Sinus vs Migraine - Headache during dives, but it will go away afterwards.

[kebosatu]

Hi Guys,

I have a symptom that made myself confused. Even After reading few articles and read some discussion in this forum.

It's only happened recently, my last 7 dives... Normally I go for 5 dives a day and had no issue at all.

Recently, during my mid towards end of my dives, I develop a severe headache, yes it started to gets persistent. However this headache typically go away by itself after 2-3 hours (during our surface interval), but it will come again during next dives .

To address this quickly, I took paracetamol if it's not getting better 30 minutes before our next dives. But it not always works.

When I shared this to the dive master/guides/seniors, they always said "maybe sinus", some said "maybe you ascend too fast". The problem is it happens when I was under the water and swimming, not ascending. and max depth is 65 feet.

I'm wondering what may cause this... I'm suspecting:
1. Bad Gas ... (but) none of my friend experience the same, if it is, only 1 or two but not persistent.
2. Sinus issue ... (but) I don't have sinus issue in the past, is it possible to have it now?
3. Skip breathing ... Recently I practice slow breathing... exhale inhale pause, exhale inhale pause. And of course to hold my breath more than a second to control my buoyancy sometimes when I'm too close to coral. (But) I'm not sure if this can cause headache??
4. Late to equalize / incomplete equalization... I'm learning how to equalize by swallowing my saliva, but I realize sometimes it's clearer to equalize by holding your nose. Can this cause a headache?
5. zipping in some salt waters... Okay I normally inflate my bcd orally even under the water, swapping between reg and bcd inflator sometimes make me zip a little amount of salt water sometimes, can salt water cause a headache?

Any idea based on your experience? are all the above make sense? I'm not sure at this point going to ENT for advise is needed. Would like to hear from experienced divers here.

feed backs are welcomed!

Cheers,
Kebo

 

[MB NZ]

As a medical doctor and migraine sufferer, I can tell you that you are not experiencing migraines. Beyond that, it is difficult to say and I think you should seek proper medical advice (i.e. DAN) rather than talking to people on the internet. However, I will say that skip breathing/CO2 retention headaches are a likely possibility. You might find this article interesting:
https://www.diversalertnetwork.org/medical/faq/download/HeadachesandDiving.pdf

 

[Bob DBF]

I'll choose #3.

Stop skip breathing and see what happens. CO2 can give a nasty headache, and it will hang on for a while as your body readjusts.


Bob

 

[drrich2]

Migraines are a type of headache, not just a bad one. It's a specific condition/diagnosis, in other words.

Once in Grand Cayman on a cruise stop I did skip breathing, pausing for awhile after exhalation, and got a severe headache. Almost called the 2nd dive but it largely went away so I dove.

Pausing after an inhalation is something I do now, but obviously there's the '1st rule of scuba diving is don't hold your breath' & the risk of lung over-expansion injury. So I keep my airway open (so air could escape if it did expand), don't take real large breaths, don't ascend significantly at the time, and still accept that this is a choice that requires mindfulness and is not without some risks. I'm not advising it to you. If you choose to do this sort of thing, you ought to read up on over-expansion injuries like arterial gas embolism, pneumothorax and mediastinal emphysema, and carbon dioxide retention. And be aware it takes some mindfulness.

In my case, I once did an exercise from the SDI Solo Diving manual and determined my resting surface gas consumption sitting at my computer dozing and very relaxed was every so slightly under 0.5 cf/min., so if I wanted pretty good air consumption on actual dives, I was probably going to have to have to do something.

Have you been having trouble with rapidly going through a tank on your dives? Your gas use cutting dives, including other people's dives, short? Any idea what your SAC rate is?

Richard.

 

[flots am]

I have a symptom that made myself confused. Even After reading few articles and read some discussion in this forum.

It's only happened recently, my last 7 dives... Normally I go for 5 dives a day and had no issue at all.

Recently, during my mid towards end of my dives, I develop a severe headache, yes it started to gets persistent. However this headache typically go away by itself after 2-3 hours (during our surface interval), but it will come again during next dives .

To address this quickly, I took paracetamol if it's not getting better 30 minutes before our next dives. But it not always works.

When I shared this to the dive master/guides/seniors, they always said "maybe sinus", some said "maybe you ascend too fast". The problem is it happens when I was under the water and swimming, not ascending. and max depth is 65 feet.

I'm wondering what may cause this... I'm suspecting:
1. Bad Gas ... (but) none of my friend experience the same, if it is, only 1 or two but not persistent.
2. Sinus issue ... (but) I don't have sinus issue in the past, is it possible to have it now?
3. Skip breathing ... Recently I practice slow breathing... exhale inhale pause, exhale inhale pause. And of course to hold my breath more than a second to control my buoyancy sometimes when I'm too close to coral. (But) I'm not sure if this can cause headache??
4. Late to equalize / incomplete equalization... I'm learning how to equalize by swallowing my saliva, but I realize sometimes it's clearer to equalize by holding your nose. Can this cause a headache?
5. zipping in some salt waters... Okay I normally inflate my bcd orally even under the water, swapping between reg and bcd inflator sometimes make me zip a little amount of salt water sometimes, can salt water cause a headache?

