Raging headache after ascending

[indigo_dc]

Wasn't sure if this was a physiology forum question or a basic scuba one, apologies if it's incorrect. But it seemed to be a "basic" kind of question newer divers might ask

After a recent trip, on the last couple of dives I got back on the boat with a pretty painful headache. The DM and other divers suggested it was reverse block, would pass with time and that painkillers/hot towels might help. Rest on the surface interval did help, and considering I'd felt absolutely fine on the first dive I followed the advice and did dive #2 with a headache, albeit not "raging".

As soon as I started descending it disappeared, immediately, and I felt wonderful. One of the best dives of the trip followed, set a new personal record for air consumption, no problems whatsoever. However, on the basis that it was reverse block, I decided to do a longer, slower ascent. Very slowly approached the boat from 60ft and I stopped for 3 mins at 20 ft, 3 @ 15ft and had intended to do 3 more at 10ft but as soon as I hit 15ft/10ft the pain started again and I just wanted out of the water. Struggled through my 3mins @ 15ft then just slowly ascended and got out as promptly as I could. We hadn't gone deep, I kept within 60' and I'd done a slow, controlled ascent and 6 mins of safety stops. But I came out and again had a splitting headache.

2 or 3 hours later, after ibuprofen and a short nap the pain had disappeared completely. Back to normal.

Now, earlier that morning, a few hours before diving, I had a crick in my neck from the hotel pillows - seriously, who needs FOUR pillows - so took a painkiller. Nothing major, pain dissipated, felt absolutely fine before diving. Turns out it was an Advil decongestant AND painkiller though. So even though I had no sinus problems, no cold/lingering cold, no trouble equalising on ascent/descent, I assumed having had the advil earlier meant the reverse block kicked in when it wore off somehow. Seemed like a long time for advil to linger in my system, but I heeded the advice of those with more experience. I thought the fact I'd done a longer, slower ascent might even rule out reverse block?

However...

Back home (still fine, no problems) and describing the incident to a diver friend he says that after any extended dive sessions on air, he ALWAYS gets sinus headaches, without fail. Not reverse block, just a headache, and he claims nitrox has solved that issue for him entirely. Stats for the last two dives were 54 mins at 60' max and 73 mins at 61' max so I was under a fair old time. Definitely the first time I've had headaches after diving and two of the longest back to back dives ever. Is this a common occurrence for others?

Any advice or tips to avoid it appreciated!

(also, just to stress, I understand the risks associated with diving under the influence of drugs/painkillers etc. I'm not sure if in this case it's even linked to my headache, just wanted to give all the facts for the day rather than leave out anything important)

---------- Post Merged at 04:45 PM ---------- Previous Post was at 04:37 PM ----------

actually, once I'd posted this it showed me some similar threads - none posted more recently than 2005 apparently - but it suggests dehydration and CO2 buildup are common causes?

Dehydration - I'm usually very anal about staying hydrated and although I pee quite a lot while diving (it's my personal test to make sure I'm properly relaxed and helps breathing, is that weird?? ) I didn't feel too bad, drank on the surface interval etc.

CO2 buildup is something I'm going to look into now.

 

[Doc]

Like "Dr. House" advises, don't diagnose for a Unicorn just because it sounds like a Pony coming down the hallway.

It was reverse block.

The advice never ever works on someone who has not yet experienced this....

Re-descend a few feet so the pain in your sinus cavities (learn where they are located) abates.

Perform a reverse valsalva. Pinch and suck, (not pinch and blow)

Better try this first at the surface.

If you are dealing with an individual with reverse block, you can get them to do this even on the boat deck, it may be released much sooner.

Pre medicate with Ibuprofen or nasal decongestants. The spray in the nostril kind actually involve some training to use to the best advantage. Some Agencies proscribe this behavior.

Simple thumb pressure massage deep into the area between the eyebrow and eyeball (on the side next to the nose) can create a release.

Much as a valsalva puts air into and inflates sinus cavities (through ducts), when these ducts become inflamed and thus swell up, the natural escape of this (now) compressed air is difficult.

While you Google "sinus cavities", also note the myriad ducts that are available to do this. That will explain why teeth can hurt, as well. This is where the advice comes-in talking about "chew with your jaw". It's all plumbing.

Worrying about hydration? There should never be a question- drink water, and a lot of it.

Most reverse block squeeze problems are caused by irritation from the initial val salva. You may be hyper sensitive, but most divers with this issue need coaching on their initial "pressurization" techniques: Pre medicate if you decide to, begin valsalva before your entry, descend slowly equalizing often. Your ascents should be torturously slow... this gives you time to look for critters, enjoy the view, and your sinuses can depressurize at their own speed.

 

[andrewy]

Air or Nitrox has nothing to do with sinuses i dont think. Proper ascent technique does.
CO2 buildup happens when you work hard and do not exhale al the way. i.e. using lungs for buoyancy a lot.
i do not like having either

 

[indigo_dc]

Like "Dr. House" advises, don't diagnose for a Unicorn just because it sounds like a Pony coming down the hallway.

It was reverse block.

Trimmed the quote for brevity, but cracking reply - thank you. Will bear it in mind.

 

[Peter_C]

One of the best dives of the trip followed, set a new personal record for air consumption, no problems whatsoever.

I wouldn't rule out a combination of both. You are a newer diver and still working on buoyancy and learning to dive. Breathing doesn't come naturally yet either. CO headaches are very common, probably more so than reverse blocks. Neither are fun! Instead of trying to conserve air start breathing all you want and more. I used to get headaches and found I was skip breathing just enough to cause CO retention. I also switched to Nitrox, and haven't had any headaches since.

If you think you are getting a reverse block learn to flush your nasal cavities often. Nettie Pots or the squeeze bottles with "clean water" and the packets works great.

Breathe more than you probably are already. Enjoy the dive, and come up when necessary feeling much better. Learn to do deep stops and ascend really sloooow.

 

[TSandM]

The differential diagnosis of headache after diving isn't short. HERE is a good article covering some of the more common causes. The fact that the headache began during the last portion of the dive, with the biggest pressure differential, and went away after a short time, does suggest sinus barotrauma. If you felt the pain in your face or retroorbitally, or in your forehead, this would also support that. A global headache, or headache in the back of the head, would be less likely to be sinus-related, and would raise more of a question of CO2. If you were using your breathing to control your buoyancy quite a lot during the ascent, that could produce CO2 retention as well.

 

[FuzzyNutz]

If it feels like the worst migraine/headache you ever had in your life, I would put my money on it being CO2 retention. I learned all about this the hard way - went diving with friends who had better air consumption, so I started to 'skip-breathe' to help stay on their pace. WRONG. Just breathe normally and fully and wait for time and experience to extend your bottom times. CO2 retention is the punishment for 'cheating', it hurts pretty bad, and painkillers have little effect (at least in my experience, my head was POUNDING).

 

[djensen]

As a related tangent to this discussion, I used a nettie pot (nasal flush) daily on my last trip to Mexico and never had an issue with equalization or blocks. I'm sold. I'll use it every day on every dive trip from now on. Also, no rebound effect as with some antihistamines. If you're prone to ear/sinus difficulties like me, give it a try.

 

[CaveMD]

While I'm not writing a prescription, I personally take a prophylactic pseudophed before most dives. I especially take an extended release one before any dive below 100' or >1hr deco and I usually take one regardless of planned depth/deco.

 

[promocop]

Why did you do 9. Minutes worth of safety stops for such a relative shallow dive?