Headaches and SCUBA Diving

[PRL]

One thing I noticed from personal experience. After a long dive or series of dives(depth is irrelevant, lets say 20ft) I would get nausea, a headache and sometimes vertigo. All of the symptoms would go away within 1 hour, except the headache. One side symptom would be that my teeth didn't quite fit together, and jaw was fatigued. I read somewhere that because of my mouthpiece, my jaw muscles were deforming my semicircular canals in the ears, and might be the cause of all my symptoms. Not much different than a balance disorder.
With a better fitting mouthpiece and some adjustments to the hoses my symptoms did not return.

 

[Thalassamania]

I hate to think that every post dive headache I've ever had was DCS, especially back when I was young and stupid and trying to lower my SAC rate to virtually nothing. But Jon's piece makes some good points, the economic one I have heard during dinner and drinks conversation at various conferences over the years. For my own evaluation I have to fold two things into this, the first is the lack of credibility that Peter Bennett has (at least in my mind) due to his highly questionable actions whilst the ED of DAN. It has, frankly, made me question everything that I see from DAN down to this day, despite the fact that the current ED is an old, old friend. The second is the level of "gunshy" that is displayed by many of the leading hyperbaricists as a result of the claims that were made early on. We must remember that there was a time when hyperbaric chambers were all the rage and were the cure for almost all the might ail ya.

 

[DocVikingo]

For my own evaluation I have to fold two things into this, the first is the lack of credibility that Peter Bennett has (at least in my mind) due to his highly questionable actions whilst the ED of DAN. It has, frankly, made me question everything that I see from DAN down to this day....

Hi Thalassamania,

Does "everything that I see from DAN" suggest that the science and medicine generated by DAN was somehow tainted, degraded or distorted by Dr. Bennett? If so, I have to say I find that a bit much.

Dr. Bennett's "lack of credibility" is a matter of debate. And it never involved scientific or medical aspects of DAN's activities. Rather, the questions were about various organizational and financial aspects of his leadership, especially about his moving DAN dive insurance plans from underwriters to a wholly-owned for-profit DAN corporation and later offering supplementary life insurance to members under a similar corporate entity. I'll point out here that due to the litigious nature of this fighting and an eventual agreement by all parties involved to drop all legal actions, few solid facts have become public.

Despite years of costly and acrimonious battling carried on by a certain 5 members of the Board of Directors, all of who may have had political agendas, grounds for firing him were never established. He retired because his presence was proving so disruptive to DAN and he was simply worn down by the constant and intense fighting. And, he received quite a generous retirement package. BTW, his "lack of credibility" didn't prevent Duke from subsequently honoring him with Scientific Symposium or from his from being appointed as Executive Director of the prestigious Undersea and Hyperbaric Medical Society where he continues to serve.

Regards,

DocVikingo

 

[JonKranhouse]

Are you suggesting that headaches be considered as potential DCS indications? Unless I'm very wrong I would suspect if this were true and if people believed it that DAN membership costs would spike pretty quickly. Is there any evidence that normal headaches from diving without any other symptoms have any indication of DCS?

As the OP mentioned, headaches have long been considered a symptom of DCS. Hence, a group of US Air Force doctors collaborated on a paper to suggest the reclassification of headaches after unexpected decompression aboard aircraft (flying at altitude) as DCS-1 rather than DCS-2 (my earlier long post). Other "proof" of DCS if a "normal" severe headache presents with no other symptom? I don't know - and I suspect there's no way to prove it's DCS without an MRI or SPECT scan (costly and impractical) - or a "test with pressure" in an HBO chamber (the tradition of the US Navy). There is a body of research that finds an increased incidence of lesions of the brain and spinal cord among active recreational divers who have no history of DCS. Indeed, that was a major predicate motivating the original promoters of Nitrox for recreational diving - to reduce risk of neurological insult. Researchers from the various studies have not said so, but presumably, some diver-subjects had a history of occasional "normal" (i.e. thought-to-be-benign) dive headaches.