Any idea based on your experience? are all the above make sense? I'm not sure at this point going to ENT for advise is needed. Would like to hear from experienced divers here.

It could be any of the things you mentioned but it isn't a migraine.

#1 is possible, but not the most likley reason.

#2 is possible, if the pain is around your sinuses

#3 is definitely possible. Just breathe normally. If you want longer bottom time, learn to be more relaxed and quiet and move less.

#4 is possible if your ears hurt.

#5 isn't likely. Breathing in salt water can cause coughing or choking or possibly an infection, but shouldn't cause a headache.

 

[TSandM]

As a physician diver, having read what you wrote, I'll vote for skip breathing. CO2 retention can cause nasty headaches; they can start during a dive, but generally resolve after a while on land. They are very common in people who are artificially varying their breathing to lower their gas consumption.

 

[daz88]

most likely not exhaling enuff causing CO2 build up. be sure to exhale fully and empty you lungs.(unless you're trying to keep from bumping the coral at one point) short breathes will give you a headache. Once out of the water, if you give yourself a headache, do some deep breathing being sure to fully exhale until you can exhale no more. It helps get rid of the headache sooner

 

[kebosatu]

As a medical doctor and migraine sufferer, I can tell you that you are not experiencing migraines. Beyond that, it is difficult to say and I think you should seek proper medical advice (i.e. DAN) rather than talking to people on the internet. However, I will say that skip breathing/CO2 retention headaches are a likely possibility. You might find this article interesting:
https://www.diversalertnetwork.org/medical/faq/download/HeadachesandDiving.pdf

Hi Andrew,

Thanks for the article, very interesting. Most of the situation actually similar to my condition.

From psychology, physical tight wetsuit (after i gained few pounds since I bought the wetsuit), neck issue to skip breathing.

I will try to fix my posture during dive, breathe properly and probably getting new gear as well and see how it goes.

But it's great article. thanks for sharing!

---------- Post added October 6th, 2014 at 02:00 PM ----------

Migraines are a type of headache, not just a bad one. It's a specific condition/diagnosis, in other words.

Once in Grand Cayman on a cruise stop I did skip breathing, pausing for awhile after exhalation, and got a severe headache. Almost called the 2nd dive but it largely went away so I dove.

Pausing after an inhalation is something I do now, but obviously there's the '1st rule of scuba diving is don't hold your breath' & the risk of lung over-expansion injury. So I keep my airway open (so air could escape if it did expand), don't take real large breaths, don't ascend significantly at the time, and still accept that this is a choice that requires mindfulness and is not without some risks. I'm not advising it to you. If you choose to do this sort of thing, you ought to read up on over-expansion injuries like arterial gas embolism, pneumothorax and mediastinal emphysema, and carbon dioxide retention. And be aware it takes some mindfulness.

In my case, I once did an exercise from the SDI Solo Diving manual and determined my resting surface gas consumption sitting at my computer dozing and very relaxed was every so slightly under 0.5 cf/min., so if I wanted pretty good air consumption on actual dives, I was probably going to have to have to do something.

Have you been having trouble with rapidly going through a tank on your dives? Your gas use cutting dives, including other people's dives, short? Any idea what your SAC rate is?

Richard.

Hi drrich2,

One thing is not clear for me yet is the difference between pausing and holding breath. Is it correct my assumption that any pause more than 2 seconds is considered as holding breath? or pause is something different?

I normally go through a tank faster than others, that's why i'm learning to do slow breathing (but probably not in proper way), I can reach one hour for a dive and left 70 bar (we use bar here). Without slow breathing, normally i can only have 43 minutes a dive with 50 bar left. is there any calculation to measure SAC rate? and what's the normal SAC rate?

Talking about slow breathing techniques which I'm not sure I'm doing it right or wrong, let me share how I do it.... inhale for over 5 seconds.. pause 1 seconds (by saying pause I mean hold my breathe), and then exhale for over 10 seconds, then repeat the same again. Not sure if this is a right way to do... ? inputs are welcome.

Kebo.

---------- Post added October 6th, 2014 at 02:25 PM ----------

It could be any of the things you mentioned but it isn't a migraine.

#1 is possible, but not the most likley reason.

#2 is possible, if the pain is around your sinuses

#3 is definitely possible. Just breathe normally. If you want longer bottom time, learn to be more relaxed and quiet and move less.

#4 is possible if your ears hurt.

#5 isn't likely. Breathing in salt water can cause coughing or choking or possibly an infection, but shouldn't cause a headache.

Thanks flots, straight to the point. I have never experience pain in my forehead or around nose during descending. but I do have a lot of phlegm coming out after the dives. Tempted to visit ENT to check out on my sinus... not sure if it's worth my time and $$ as their fee pretty high i feel.

 

[Doomnova]

Well the basic of "holding" vs "pausing" is this.

