Severe headaches after flying


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If you get headaches, you’re not alone. Lots of kids have headaches from time to time.

Let’s find out more about headaches and how you can feel better.

What Is a Headache?

Although it may feel like it, a headache is not a pain in your brain. Your brain tells you when other parts of your body hurt, but it can’t actually feel pain. Most headaches happen in the nerves, blood vessels, and muscles that cover a person’s head and neck. Sometimes the muscles or blood vessels swell, which means they get larger.

They also can tighten or go through other changes that stimulate or put pressure on the surrounding nerves. The nerves send a rush of pain messages to your brain, and you end up with a headache.

What Are the Kinds of Headaches?

The most common type of headache is a tension, or muscle-contraction, headache. This happens when stressed-out head or neck muscles keep squeezing too hard. When you get this kind of headache, the pain is usually dull and constant. It might feel as though something is pressing or squeezing on the front, back, or both sides of your head.

Pain that’s especially sharp and throbbing can be a sign of a different kind of headache called a migraine (say: MY-grayne). Migraine headaches aren’t as common as tension headaches, especially in kids, but they can still happen. Sometimes, just before a migraine happens, the person sees wavy lines or bright spots of light. This is called an aura (say: AWR-uh). Also, kids who get migraines often feel sick to their stomachs and sometimes throw up.

What Causes Headaches?

Sometimes a headache is just a part of another illness, such as a cold or flu or strep throat. When you get better, the headache gets better, too.

If you’re not sick, other triggers may cause a headache. For example, staying up too late, skipping a meal, or playing in the hot sun too long can set off a headache.

Excitement about a special event or worry about something (a school exam, for instance) can also cause headaches. Some kids get headaches from riding in a car or bus or from straining their eyes by spending too much time watching TV or using a computer.

Strong odors, such as perfume, smoke, fumes, or the smell of a new car or carpet, can start a headache.

Some foods can cause headaches in some kids, such as bacon, bologna, and hot dogs. The caffeine in sodas, chocolate, coffee, and tea may cause headaches, too. Kids don’t need caffeine, so it’s a good idea to limit it in your diet.

Sometimes no one knows why a kid gets headaches, but if you get them, chances are someone in your family gets them, too. The tendency to get headaches is often inherited. In other words, it runs in the family.

Headache Help

Most headaches will go away after you’ve rested or slept awhile. When you get one, the first thing you should do is tell an adult, so he or she can help. Lie down in a cool, dark, quiet room and close your eyes. Put a cool, moist cloth across your forehead or eyes. Relax. Breathe easily and deeply.

A grown-up can give you a pain relief medicine — either acetaminophen (say: uh-see-tuh-MIH-nuh-fun) or ibuprofen (say: i-byoo-PROfun). You want to avoid taking aspirin for a headache because it may cause a rare but dangerous disease called Reye syndrome (say: RYE SIN-drome).

When Should I Go to a Doctor?

Headaches are very rarely a sign of anything serious. Headache triggers such as eating certain foods, being stressed out, or not getting enough sleep are much more likely causes of headaches in kids. Or sometimes, there’s no obvious reason at all.

Still, there are times when your mom or dad should talk with the doctor about your headaches:

  • when a headache is particularly painful
  • when a headache doesn’t go away easily
  • when a headache follows an injury, such as hitting your head
  • when your vision is affected
  • when you feel tingling sensations
  • when you just don’t seem like your usual self
  • when headaches occur once a month or more
  • when headaches cause you to miss school

A doctor can help you and your parents figure out why you’re getting headaches and might be able to help you keep them from happening so often. Sometimes relaxation exercises or changes in diet or sleeping habits are all that’s needed. If necessary, a doctor also can prescribe medication to control headaches.

If you’re bothered by headaches, you don’t have to put up with the pain. Sometimes relief is just a nap away. Other times, seeing a doctor may be necessary. But there’s almost always something that you, your parents, and your doctor can do to help.

Reviewed by: Elana Pearl Ben-Joseph, MD Date reviewed: September 2018

Possible Dangers

Many migraine symptoms — which can come on before, during, or after an attack — can make a dangerous mix with motor vehicles. These include:

Nausea and vomiting. It’s hard to keep your eyes safely on the road if you’re dealing with either of these problems.

Visual aura. You may see spots, have tunnel vision, or be unable to see clearly around you. Or your vision may get blurry. These vision disturbances can be hazardous.

Photophobia and phonophobia. Extreme sensitivity to light (photophobia) or sound (phonophobia) is common with migraines. This means sun glare or bright lights from other cars can make your migraines worse. So can honking horns or loud trucks.

