Migraines triggered by diving.

[uncfnp]

On my last dive trip i had several issues come up that are still concerning me. I did call DAN but they seem unclear to exactly what occurred and how much was related the the Diving. So the first point I want to clarify is if there are any SB divers that have migraines that have found their migraines are triggered by diving? Of my last 6 boat dives, I had a migraine within 30 minutes returning to shore on three of them. These are migraines with aura. Anyone with any thoughts to share? Can I expect this pattern to continue. Could it be a sign of worse to come. During the week I also developed new tmj symptoms. The last dive left me with a migraine, worsening tmj and possibly mild skin bends, itchy red rash lower back that resolved in just a few hours. So what do you think.

 

[vladimir]

While you wait for an authoritative reply I will point out that migraine with aura is associated with patent foramen ovale (PFO). Whether that relationship is causal or not is undetermined. Skin bends is also associated with PFO.

http://www.americanheadachesociety.org/assets/1/7/Schwedt.pdf

 

[chillyinCanada]

I don't have anything to offer with regard to the headaches, though the reason for an increase in your tmj, to my mind is self-evident. What kind of mouthpiece do you use? As for your possible skin bends, hard to say. Mine presented with lots of itch initially, then deepest pain in upper hip area in lwerback and sides. Upon looking into the mirror could easily see the classic marbling that resembles bruising. I then managed to convince myself that the itching had not been related to the pain and bruising, believing myself to somehow have gotten hurt backrolling or 're-entering g the boat. It wasn't until I had returned home that I spent more thought on it, did my research and realized the truth of the matter.

Not that it really matters in the overall situation you seem to be in, but how long did your itchy rash last?

 

[Laurence Stein DDS]

Allow me to posit a cause and effect: TMJ and migraine may share a commonality: Occlusal Parafunction, i.e. bruxism, clenching, moving the jaws beyond the normal "envelope of function." In both, the Trigeminal nerve ganglion is involved. The muscles of mastication (chewing) are overused and then fatigue. The muscles then fatigue and are no longer synchronized with each other in their function... leading to muscle pain and headache. An increase in parafunction may be associated with headache formation in persons who are prone to migraine.

Parafunction is not the only cause of migraine and thus the condition should be evaluated rather than assume that TMJ is the CAUSE of your migraine. However, there may be an association.

The act of holding the scuba mouthpiece may serve to exacerbate the already existing muscle fatigue and perhaps trigger the migraine experienced following diving.

There is an FDA approved dental device for the treatment of migraine called and NTI-tss. It serves to relax the major muscles of mastication and thereby reduces the incidence of headaches.

You might want to look into the device. Certainly your headaches should also be evaluated by an MD specializing in migraine diagnosis and treatment. I am enclosing a link to the NTI-tss site. There are a number of videos and other information provided there that may be of interest.

While I have made these devices for patients, it is usually in the treatment of TMJ without migraine. The results can be variable and often requires that the patient is actually willing to learn to wear a new "gadget" in their mouth while sleeping. There is also a device for daytime use.

I have no affiliation or financial interest in the sale or manufacture of the NTI and am providing this information for discussion between you, your physician and dentist.

NTI-TSS.com - The most effective FDA-cleared Dental method of migraine prevention.

The PFO/migraine association should also be evaluated.

Laurence Stein, DDS

 

[uncfnp]

Thanks for your thoughts. For some clarification. I have had migraines with aura (my aura is visual) since age 18. I am 53 now. My post dive migraines were very typical migraines for me except that they start after a dive. In 2 of the 3 cases my triptan aborted the headache very well. On the last dive the headache lasted a little longer. My concern is am I now to expect migraine headaches about every other dive? BTW, Ihave a lot of sinus /allergy problem and wonder the the sinus pressure changes may be triggering the migraines.

The TMj issue was very new for me. I have never had TMJ pain before. I have the aqualung mikron with the comfort fit mouthpiece. I have ordered a SeaCure to try but am hopeful this was a one and done problem.

Lastly, my itch was mostly at flanks and was bright red, solid not mottled. The itch lasted about 2 hours and the red was gone the next morning (it was a night dive) except that there was some purpura that gradually resolved over 2 to 3 days. To complicate the issue, I do have a history of occasion hives, mostly stress related. I also felt a little sore in the chest/axilla area but it was the 4th dive that day in a week of diving and I attributed that to a tight BCD.

I also considered the PFO association but since I understand that surgical correction is controversial as well I am not sure that a bubble test would make any difference for me at this point. With the migraines, I already plan to dive very conservatively in the future.

 

[TSandM]

I'm with the posters above. With a history of migraine with aura, recurrent migraines with diving, and what sounds suspiciously like skin bends, I'd get a PFO test.

 

[Peter_C]

Lots of good information to heed above, especially coming from doctors.

Sea Cures work well for me, and I don't get a sore jaw anymore. It is important to cut the ends of the Sea Cure off all the way back to the cut marks and maybe a little beyond. Make sure it doesn't gag your dive buddy. My partner has a very small mouth and is perfectly fine with my reg. When you go to set it to your teeth, do not bite too far. You want your teeth open some to allow airflow.

Sinus problems can often be helped by performing daily sinus flushes. Costco has kits, as does every drug store out there.

Trim and breathing patterns can also have an effect on migraines and diving. I have gotten migraines when I was a new diver. I found that I often was inverted looking into holes and just having poor trim, but more importantly in trying to conserve air and control my breathing I was skip breathing, causing a CO2 headache.

If I had the symptoms you do I sure would want to know if I had a PFO. Then at least the dives and gas mixtures could be planned accordingly.

 

[uncfnp]

I did check with the local hospital and cardiologists, none do the test. I also got several names from DAN but the local MDs were no longer available. This means a drive to Durham for me. I assumed (perhaps wrongly) that unless I was willing to have surgical correction, that I would just dive as if I do have one. But other than diving very conservatively and slow ascents, I'm not sure what other precautions to take.

Peter_C I think I have pretty good buoyancy control although I do admit to some head down diving, even floating inverted at times, to try and get that just right photo. I will be more cautious.

The dive related migraines stated with approximately dive 110. Those dives occurred in September. My next dive trip is Bonaire in March.

 

[TSandM]

You might try checking with your local MDs over whether anybody does transcranial Doppler. It is not as specific as transesophageal echo for a PFO, but it is highly sensitive for shunt.

 

[Imla]

You say you sometimes dive inverted for "that photo".
Do you ever catch yourself "controlling" your breath to minimize motion to get focus, or just the right picture?

Sometimes I focus so much on what I am doing, that my breathing ends up not being effective enough.
Especially while doing macrowork with 105mm and 10+diopter, the sensitivity to movement is so great that I catch myself breathing to slow for the body to vent Co2, and I end up with a massive headache after the dive.

(Although... I must admit, with a week of diving, 4 dives a day, skin rash, itching, muscle pain and headaches, I am prone to believe you might have been bent, and subsequently might benefit from testing for PFO)

A question... if you went on a single dive one day. No camera. Shallow profile. Nitrox? (If you have done this...) Do you still get the headaches?