Holding is when you close the glottis so no air gets in nor out regardless of how much the air needs to get out. This then turns your lungs into a "closed system" and thus a balloon made of membranes.

A "pause" is where you simply stop inhaling and thus relax your diaphragm and thus remove the low pressure in your lungs that lets you inhale but the glottis is still open then air can freely pass in or out as pressure dictates and thus is a "open system".

So to feel a "closed system" and an increase in pressure you can exhale while holding your breath your lungs will be pressurized but no air is getting out(your glottis is closed). The other s simply exhaling as normal and thus and "open system". This can also be done with a balloon. With the bottom not tied off it is an open system and thus you can squeeze the air out of it(open system and an analog to a pause) but when its tied shut you cannot and thus build internal pressure till well we all know the fate(closed system and thus analog to a hold).

I think part of your issue is your trying to force your body to do something its not ready to yet. That is go longer than is metabolically needed without poper oxygenation and thus getting a CO2 headache. Your likely still too tense even though you do not realize it. To that I say go with the flow(yes a pun but I could not resist). Focus on instead of forcibly prolonging dives focus on breathing as you need to and just relax. As a friend of mine (not that we are anymore) once said to me. "The first to half air wins the race. I don't care if its 10min, 20 min, 30min, an hour so long as you have fun and enjoy it. You'll get better with time." I used to be winning the race at 15min. Now usually I'm the one getting out with 1200+PSI.

Also I dunno what kind of physical shape your in but I would suggest hitting the pool or biking to work on the muscles used for diving and the cardio. When I swimming I'm not working on my arms its my kicks I do. Another suggestion would be to use a frog kick (the kick part of the breast stroke) since it uses alot less energy per-kick and also with the rest phase is less likely to kick you into aerobic respiration which is what happens a lot of time to people using the flutter/freestyle kicks. Also buoyancy control is a massive thing. since that is where people get stressed the most by their body doing things they don't want it to do once this is under wraps you'll be much better. I used to have all these issues and finally it just clicked and I just went into "scuba zen mode". Try to find someone who is willing to go slow with the dive swimming more does not mean seeing more(usually is the reverse you see less) most people swim fast to account for their poor ability at buoyancy control an fine finning skills to make up for slight drifts/imbalanced weight loads. Thus find people who go slow and enjoy the dives and they will get longer with time. FYI I speak from experience here. It wass not one thing that sorted me out it was a bunch of little things. There is no "cure all" other than time and experience and skill refinement.

for example.
I went for a 45min dive the other day and it was my first since march due to illness and honestly if I was inform like I used to be it would be an hour long but I was more than a bit over tense and was not a relaxed as I liked to be.

 

[drrich2]

Okay, I'll try to explain my thinking here. Another poster already went into it; perhaps hearing it in different words may also help?

When we inhale, the diaphragm muscle sheet pushes our viscera down into the abdominal cavity, and other muscles raise our chest walls upward, both of which increase the size of the potential space inside the chest, which leads to a negative pressure and that's what air's drawn into, filling the lungs.

On land, when we 'hold our breath,' we usually take a deep breath, shut our mouths, and may even relax our chests, which raises the pressure inside our chests, at which point our cheeks bulge outward. This is because we are blocking the exit of (positively) pressurized air.

It's also possible to hold your breath against pressure with your mouth open, but drawing your rear tongue back (which is how I'd do it underwater, if I did that, but I don't). This creates a block against escaping air, which if you ascend during a scuba dive can lead to pressurized expanding air and arterial gas embolism, pneumothorax or mediastinal emphysema.

It's important not to do that. So, what is it I do?

Okay, on land, open your mouth and take a breath, but at the end of the inhalation, keep your chest wall raised and your diaphragm down (gut pooched out), so you don't exhale. Do not close your mouth or draw the rear of the tongue back.

There is no mechanical obstruction to escaping air. If someone hugged you around the waist and squeezed, air would flow out your mouth easily, because you're not truly holding your breath, as I understand it. Therefore, in theory, there should be minimal risk of barotrauma to the lung from trapped expanding air.

If you do it right. Which requires some mindfulness. And is why I usually don't take real deep breaths when doing this, to give myself some reserve space just in case.

You may ask why I choose to pause at the end of an inhalation instead of at the end of an exhalation. After all, it'd be safer to pause when your lungs contain very little air, instead of being, oh, 1/2 to 2/3'rd full maybe? Yeah, but...

Our primary drive to respire is to expel CO2 buildup from our bloodstream, rather than because we've used up too much oxygen. If the CO2 in our lung air builds up too much, bad things can happen, such as severe head ache.

I reason, and this is just me now, not Scuba Board or anyone else on it or any agency, that if there's a normal inhalation volume in my lungs when I 'skip a breath,' so to speak, that this volume will be able to absorb more CO2 from my blood stream without head ache or other adverse effect (than the small volume left after an exhalation). It's an informed decision I make to achieve results I wish to achieve.

I am not advocating it for anyone. I am explaining it.

Richard.