Slower reflexes. You might feel your arms or legs move more slowly before or during a migraine. Or you might feel dopey or just a little “off,” as if your thinking is foggy. You might not be able to hit the brakes in time or have trouble steering the car.

Paralysis. A rare form of migraine called hemiplegic migraine can cause weakness on one side of the body before a headache starts. You shouldn’t drive or use any machinery if you have this type of migraine.

Dizziness/vertigo. This doesn’t happen often. But it can make you feel like the car is spinning.

Tinnitus. Ringing in the ears, or hearing sounds that aren’t there, isn’t a common migraine symptom. But it can make it hard for you to concentrate on driving.


Asked by bonnie

Can Riding In Or Driving Cars Give You A Headache Or Migraine?

I get bad headaches whenever I go over 20 minutes or so in a car. I’m ususally riding as my husband usually drives, but it doesn’t make any difference. I’m wondering if the scenery that goes by as the car goes down the road could be a trigger for a migraine?


Hello, Bonnie,

Are you talking about headaches or Migraines? You’ve hit on a possible answer — the scenery going by. The flashing scenery or the flickering of sunlight through scenery is a common Migraine trigger just as strobe light and some animations are.

The “visual Migraines” you mention may well be Acephalgic or Silent Migraines. Not being able to think of the right words is also a common Migraine symptom called aphasia. Here are a couple of articles that address your questions:

• Acephalgic or Silent Migraine – The Basics
• Anatomy of a Migraine

Have you talked to your doctor about this? Depending on how frequently this happens, he may suggest taking a Migraine abortive such as a triptan when this happens. Some people who tend to get Migraines in the care have told me that taking a medication for motion sickness, such as Dramamine, when they start out keeps them from getting Migraines in the car. That’s something else you can suggest to your doctor.

Hope this helps!


24 Tips To Avoid A Migraine While Traveling

There is only one thing worse than a migraine and that’s a migraine attack while traveling.

Travel is a perfect storm of factors that can trigger attacks in even those who do not frequently get migraine. Why is that?

How Travel Causes Migraine Attacks

Travel might be by car, boat, bus, train or while flying and all of these involve potential triggers. Travel can cause a migraine attack because there are so many potential triggers involved.

The migraine brain likes routine: including regular sleep-wake cycles, regular stress levels, eating timetables, exercise, and movement. Travel is a disruption to the routine for most people and significant disruptions can cause an attack in those vulnerable.

Triggers When Traveling

Travel is stressful. You need to remember everything to pack. You may be helping to organize others or kids. You need to run on time. Delays result in missed connections. All of this can be stressful. This change in stress level is enough to trigger an attack.

Others may be familiar with high levels of stress and not bothered by the level of stress involved in travel. When they arrive at their holiday destination their stress levels may fall significantly. This fall in stress has also been known to trigger attacks. Teachers, for example, may report migraine attacks on weekends after an intense week in the classroom full of students.

It is the change in stress, not the absolute level of stress which is a trigger factor for many.

Sleep and Jet Lag

Lost sleep and jet lag are very common triggers for those who cross time zones.

The more dramatic the change in the time zone the more likely the risk of an attack when all else is constant. Jet lag often takes several days to recover from which can be a vulnerable period for someone with migraine.

Processed Foods

When we travel we are often forced to eat what is available or nearby in the rush to our destination. This change in diet is often towards quick, takeaway and heavily processed foods. Many processed foods contain harmful chemicals, compounds, and ingredients which can stack up and trigger a migraine attack.

Bright Lights and Glare

Whether you’re traveling by air, sea, or land, bright lights are everywhere. In the air, the glare from the sun through the plane window and in the airport can be a strong irritant. Window shades are also usually required to be open for landing and take off which make it difficult to avoid.

By sea, the sun shining on the water can feel as strong as staring directly at the sun. On a train, bus, or car, there can also be a significant amount of light affecting the traveler. This is especially if the sunlight flickers through a treeline alongside the road or train tracks.

Loud Noises

Traveling by public transport of any kind involves noise. There are announcements over the loudspeakers in terminals and in-cabin announcements. Boat and plane engines can roar for the entire journey while the horn and breaks on a squeaky train can be deafening.

Passengers can talk for lengthy periods in loud voices which can be irritants. Stations and restaurants in airports and other terminals can also play loud music.

Lack of Movement

Typically when we are traveling, we are not moving much or exercising. We are typically sitting or standing still for an extended period of time. Being sedentary for a long time is not ideal for the body.

