeminal sensory neurons. Molecular middle-man pathways might involve calcitonin gene-related peptide (CGRP) and substance P. (Several papers show that nitric oxide-induced headache in humans is correlated with increased levels of CGRP, which normalize in response to administration of triptans.)

Bubbletrubble

I followed almost all of what you said.....except this.....and I get the jist of it. The triptans are responsible in some way for vasoconstriction in my head. This makes it stop hurting. And makes me stop throwing up.

But what about the part above where you write "nitric oxide-induced headache"? What does that mean?

Thanks for the interesting answer.

 

[lulubelle]

I understand the vasodilation. An interesting thing to note: when I exercise to 80% or better of my maximum heart rate for any length of time, the left side of my face gets flushed, and the right side stays normal. There is a distinct line right down the middle of my face. Those little blood vessels are very active on the left side. I get only left-side migraines.
And yeah, if I had a migraine there would be no diving. I'd be in bed and with a cool cloth on my head in a quiet room. No other drugs touch my migraines - only the triptans. Immitrex is too potent in injection form and the pills take too long. Maxalt is a tab that melts on my tongue and works in 10-20 minutes.

There is some good data behind using extract of butterbur and B2 for prevention. And some decent data with Magnesium for prevention. 800 mg of Ibuprofen plus coffee works for me but I can't take that regularly. I have not found that Maxalt acts any quicker for me than the others. In fact today, I got a prescription for my 4th. I'm trying to find efficacy without incapacitating fatigue afterwards. Phenergan can be a good adjunctive treatment with the triptans too, but I'm sure it would have some theoretical risks while diving too. I personally like the suggestion that if we dive more our migraines will get better!

 

[super7]

I don't mean to contradict any of the posts, but in case you're interested,

1)there are cases where the migraine aura appears without the headache. Under these conditions, TIA (warning stroke) and epilepsy must be ruled out before diagnosing them as "silent migraine" or "migraine aura without the headache".
Then, there has been reports relating subarachnoid haemorrhage to recurrent auras.

2)nitrogen bubbles have been known to injure/remove the endothelium, the cells lining the artery walls, under experimental conditions (rabbits, carotid artery)

3)with endothelial injury or removal of the endothelium, thrombosis will be triggered, possibly resulting in an artery-to-artery embolism.

Combining all three, the scenario where bubble formation in the posterior circulation results in a TIA mimicking an aura is possible, which in turn may be interpreted as a sign of pending ischemic stroke in the posterior circulation. Subarachnoid haemorrhages may also mimic classical migraine, with preceding auras representing the minor leaks, and the major rupture of the aneurism presenting as the pulsating headache.
I think the dive doctor lulubelle saw was thinking in this line.

I don't mean to frighten you away from diving. Just a guesstimation, on what the consulted dive doctor MAY have thought, from my point of view.

Kaza

 

[cdolphin]

Combining all three, the scenario where bubble formation in the posterior circulation results in a TIA mimicking an aura is possible, which in turn may be interpreted as a sign of pending ischemic stroke in the posterior circulation. Subarachnoid haemorrhages may also mimic classical migraine, with preceding auras representing the minor leaks, and the major rupture of the aneurism presenting as the pulsating headache.

We aren't saying that we have auras or dive-caused migraines, though, so not sure why this was mentioned....as a matter of fact, neither of the migraine patients in this thread so far have reported visual disturbances, and we've both been examined and diagnosed.

Are you saying that we may dismiss a possible DCS hit as a migraine if it presents with an aura? Because earlier we discussed the fact that migraine alone would not be sufficient indication of a DCS hit, and that DCS would most likely progress with other additional symptoms occuring.

 

[lulubelle]

I don't mean to contradict any of the posts, but in case you're interested,

1)there are cases where the migraine aura appears without the headache. Under these conditions, TIA (warning stroke) and epilepsy must be ruled out before diagnosing them as "silent migraine" or "migraine aura without the headache".
Then, there has been reports relating subarachnoid haemorrhage to recurrent auras.

2)nitrogen bubbles have been known to injure/remove the endothelium, the cells lining the artery walls, under experimental conditions (rabbits, carotid artery)

3)with endothelial injury or removal of the endothelium, thrombosis will be triggered, possibly resulting in an artery-to-artery embolism.

Combining all three, the scenario where bubble formation in the posterior circulation results in a TIA mimicking an aura is possible, which in turn may be interpreted as a sign of pending ischemic stroke in the posterior circulation. Subarachnoid haemorrhages may also mimic classical migraine, with preceding auras representing the minor leaks, and the major rupture of the aneurism presenting as the pulsating headache.
I think the dive doctor lulubelle saw was thinking in this line.

I don't mean to frighten you away from diving. Just a guesstimation, on what the consulted dive doctor MAY have thought, from my point of view.

Kaza

Thanks for your post. I have no aura or other neurological symptoms such as paralysis, visual loss, numbness, etc. Just ungodly L temple pain, followed by nausea and vomiting if I so much as roll over in bed. My migraines are hormonally triggered, I usually wake up with them, and if they have onset during the day, they start as a tension headache that simply progresses. I'm not frightened away from diving, information is power.

The doctor also tried to warn me away from diving because "diving is dirty" and i had a recent episode of sepsis. I asked him if the ocean was any dirtier than airplanes, airports, buses,...the world. One can't live in a bubble.

 

[cdolphin]

There is some good data behind using extract of butterbur and B2 for prevention. And some decent data with Magnesium for prevention. 800 mg of Ibuprofen plus coffee works for me but I can't take that regularly. I have not found that Maxalt acts any quicker for me than the others. In fact today, I got a prescription for my 4th. I'm trying to find efficacy without incapacitating fatigue afterwards. Phenergan can be a good adjunctive treatment with the triptans too, but I'm sure it would have some theoretical risks while diving too. I personally like the suggestion that if we dive more our migraines will get better!

lulubelle,

I've found that a migraine does not respond to any other treatment other than triptans for me. I do get other headaches that are treatable with NSAIDS and even caffeine, but those are not my classic left-side migraines. Magnesium supplement is something I integrated into my diet sometime ago. I can't say if it helped with migraines or not. It's something I wasn't getting enough of without really making an effort.

As in everything else in life; clean diet, exercise and plenty of water seem to cure whatever ails me.

 

[cdolphin]

The doctor also tried to warn me away from diving because "diving is dirty" and i had a recent episode of sepsis. I asked him if the ocean was any dirtier than airplanes, airports, buses,...the world. One can't live in a bubble.

Time for that drysuit and head gear. That's a strange thing for the doctor to say. Did you get recommended to him by DAN? Or how did you happen to find this "dive doctor" ?