Migraines triggered by diving.

[uncfnp]

My last day diving was the only day with 4 dives and it was 2 morning dives on nitrox then 2 night dives. I would have to look back at log for specifics but I can say they were all within NDLs. That was the only dive that had the rash.

I did about 100 dives air and nitrox, mostly with a camera without triggering a migraine. My first 2 headaches occurred without any other bends symptoms. The first headache of the trip was after a two dive trip to about 70 feet. The headache started as a visual aura. The headache itself resolved shortly after a triptan and NSAID.

I am not a very good photography so other than some awkward diving I can't say that I have done anything else unusual. If I am altering my breathing I am not aware of it. I will pay more attention next time.

 

[Duke Dive Medicine]

There is a weak correlation between migraines and PFO (example: Patent Foramen Ovale, Ischemic Stroke and ... [Neuroepidemiology. 2012] - PubMed - NCBI), but to my knowledge there is no correlation at all between PFO and migraine that occurs post-dive. Also, while it's possible that the rash you described was type I skin bends, it was not cutis marmorata, which is the type of skin bends that is associated with PFO. I would look for another explanation. Dr. Stein's theory sounds very reasonable. Where in NC are you? We'd be happy to see you in clinic if you're concerned.

Best regards,
DDM

 

[uncfnp]

Thanks DDM. That's very reassuring. I had been leaning toward sinus changes as the trigger, it is not uncommon for me to need a round of antibiotics and steroids for sinusitis after a dive trip but I will definitely give the TMJ trigger another look and talk with my dentist. I live near Asheboro, home of the NC Zoo so a trip to Durham is certainly feasible but as a UNC-CH graduate I'm not sure I can cross that line!

 

[Duke Dive Medicine]

Usually we use bigger needles on UNC grads but we can make an exception Don't rule out the sinus issues just yet; I'd explore both possibilities.

Best regards,
DDM

 

[gtboomer]

Hi uncfnp, I have TMJ, and it has been the cause of many headaches for me (Pre and Post Dive). I mostly do cold water drysuit dives. A custom hood and a mouth piece with a thinner bite surface helped me a great deal. For whatever reason my headaches tend to resolve while I am diving.

Hope you find some answers.

 

[uncfnp]

Thanks. I have purchased a Seacure but haven't tried it yet and I actually have an appoint with an ENT today to see if we can improve or hopefully prevent my sinus and ear problems when I dive. Thanks for your input!

 

[lulubelle]

Seems that since you had an uneventful dive history prior to the dive associated migraines, an eval is in order and I would also bark up the TMJ tree first. Also keep in mind the theoretical risk of triptans interfering with off gassing due to the vasoconstriction they cause. I had a bubble test here in the Triangle a while back. For me, the problem, which showed up early on, was corrected with correcting my breathing and I suspect the migraines were caused by CO2 retention.

UNCPNP
Beat Dook

 

[lucky83]

I can relate to some of your text uncfnp. I also get those annoying migraines very often after diving, and i also am experiencing problems with my sinuses. I have noticed my attacks usually comes with early morning diving (like 6.30ish) and repetitive diving. When you say migraine with aura, what do you mean? I'm sorry for my non sufficient english skills. I will definately look closer to PFO even though a lot of you have pointed out some mistakes i know i am doing, by not breathing properly.

lulubelle, can you tell me more about the risks of triptanes as i also take them for my migraine. I'd really appreciate that.

 

[DocVikingo]

lulubelle, can you tell me more about the risks of triptanes (sp?) as i also take them for my migraine. I'd really appreciate that. (sic)

Hi Lucky83,

Not lulubelle, but I can offer a little info regarding TRIPTANS and diving.

The real risk with this class of drugs is to individuals with cardiovascular disease or uncontrolled high blood pressure as the constriction of blood vessels caused by triptans can in some such cases result in serious, even fatal, reactions.

While generally quite safe, like all drugs triptans have side-effects. Although these usually are not especially worrisome, some are of concern to the otherwise healthy diver, including drowsiness, dizziness, nausea & dry mouth. Interestingly, if triptans are taken too often/in too large doses, they themselves can cause headache. On the bright side, the half-life of most triptans is quite short (about 2-hrs or even less), meaning that in about 12-hrs 98% of the drug has been eliminated from circulation. As with all drugs, triptans should be given an adequate topside trial before diving to assess for possible adverse effects on safe scuba.

As to the possible adverse impact of the vasoconstrictive effect of triptans on inert gas loading/offloading during scuba, to the best of my admitedly limited knowledge any such action is entirely theoretical.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship and should not be construed as such. Discuss any health issues with your personal physician before diving.

 

[lucky83]

Thanks Doc for the clarification. Regarding my blood pressure, it is pretty normal, although it's closer to low than high pressure. I have tried more or less every migrane pill available and the one i am using atm (the one with triptane) seems to be the only one working properly. I will definately take your recommendations in consideration.

This is why i fell in love with SB