Flying for long periods of time increases the risk of deep vein thrombosis or in rare cases a blood clot in high-risk individuals. For most people the risk is low but it demonstrates an important lesson. Our body thrives on movement. Exercise releases endorphins, it can reduce pain, increase our pain threshold, and make us feel good (1)

Strong Odors

We are often inevitably subjected to strange and unpleasant smells while traveling:

  • The smell of the engine or fuel from the plane or boat.
  • The cigarette cloud of smokers lingering outside the terminal.
  • The overly strong perfume of people in the crowd.

These can act as triggers for migraine patients who are sensitive to odor.

Cabin Pressure

Flying in a plane inevitably changes the atmospheric pressure around us as the plane gains altitude. This pressure change is another trigger which can lead to an attack in those with migraine.


Dehydration is one of the most common health problems of passengers flying and is also a migraine trigger. Dehydration occurs due to a lack of humidity in the air. Planes bring in outside air to circulate the air in the plane. At 30,000 feet the air is cold and does not much moisture which results in lower humidity within the plane for passengers.


Travel disrupts our schedule and may cause missed meals, hunger or insufficient food. All of these can be contributing factors to a migraine attack.


Changes in altitude, climate, temperature, air pressure or even humidity may all act as potential triggers for those vulnerable.


A holiday may be a great time to relax and celebrate with your friends or family, but alcohol can also cause problems for those with migraine.

Alcohol might help you unwind on your break but it can also make several of the above triggers worse. Alcohol leads to dehydration. Drinking in excess can prevent quality sleep no matter how long you sleep after consumption. This can exacerbate jetlag and sleep disruption. Alcohol also increases appetite which may lead to an increased consumption of heavily processed foods full of potential trigger ingredients.

Given this collection of potential migraine triggers, it might seem completely overwhelming to be able to enjoy a holiday or trip without a migraine attack. Should we all simply give up trying to travel?

The good news is that with some preparation and preventive strategies, traveling frequently without migraine is very possible. See the next section for tips.

How To Avoid A Migraine When Travelling

There are many things we can do to reduce the risk of an attack while we are traveling. These tips are broken up into 3 sections.

  • Before You Go
  • While Traveling
  • What To Do If You Have An Attack

Before You Go

(1) Raise Your Migraine Threshold

Migraine is a moving a target. The nature of this disease means that it can change over time. Triggers can evolve. Attacks can change and our overall resilience can improve or decline based on a number of genetic and environmental factors.

Fortunately, we can control many factors that help protect us from a migraine attack.

It’s important to understand that migraine triggers can stack up. One trigger might not trigger an attack but three triggers all at once may. When the triggers lead to a migraine attack it crossed our migraine threshold.

The ‘migraine threshold’ refers to our resilience. It’s the level at which we can endure potential triggers without having a migraine attack. Once that level is exceeded, then a migraine attack occurs.

The good news is that our migraine threshold can be improved. Some preventive medications can help such as these. Other things we can control directly.

This includes having good sleep hygiene.

It’s about quality, consistency, and duration of sleep. Get at least 8 hours and go to bed at the same time each night.


Diet is another very important part that is not often discussed by doctors. There are several reasons for this. One is because diet is hard for doctors to manage in their patients and they are not trained extensively in diet and preventive health. For more information about the best migraine diet visit this article.


Sitting is the new smoking. Our sedentary lifestyles are as bad or worse than smoking or obesity to our longevity according to the Mayo Clinic.

Exercise is a powerful migraine prevention tool. Studies have compared regular exercise to a billion dollar migraine preventive drug Topamax and found that exercise was just as effective with only positive side effects. (1)

Not only are these habits or practices good for migraine but they’re also good for our brain health and our longevity. Build up your resilience so that when some of the triggers you can’t control like weather or timezone changes become a factor, you are strong enough to withstand them without an attack.

(2) Plan Ahead

“If you fail to plan you plan to fail.” – Benjamin Franklin

Write A List

Write a list of everything you need to travel including all your documents, medications, vitamins, devices or therapies you need to prevent or treat a potential attack.

Having a list with everything takes the stress out of travel preparation. Once you’ve got your list you simply tick off each item once it’s packed and ready. After some practice, it will feel great ticking things off your to do and packaging list.

Avoid Rushing

Be prepared and give yourself time to see a doctor, obtain refills, get polarized sunglasses, etc. When you have done this once, it will be easier in the future.