Chronic Neurological Adverse Effects of Diving
Long Term Effects of Sport Diving
PubMed to download FREE the complete Swiss research paper (link at top-right of page)
​

Carbon Monoxide has not yet been mentioned in this thread.
I cannot find in PADI's Encyclopedia of Recreational Diving any mention that headaches are a primary symptom of Carbon Monoxide poisoning. I may have overlooked it, though I checked PADI's Encyclopedia very carefully (2005 edition). If indeed absent, I think that's provocative, particularly in light of the 3% to 5% incidence of CO test failures, per research and reliable sources.

Conversely, the US Navy Diving Manual (which you can download for free here) lists headaches as the #1 symptom in the non-alphabetized list of symptoms of CO poisoning; from page 3-21 of the Rev6 edition: The symptoms of carbon monoxide poisoning are almost identical to those of hypoxia. When toxicity develops gradually the symptoms are:

Headache
Dizziness
Confusion
Nausea
Vomiting
Tightness across the forehead​

Then on page 3-22 (3-5.8.3):
Treatment of Carbon Monoxide Poisoning. The immediate treatment of carbon
monoxide poisoning consists of getting the diver to fresh air and seeking medical
attention. Oxygen, if available, shall be administered immediately and while
transporting the patient to a hyperbaric or medical treatment facility. Hyperbaric
oxygen therapy is the definitive treatment of choice and transportation for
recompression should not be delayed except to stabilize the serious patient.
Divers with severe symptoms (i.e. severe headache, mental status changes, any
neurological symptoms, rapid heart rate) should be treated using Treatment Table 6.

Everybody on ScubaBoard should download their own copy of the US Navy Diving Manual - it's a wonderful resource of information that is, arguably, less tainted with agendas shared by the for-profit corporations that dominate the recreational diving industry.

To be clear of my agenda... I don't want a "nanny state" or a country where kids grow up afraid to take risks. I'm no Chicken Little and have taken plenty of calculated risks in diving and aviation. I just think the predicate of the OP's question, coming from someone involved with dive boats that operate, presumably, far from shore in the Red Sea, begs the question: "How much could, and should, the dive industry do that it's not doing already to ELIMINATE variables that add to risk?" For decades, many diving MDs have advocated the installation of oxygen concentrators on liveaboards to provide near-100% O2 during safety stops to better reduce risk of DCS. In an era when divers rely on computers with proprietary algorithms, which many deem more aggressive than traditional tables, that's just common sense.

I don't want the OP thinking I'm singling him out - I AM NOT - but I do believe there's a chance that he, and MANY dive professionals are unwittingly caught up in a systemic failure to ensure gas purity.

When a few SB members have rung the alarm bells about CO on ScubaBoard, this forum of KNOWLEDGE should not have to defend its very existence.

Once you fully eliminate the "scary" causes of headaches, then you can be confident that a headache is most likely caused by a benign factor.

 

[JonKranhouse]

Hi Thalassamania,

Does "everything that I see from DAN" suggest that the science and medicine generated by DAN was somehow tainted, degraded or distorted by Dr. Bennett? If so, I have to say I find that a bit much.

In light of what is mentioned in this post -- and here -- I believe that Thal's concern to "trust but verify" is reasonable.

 

[Thalassamania]

Hi Thalassamania,

Does "everything that I see from DAN" suggest that the science and medicine generated by DAN was somehow tainted, degraded or distorted by Dr. Bennett? If so, I have to say I find that a bit much.

Dr. Bennett's "lack of credibility" is a matter of debate. And it never involved scientific or medical aspects of DAN's activities. Rather, the questions were about various organizational and financial aspects of his leadership, especially about his moving DAN dive insurance plans from underwriters to a wholly-owned for-profit DAN corporation and later offering supplementary life insurance to members under a similar corporate entity. I'll point out here that due to the litigious nature of this fighting and an eventual agreement by all parties involved to drop all legal actions, few solid facts have become public.

