Headache Due to Diving?

[crispix]

My question is: is diving causing my headaches?

History: In November, ~4 days after a dive, I had severe shooting headaches on my right side. Was treated for sinusitis for over a month with various drugs and little success. A CT scan eventually showed no signs of sinus infection, so that has been ruled out. No rash (shingles), and the pain was always better in the mornings, so no MRI ordered. The headache slowly went away on its own after many weeks, a little better each day.

After the headache was gone, I did a shallow 15' max, 1 hour dive last month. No problems, and no headaches. Last week I did at 60' dive for 30 minutes. Now, a few days later, the headaches are coming back, same symptoms, but not as severe as the first time.

Is there any evidence that diving can cause headaches like this days later?

 

[The Chad]

I'm not sure if this applies since it seems quite a bit of time passed from the end of the dive and the onset of the headaches. CO2 buildup has been an issue for me from time to time. I think once it was due to using a crappy breathing reg and the other was due to my lack of proper breathing. Both times I was worthless and bed ridden for over 12 hours due to the intense pain. Like I said not sure if it applies to you but figured I would throw it out there.

 

[DocVikingo]

Hi Crispix,

This should get you started:

Diving Medicine Articles
Headaches and Diving - UPDATED 2005
DAN Divers Alert Network : Headaches and Diving - UPDATED 2005

I'd look for a musculoskeletal cause first.

Regards,

DocVikingo

 

[fisherdvm]

I was not aware of CO2 headaches too much, until I practiced breath holding last year. I can induce a very nasty one on the left back side of my head by running and breathholding - quite consistantly. It will be interesting if you can recreate yours ..... Just don't sue me if you blow an artery or something....

 

[crispix]

Yeah, this happened several days after the last dive -- during and immediately after the dives I've always been fine. I'm wondering whether or not my headaches are dive-related at all. The ENT I saw last time was of the opinion that it had to be diving related, and no one should ever scuba dive, ever! My primary care doc is a bit more understanding and isn't sure if it is diving related or not. I suspect diving medicine is not their area of expertise.

 

[crispix]

I'd look for a musculoskeletal cause first.

Boy, were you spot-on. I went back for another exam and was diagnosed with TMD. I wish they would have found that the first time around; it would have saved all the sinus treatments, antibiotics, CT, etc.

I wonder how often the fact that the patient is a frequent diver leads to wrong or delayed diagnosis? That certainly seems to be the case here. Ah, well.

 

[DocVikingo]

Hey crispix,

Even a blind squirrel finds an acorn once in a while ; )

Seriously, glad it appears you've finally been properly diagnosed. Hope the treatment is effective.

Best of luck.

Doc

 

[fisherdvm]

Boy, were you spot-on. I went back for another exam and was diagnosed with TMD. I wish they would have found that the first time around; it would have saved all the sinus treatments, antibiotics, CT, etc.

I wonder how often the fact that the patient is a frequent diver leads to wrong or delayed diagnosis? That certainly seems to be the case here. Ah, well.

If TMD is the same as TMJ, a good treatment would be the SEA CURE custom mouthpiece. Even if you don't have TMJ, and do alot of diving..... You'd love the feel of this mouthpiece. It keeps your reg stable in your mouth. No jaw fatigue. Current doesn't pull on your reg. You hardly feel the reg pull, so a large heavy reg feels like a bitsy little one.

If I were your dentist, I would recommend this mouthpiece. Just be cautious when you mould it. I accidently grabbed the oval end and deformed it. So grap it gently when it is warmed up.

 

[DocVikingo]

Yes, TMD (temporomandibular disorder) includes TMJ (temporomandibular joint disorder).

Also, there's more that should be done besides getting a "SeaCURE."

Here's a piece I wrote on the subject:

TMJ & Scuba
http://www.awoosh.com/DocVikingo/TMJ.htm

Regards,

DocVikingo

 

[shakeybrainsurgeon]

TMD is hard to diagnose; I would suspect you would have noticed pain in the joint when chewing, and that the relationship of pain to diving would be more immediate than you describe. It is still a likely cause, but I wouldn't take that as the correct diagnosis just yet.

If you are over 50 or 55 years of age, another cause of severe, sporadic and long-lasting unilateral headache is temporal arteritis, an inflammation of the scalp arteries, particularly the temporal arteries. This can be diagnosed by simple, easy blood work such as a sedimentation rate/C-reative protein levels. Often the arteries are swollen and tender to touch, but not always. This is a very dangerous disease if left untreated, as it can lead to blindness when the arteries to the retina become involved. It is treated with steroids very easily. The disease is extraordinarily rare in young people, virtually unheard of, so if you are young, forget this diagnosis.

Dental problems (a leaking filling, a cracked root, an undiagnosed abscess) can cause this and can be triggered by pressure changes as well. A panorex xray and dental exam should rule this out (in fact, you should be seeing a maxillofacial surgeon if you have TMD anyway, since I wouldn't trust anyone other than a maxillofacial expert with TMJ experience making a diagnosis of TMD or treating it in the first place --- a PCP doesn't know TMD from a brain tumor, trust me).

The time course (your headache was lasting weeks at a time) is wrong for migraine, but men (particularly men over forty or fifty) get a migraine variant known as cluster headache, which tends to settle around one eye, occurs sporadically and can last for days or weeks. It is treated with vascular headache agents like other forms of migraine.

This isn't carbon dioxide retention, the time course is wrong and it lasts only briefly.

Finally, anyone with new onset headaches MUST have their eyes examined and their ocular pressures checked. You could be harboring an undiagnosed case of glaucoma, which can also be affected to a certain degree by diving pressures. This can occur in any age and at any time and can be vision-threatenting as well. If this has been done recetly, fine. If not, I strongly recommend it. This can also cause unilateral headache lasting weeks and can vary with the time of day, since ocular pressures also vary with time of day.

Consider getting a home bp kit, too, and checking your bps freqeuntly. A person may be normal in the office and 180/120 at home or after a dive. Hypertension can cause headache.

These are simple things to check which are far more serious than TMD. TMD is what you're left with when the serious possibilities are rejected.

Just some thoughts...