Headaches/Migrains on surfacing from a dive

[Nick Stephens]

Hi,
My wife and I have been ding now for around 4 years. My wife has not had any problems up to now, until recently on a couple of occasions when surfacing from a dive, a migrain or headache has started. On another occasion about an hour after the dive she felt generally ruff, kept going hot and cold.
Problem is we have a trip booked which we have waiting for a very long time and she obviously wants to go, (becuase we wouldn't be able to go again due to various reasons). She could possibly have a PFO, which is what the classifc diagnosis for these symptoms are.
When embark on this trip she maybe fine, she may not, its all a bit of a nightmare.
Any advice.
Thanks,
Nick..

 

[Doc Intrepid]

Severe headaches after a dive can result from CO2 retention. This has to do with, among other things, proper breathing - consistent, deep, calm/slow respiratory cycles. Suggest you do some reading on it (google search, etc.) and determine whether or not it may be playing a role in your wife's discomfort.

I am unaware of any citations that link severe headaches with PFOs. If you are aware of any, please post.

Regards,

Doc

 

[Nick Stephens]

Ok, thanks for the reply, I'll have to find some info on pfo and mrgrains and post it.

 

[Dr Deco]

Hello Nick:

There is indeed and association between migraine and a PFO. Two physicians associated with diving and PFOs (Wilmshurst and MP Spencer) and others are referenced below.

Dr Deco :doctor:

Readers, please note the next class in Decompression Physiology is September 10 – 11, 2005 :1book:
http://wrigley.usc.edu/hyperbaric/advdeco.htm


References :book3:

Reisman M, Christofferson RD, Jesurum J, Olsen JV, Spencer MP, et al. Migraine headache relief after transcatheter closure of patent foramen ovale. J Am Coll Cardiol. 2005 Feb 15;45(4):493-5.

Azarbal B, Tobis J, Suh W, Chan V, Dao C, Gaster R. Association of interatrial shunts and migraine headaches: impact of transcatheter closure. J Am Coll Cardiol. 2005 Feb 15;45(4):489-92.

Beda RD, Gill EA Jr. Patent foramen ovale: does it play a role in the pathophysiology of migraine headache? Cardiol Clin. 2005 Feb;23(1):91-6. Review.

Finsterer J, Sommer O, Stiskal M, Stollberger C, Baumgartner H. Closure of a patent foramen ovale: effective therapy of migraine and occipital stroke. Int J Neurosci. 2005 Jan;115(1):119-27.

Wilmshurst PT, Pearson MJ, Nightingale S, Walsh KP, Morrison WL. Inheritance of persistent foramen ovale and atrial septal defects and the relation to familial migraine with aura. Heart. 2004 Nov;90(11):1315-20.

Schwerzmann M, Wiher S, Nedeltchev K, et al. Percutaneous closure of patent foramen ovale reduces the frequency of migraine attacks. Neurology. 2004 Apr 27;62(8):1399-401.

Domitrz I, Mieszkowski J, Kwiecinski H. [The prevalence of patent foramen ovale in patients with migraine] Neurol Neurochir Pol. 2004 Mar-Apr;38(2):89-92. Polish.

Morandi E, Anzola GP, Angeli S, Melzi G, Onorato E. Transcatheter closure of patent foramen ovale: a new migraine treatment? J Interv Cardiol. 2003 Feb;16(1):39-42.

Sztajzel R, Genoud D, Roth S, Mermillod B, Le Floch-Rohr J. Patent foramen ovale, a possible cause of symptomatic migraine: a study of 74 patients with acute ischemic stroke. Cerebrovasc Dis. 2002;13(2):102-6.

Anzola GP, Del Sette M, Rozzini L, et al. The migraine-PFO connection is independent of sex. Cerebrovasc Dis. 2000 Mar-Apr;10(2):163.

Anzola GP, Magoni M, Guindani M, Rozzini L, Dalla Volta G.
Potential source of cerebral embolism in migraine with aura: a transcranial Doppler study. Neurology. 1999 May 12;52(8):1622-5.

 

[ckharlan66]

It might also be a sinus issue. My girlfriend is having simular problems. She has a block in her sinus that appears to be causing a barotrama during the dive and triggering a migrain....she is a long time sufferer of migrains. At least that is the best explaination so far. The docs are still looking for other explaination as well though.

Chad

 

[Doc Intrepid]

There is indeed and association between migraine and a PFO. Two physicians associated with diving and PFOs (Wilmshurst and MP Spencer) and others are referenced below....

I appreciate the cites. I was unaware of this previously. Thanks again,

Doc

 

[WarmWaterDiver]

It might also be a sinus issue. My girlfriend is having simular problems. She has a block in her sinus that appears to be causing a barotrama during the dive and triggering a migrain....she is a long time sufferer of migrains. At least that is the best explaination so far. The docs are still looking for other explaination as well though.

Chad

Sinus barotrauma is not uncommon above water with migraines. I too am a lifetime migraine / cluster headache sufferer - and the thin linings of the nasal passages will often get a 'nosebleed' with migraines. I have seen some medical literature that in the early 1900's, leeches were still prescribed for migraines, as the nosebleed link made some physicians' think that by placing a leech on the outside of the nose, in the cleft behind the nostril, the reduction in blood pressure from the leech sucking would alleviate the migraine, and also minimize scarring, for the females who statistically are more prone to migraines than males.

When I'm having 'a bad spell', I'll often awaken with nosebleeds. I also will have some minor nosebleeding in the first day or two of diving a nice tropical location typically, but the moist salt water environs usually make this cease within a week, while in winters above water, I have some degree of sinus barotrauma any time the temperature is near or below 32 degrees F, exacerbated when I'm having 'a bad spell'.

I have had EKG etc. and never had a diagnosis of PFO, so I'm part of the 'other percentage' of the statistic. But, it is worth getting checked, certainly, as the good Doc pointed out.

Hope things go well, and be safe!

 

[Tamas]

What exactly is PFO?.....I am often 'blessed' with migraines/headaches so this is helpful info.

 

[Bzzzz]

Hi,
My wife and I have been ding now for around 4 years. My wife has not had any problems up to now, until recently on a couple of occasions when surfacing from a dive, a migrain or headache has started. On another occasion about an hour after the dive she felt generally ruff, kept going hot and cold.
Problem is we have a trip booked which we have waiting for a very long time and she obviously wants to go, (becuase we wouldn't be able to go again due to various reasons). She could possibly have a PFO, which is what the classifc diagnosis for these symptoms are.
When embark on this trip she maybe fine, she may not, its all a bit of a nightmare.
Any advice.
Thanks,
Nick..

I sometimes get headaches after a dive.... I've found it's usually related to one of two things: Either I have not had enough to drink before the dive (dehydrated) or it's been a somewhat strenuous dive and therefor my heavy breathing has affected my CO2 levels. I find that a lot of times we look for a more complicated answer for a fairly simple fix. Though, the fact that this is a new occurance does point to perhaps a bigger problem and when in doubt check with your Dr. Especially sinse you don't want your trip ruined!
Good luck!
Bzzzz

 

[BigJetDriver]

In short: Patent Foramen Ovale

A flap in the heart between the chambers which is utilized by the human baby to aid in pre-natal circulation. It closes upon birth.

In a small percentage of the population, it fails to close completely, or, remains closed until unusual circumstances force it to open. These may be, in our case, decompression stress, i.e. bubbling, possibly combined with some other mechanism, such as coughing.

This allows the bubbles to cross from one chamber of the heart to the other, enter the arterial circulation, and cause all sorts of problems.

For more information see: http://www.emedicine.com/med/topic1766.htm