Despite years of costly and acrimonious battling carried on by a certain 5 members of the Board of Directors, all of who may have had political agendas, grounds for firing him were never established. He retired because his presence was proving so disruptive to DAN and he was simply worn down by the constant and intense fighting. And, he received quite a generous retirement package. BTW, his "lack of credibility" didn't prevent Duke from subsequently honoring him with Scientific Symposium or from his from being appointed as Executive Director of the prestigious Undersea and Hyperbaric Medical Society where he continues to serve.

Regards,

DocVikingo

It is my observation that whenever a judgment call needed to be made DAN always came down in line with the industry, elimination of suspected "heart attacks" from the list of diving accidents is a perfect example. McAniff refused to do this and a great deal of pressure was brought on the National Underwater Accident Data Center to do what DAN seems perfectly happy with. You and I have both been in academics and around long enough to know that funding talks and has a long tail.

 

[JonKranhouse]

The Current Medicine Group publishes Current Pain and Headache Reports. From this source, © 2004 by William P. Cheshire MD of the Mayo Clinic: Headache and facial pain in scuba divers.

Abstract Headache occasionally occurs during or after scuba diving. Although its significance often is benign, headache may signal a serious neurological disorder in some circumstances. In addition to the usual causes of headache, the diagnostic evaluation should consider otic and paranasal sinus barotrauma, arterial gas embolism, decompression sickness, carbon dioxide retention, carbon monoxide toxicity, hyperbaric-triggered migraine, cervical and temporomandibular joint strain, supraorbital neuralgia, carotid artery dissection, and exertional and cold stimulus headache syndromes. Focal neurologic symptoms, even in the migraineur, should not be ignored, but rather treated with 100% oxygen acutely and referred without delay to a facility with a hyperbaric chamber.

 

[Jess_]

Hey all,

I went scuba diving just over a week ago now in Zanzibar. On my second dive I got a really bad headache underwater but carried on the dive. On surfacing I went dizzy, had trouble with light-sensitivity, felt nauseous and, as soon as I got onto the boat, vomitted - the water was quite choppy though. I had a very painful headache all night after and felt drained of energy and since then - I've had dull headaches every day. I'm a little bit wary as I have no other symptoms but usually wouldn't get headaches all the time. Does anyone have any tips or advice for me or thoughts as to whether this might be related? Painkillers don't seem to subside the pain.

Thanks,
Jess

 

[Bubbletrubble]

Hey all,

I went scuba diving just over a week ago now in Zanzibar. On my second dive I got a really bad headache underwater but carried on the dive. On surfacing I went dizzy, had trouble with light-sensitivity, felt nauseous and, as soon as I got onto the boat, vomitted - the water was quite choppy though. I had a very painful headache all night after and felt drained of energy and since then - I've had dull headaches every day. I'm a little bit wary as I have no other symptoms but usually wouldn't get headaches all the time. Does anyone have any tips or advice for me or thoughts as to whether this might be related? Painkillers don't seem to subside the pain.

Thanks,
Jess

@Jess: You should be seen by a dive-savvy neurologist and/or internist. Feel free to consult Divers Alert Network to get a referral to the appropriate physician in your locale. Please do this.

 

[Red Sea Shadow]

Hey all,

I went scuba diving just over a week ago now in Zanzibar. On my second dive I got a really bad headache underwater but carried on the dive. On surfacing I went dizzy, had trouble with light-sensitivity, felt nauseous and, as soon as I got onto the boat, vomitted - the water was quite choppy though. I had a very painful headache all night after and felt drained of energy and since then - I've had dull headaches every day. I'm a little bit wary as I have no other symptoms but usually wouldn't get headaches all the time. Does anyone have any tips or advice for me or thoughts as to whether this might be related? Painkillers don't seem to subside the pain.

Thanks,
Jess

Although it sounds like carbon-related headache (carbon dioxide, carbon monoxide or both), I highly recommend paying a visit to a specialized physician.

By the way, a revised version of the article "Headaches and SCUBA Diving" has been featured in African Diver magazine (issue 12). You can download a free copy at AfricanDiver.com magazine | Free online scuba diving magazine focussed on Africa