Leave with plenty of time to arrive at the airport, train or bus terminal. Rushing is stressful and it’s what makes it easy to forget or lose items.

Keep Copies of Your Travel Itinerary

Secure your travel arrangements well in advance. Print the details and keep a copy on you while traveling.

Book Transfers In Advance

Arrange your transportation to and from hotels or locations in advance rather than upon arrival.

A little planning can go a long way to ensuring your trip is as stress free as possible.

(3) Refill Your Medications

If you’re away for a week or a month you’ll need a ready supply of medications. Refill your current scripts and ensure you have sufficient stock. That way you are prepared if the worst-case scenario erupts.

(4) Pack A Migraine Bag

Your migraine bag could be a toiletries bag which contains everything you need to manage your migraine condition. It will include things like your:

  • daily preventive medications
  • medications for an acute attack
  • your backup or rescue treatments when your abortive medications fail
  • supplements or vitamins
  • any oils or small migraine related items
  • pill cutter if needed

Keep this bag in your carry-on so that there is no risk it will end up as lost luggage.

(5) Use A Personalized Mobile Emergency Kit

In addition to your migraine bag, carry a small pill box or small plastic container that contains everything you need to survive one migraine attack or a close encounter.

This is something to keep in your purse, wallet, jacket or backpack. Along with a water bottle. This way you’ll never be caught unprepared and you’ll always be able to intervene early if you feel especially vulnerable or at risk.

If you are wondering what you can possibly do every time you feel at risk? One research has shown that ginger powder (or ginger root capsules) is as effective as Sumatriptan when taken at the first signs of an attack. Yet its much cheaper and has fewer side effects. See this article and refer to the study citation. (2)

Another option might be a high quality peppermint or lavender oil for the forehead, temples, neck or wherever you feel an attack coming on. Others who’ve learned biofeedback or meditation can intervene early through mindfulness or breathing techniques to help calm the nervous system potentially avert an attack.

(6) Letter From Your Doctor

Different countries have different rules and regulations. Customs officials may be highly suspicious and try to confiscate the small pharmacy packed in our luggage.

That’s why a letter from the doctor listing all our medications, devices, vitamins and supplements and explaining that you have been diagnosed with migraine or chronic migraine is very helpful for these situations.

Take at least two copies of this letter and be prepared to show it at customs or inspection if required.

If you have severe attacks that do not respond to conventional treatment or a status migraine where you could end up in hospital then you should also have added to this letter or a separate note from your doctor something that describes what you should be given to help you abort the severe attack or status migraine in a clinic or hospital setting. The doctor should also provide their credentials and contact information.

It is unlikely they will be called but it is important for hospital staff to be able to authenticate and check if required by their own internal compliance process for certain treatments.

(7) Check Your Travel Insurance

Travel insurance and hospital cover may sometimes be provided by your credit card or health plan but sometimes it is not. Now is the time to check before you travel to insure you’re covered if a hospitalization or doctor visit is needed.

(8) Allow Extra Time

If you’re traveling across continents or have several stops, build in some downtime. Consider staying a night or two halfway rather than trying to tackle a long journey all at once.

Give yourself plenty of time to make flight connections. Remember that delays are common and weather can plays havoc with flights in vulnerable areas.

Larger airports and busy travel hubs require more time to transfer between flights. You may also have to go through customs again when transferring at overseas airports.

(9) Pack healthy, filling snacks

To the extent possible, manage what you eat.

If you are gluten free you can often request this in advance. Pack healthy, filling foods that do not contain triggers or potentially problematic ingredients.

These are will vary by person but good options are often single ingredient, whole foods such as unprocessed nuts, seeds, fruit, some dried fruits and minimal ingredient protein bars and even dark (85%+) chocolate.

Listen to your body. Take foods and snacks you know are safe. Note that some countries don’t allow you to bring in any fresh foods so plan to eat them before you arrive. Packaged nuts or seeds are generally ok.

If you know you are going to be forced to eat a potential trigger food try eating and drinking something prior. Some patients report less sensitivity to trigger foods if they are not eaten on an empty stomach.

(10) Polarized Sunglasses

If you have good weather on your trip then you are likely to see plenty of sunlight. Pack a hat, cap and quality pair of polarized sunglasses. Many sunglasses still today are not polarized. Polarization makes a noticeable difference in reducing the glare which can be especially unpleasant for those with migraine.

(11) Eye Mask

Make sure you pack an eye mask. This will help facilitate rest or sleeping while in transit.

