Sinus pain?

[natalieinca]

On probably three or four different occasions I have had pain in my head (once in the temple area and a couple times on the back of my head near my neck) while diving. It is a sharp pain and usually while descending I think, but in the middle of a dive, not at the beginning. I don't feel any ear pain and continue to try to equalize.

I usually just move really slowly and go back to the surface. Once I feel the pain it is hard to tell whether I need to go up or down to get relief.

I think this is some type of sinus pain (possibly associated with allergies), although I don't think there are any sinuses in the back of the head. I usually take an antihistamine before the next dive and then do fine. I don't feel congested before or after the dives.

Any ideas?

 

[TSandM]

The sinuses are air-filled structures which lie behind each cheek, behind the forehead, and in the center of the skull. If the drainage passageways from them are blocked, you can get sinus squeeze. Generally, the pain will be felt in the vicinity of the sinus, although maxillary (cheek) sinus pain can sometimes be felt in the upper teeth. Although pain is sometimes poorly localized, I really can't come up with a likely scenario for why you would experience sinus squeeze pain in the lower back of your head. I'd be more interested in whether you are holding your head at an odd angle, or whether your hood is too constrictive in some way.

 

[cutlass]

I know you haven't said so, but has this ever happened outside of diving?

Are there any other complaints of "kinks" or tingles in the neck, shoulders, arms, or hands? Ever had whiplash, say from a car accident? Or taking up judo or horse riding or offroading or extreme rollercoasters or anything else that jostles you about? Maybe trying a new pillow or been crashing weird on the sofa lately?

Just based on the anatomy alone, I'm thinking of the C2 cervical nerve which can be associated with pain in the back of the head, temple, and about the eyes, usually "behind" them, sometimes about the eyebrows. The pain is typically deep or dull but it can be sharp.

Antihistamines have sedative effects which may also quiet irritated nerves. These effects are stronger in 1st-generation formulas; very common examples are diphenhydramine (e.g. Benadryl tm) and diphenhydrinate (e.g. Dramamine tm).

 

[natalieinca]

Hmm, I've never had the same type of pain out of the water. Or any whiplash or such. I am a skier so have fallen backwards and smacked my head (while wearing a helmet).

I do get migraines with a sharp pain in the left temple - that has been going on for years though. No tingles, but I do get a lot of muscle tightness in the neck/shoulder area. I always assumed it's from sitting in front of a computer too many hours a day.

I don't think it's related to my hood as it's happened in warm water with just a beanie as well as cold water with a full hood. Although sometimes it does feel a little like an ice cream headache. I may be holding my neck in a weird position.

I was wondering if it could be sinus squeeze that feels like it's in a different place than it actually is. I do recall feeling like it might be in my upper teeth once.

 

[cutlass]

I'm skeptical that sinus squeeze pain could be referred to the back of the head. It may be possible but that would be news, at least to me. To say "feeling like it might be in my upper teeth" suggests to me a deep frontal pain which is still in the ballpark for my original suspicion.

You brought up another point which is migraines. This is another important possibility. But presumably this is a new pain pattern, unlike those.

The skiing incident(s) is/are a possibility. Helmets are good for protecting the bean but not so great for the neck which has to deal with the added mass. There could've been injury to the cervical spine (disc displacement/disruption or fracture*) that went unnoticed or was dismissed, subsequently healed, and now is coming back to annoy you. "Healed" doesn't mean good-as-new. Rebuilt tissue is never as flexible or well-shaped or well-aligned as the original; to some degree, there is always some inferiority. Also, surrounding healthy tissue might not be totally happy with their neighbor's renovation and do some small defensive remodeling of their own; some degree of misalignment and instability can be expected. These can contribute to intermittant irritation to the C2 nerve.

Of course this is all pure guesswork by me, your total dive bum, so absolutely do not take any of this as a diagnosis. It'll be best to have it assessed by your doctor and, if needed, a management plan devised.


*High C1-C2 injury is about 30% of all cervical fractures. Of these, there's a fairly common (more than half of C1-C2 injuries) C2 injury called an "odontoid fracture" that usually results from falls or vehicle accidents. It's part of trauma protocol to look for signs of it.