Migraines and diving

[super7]

We aren't saying that we have auras or dive-caused migraines, though, so not sure why this was mentioned.

Are you saying that we may dismiss a possible DCS hit as a migraine if it presents with an aura?

As I said, just guessing on what the said dive doctor MAY have thought.

Kaza

 

[super7]

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.

Way to go

 

[lulubelle]

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.

Try the extract of butterbur and B2. That data is actually pretty good. I got that from the head migraine guy at Duke. I won't take prescription drug prophylaxis and am not at a point where I need it.

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" ?

Well, he is right, there are yucky things being cultured in oceans and off of beaches. But I just can't stop going out in the world now, can I?

 

[lulubelle]

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.

That is exactly what the dive doc was saying, that I might get a 50K heli ride to a chamber for migraine treatment because the symptoms could be similar, or worse, that I might think I had a migraine when in fact I had DCS. An aura would be pretty clear indication that you had a migraine and not DCS I would think. I have no aura. He was speaking only to my symptoms of L temporal pain following by nausea, vomiting, and a bit of vertigo. But I find it hard to believe that the presentation and onset would be the same, nor would any confusion last long.

I suspect that in a few years, the problem will be moot for me. Unless of course I am like my Aunt Carol, who at 60, was still pre menopausal.

 

[TSandM]

I agree with Saturation . . . DCS presenting purely as a headache, and progressing to no other symptoms, would be rare. And especially if you are familiar with your migraine syndrome, and it is very consistent, I wouldn't be unduly concerned.

Regarding your episode of sepsis, I am puzzled. Did they not find a source for it? Is your physician concerned that you may not be immunocompetent?

 

[smokey braden]

i have migraines (unilateral vascular) and my doctor has me on elavil (amitryptaline).
i might have a headache once a month.
i've never been able to say that the diving brings them on.
great thread and it's good to hear so much information along these lines.
regards,

 

[Quero]

Interesting thread; I've learned something from it. Thanks Lulubelle.

I'm also a migraine sufferer. For every dive course I've taken I've had to get specific clearance from various dive doctors who were all extremely thorough in their questioning of my migraine symptoms. Like other sufferers here, I don't get auras. My headaches are on the right side and involve my eye, face, ear, neck, shoulder and upper arm when they are at their worst. Obviously (since I now teach scuba), I have always been cleared to dive.

However, there was still that niggling thought in the back of my mind in regard to PFOs (right to left shunt), especially since I dive SO much. So I went a couple of years ago and got myself checked out via a trans-esophageal echocardiogram and a bubble test with agitated saline with and without Valsalva maneuvers. Happily, I have no PFO and my migraines are "just" migraines--apparently not a major issue for me in as far as diving is concerned.

If I wake up at 5 in the morning with a headache (this is the most common time of day I seem to get them), I just swallow my Imigran (local branding for Imitrex) and wait. I also drink down a Red Bull, both for the help the caffeine provides for controlling the headache, as well as to overcome the fuzzy-minded post-migraine feeling I always get. If I have to dive on a migraine day, diving does seem to help somehow.

Lulu, this doctor seems quite convinced that you shouldn't be diving, perhaps even since he has brought up secondary reasons (the sepsis) to discourage you. Not that I'd recommend "shopping" for a doctor in order to find one who will tell you what you want to hear, but have you thought about getting another opinion so that you can make a more informed decision to continue diving as you currently do or to adapt your diving somehow to your physical constraints?

 

[Saturation]

It was interesting to have this doc say that I shouldn't dive if I have a migraine history (even though mine does not include neurological symptoms such as aura, paralysis, visual loss, etc). I then went to the DAN website and saw that migraine was considered a relative risk condition, not a contraindication, and that from what I read I should be fine. Interesting.

I read the NIH paper. So how does one get hyperbaric O2 treatment outside of research settings? Sounds a lot less pathologic than the meds that have to be used. I haven't ever been on a dive when I had a headache and certainly not a migraine, so I have no idea what the impact might be. What I DO know is that diving is very relaxing for me.

Go Diving. Whenever you raise the P02 above 21%, that is a hyperbaric exposure.

 

[Bubbletrubble]

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.

@cdolphin: The "nitric oxide-induced headache" to which I was referring was an experimentally-induced headache in a study of migraine patients. It is hypothesized that nitric oxide may be involved in the pathophysiology of migraine and perhaps other types of headache. Read on for more info...

Nitric oxide (NO) is a gas. It's difficult to study in vivo because such a reactive and ephemeral molecule makes detection problematic. Much of the good work in the nitric oxide field manipulates the enzymes which generate NO: neuronal NO synthase (nNOS) and endothelial NO synthase (eNOS). In the smooth muscle surrounding blood vessels, it turns out that NO is involved in calcium signaling. In response to a rise in intracellular calcium, NO is produced by NOS and binds to an enzyme called guanylate cyclase that increases levels of cyclic guanosine monophosphate (cGMP). cGMP causes relaxation of the smooth muscle lining of blood vessels (vascular dilation) and a decrease in blood pressure.

As a side note, the entire class of Viagra-like drugs acts on this pathway. It turns out that sildenafil/tadalafil/vardenifil inhibit an enzyme called cGMP specific phosphodiesterase 5 (PDE5) that is responsible for degrading cGMP. Without PDE5 active, cGMP sticks around longer, enhancing the dilation of the blood vessels. FYI, PDE5 expression is largely restricted to the arterial smooth muscle in the lungs and the penis. That explains the...ahem...specific affect of the Viagra-like drugs.

There's some fairly compelling clinical research that supports involvement of NO in migraine. Jes Olesen is a researcher at the University of Copenhagen who has done a fair amount of work in this field. Here's a link to the abstract of a 2008 review article Olesen wrote on the subject of NO and headache. The review discusses at least one study which demonstrated that giving long-acting NO donors (drugs that increase NO production) to asymptomatic migraine sufferers induces migraine-like headaches. The subjects reported that the quality of the migraines they experienced were similar in intensity to that of their "normal" migraines but did not have the associated symptoms (aura, etc.). In a separate study, blood samples taken before, during, and after NO-induced headaches showed increased CGRP levels (higher levels correlated with stronger intensity of the migraine). These heightened CGRP levels decreased subsequent to triptan administration. Interesting, huh? This isn't 100% proof that the pathophysiology of migraine involves a NO- or CGRP-mediated mechanism. It just means that NO-induced migraine-like headaches are responsive to the same type of treatment that real migraines are. The data is merely "highly suggestive."

FWIW, there is data to suggest that a NO-mediated mechanism underlies other types of headache as well. If you are interested, you can do a Pubmed search for the terms "nitric oxide" and "headache." You should get numerous hits.

For more info about CGRP, the Wikipedia entry is surprisingly good.

I hope that this post clarifies things a little...

 

[lulubelle]

I agree with Saturation . . . DCS presenting purely as a headache, and progressing to no other symptoms, would be rare. And especially if you are familiar with your migraine syndrome, and it is very consistent, I wouldn't be unduly concerned.

Regarding your episode of sepsis, I am puzzled. Did they not find a source for it? Is your physician concerned that you may not be immunocompetent?

Thanks for weighing in. And don't be puzzled, the sepsis was a medication side effect. My immune system is Olympic caliber in strength unfortunately.