At your new location you are likely to have different levels of light coming into your room at potentially early hours of the morning. A sleeping eye mask comes in very handy when the shades are lighter than what you are used to back home.

(12) Ice Pack

Take an ice pack that you use. There are lots of variations designed specifcally for migraine patients that can wrap around the head. Ice and a dark quiet room are some of the most popular and effective natural treatments to reduce the pain of a migraine attack.

(13) Neck Pillow

If you are sitting down for a long period of time in the same position then a neck pillow can prevent neck strain or discomfort which can be a trigger factor for many people.

Try a few options for comfort before buying.

(14) Pack Your Migraine Device

If you use any migraine devices like the Cefaly, Spring TMS or the Vagal Nerve Stimulator they should be packed and kept on hand in case they are needed.

(15) Exercise Before You Leave

Regular exercise is important but if you have a great workout at the gym, or go for a long walk or jog before you travel then sitting down and being sedentary is much easier to do. Your body can recuperate from the exercise while in transit and you will be more likely to find rest in an otherwise tricky environment.

(16) Consider A Preventive Treatment

Many of the tips shared above are preventive strategies to prevent an attack from occurring. Their are also medications that can effectively prevent migraine attacks.

If travel guarantees a migraine attack then it may be worth discussing preventive treatment options with your doctor in preparation for the trip. Some preventive treatments may require you build up ahead of the trip while others may be able to be taken just while traveling.

Your doctor is the best person to discuss options that suit you.

While Traveling

(17) Conquer Jetlag

Some amount of jet lag is inevitable if you travel to a significantly different time zone but jetlag can be managed.

For example, melatonin is a natural hormone and sleep aid. In times of jet lag you may not be producing melatonin naturally when you need it because your body clock is out of sync. Melatonin supplements can help. There has also been evidence that 3mg of melatonin can help migraine patients in general. (3) Speak to your doctor about melatonin for the trip to help you sleep through the first few nights.

Another option is a drowsy antihistamine which may also help you sleep through the night whilst traveling. If you often wake during the night during the first few days of a trip then this may also be worth discussing with your doctor or pharmacist.

(18) Use Earplugs Or Headphones

When traveling on a plane, train, or bus, a pair of earplugs can go a long way. Just be careful not to miss any important announcements, like your stop.

Headphones technically have improved dramatically in recent years and can let in ambient sound on-demand through hand gestures or setting configurations. They also can come with plane plug adaptors giving you great sound quality in-flight entertainment. Regular travelers should consider this a worthy travel companion.

(19) Wear Tinted Lenses Inside For Fluorescent Lights

Fluorescent lights are still widely used in many transport terminals, in cabin, in hotels, shopping centers, and public venues.

Tinted lenses like the proven FL-41 tint or these developed by a migraine patient can help reduce the strain and irritation caused by these fluorescent lights.

Avoid wearing sunglasses indoors. You can dark-adapt your eyes and make yourself even more sensitive to light.

(20) Expect Strong Odors

Sometimes there is not a whole lot you can do with the strong odors from the plane, boat or from other people’s perfume.

One tactic that might help is by rubbing peppermint, eucalyptus or lavender oil under your nose or above your top lip to temporarily block strong odors. Make sure you use a pleasant scent that you have tested before.

(21) Minimize Ear Pressure

Ear pressure from the airplane cabin can quickly turn into a headache or migraine if left unchecked. To minimize the impact of cabin pressure try:

  • Taking an antihistamine. This may help reduce mucus accumulating and prevent the pressure from building.
  • Swallow or yawn during takeoff.
  • Chew something like a piece of gum or snack. Choose healthier alternatives where possible.
  • Pop your ears gently, by pinching your nose, closing your mouth and blowing gently.

(22) Stay Hydrated

This is self-explanatory but often tricky to do in practice.

If you’re not sitting in an aisle seat, drinking regularly may cause you to get up often. To avoid this consider a high-quality hydration electrolyte option like Total Hydration’s Natural Himalayan Replacement Capsules or Hydralyte.

Not all hydration electrolyte mixes are equal, some contain potential trigger ingredients, sugars, and additives while others are more naturally based. Check the ingredients before making your selection.

(23) Consider If Alcohol Is Worth The Risk

If it’s your holiday you may feel like celebrating by drinking but few celebrations are worth a migraine attack especially while traveling.

Alcohol reduces your tolerance to withstand other migraine triggers and enhances other trigger factors like sleep disruption, jet lag, and dehydration.

Alcohol is really only for the very experienced patient who knows what their limits are. If you have chronic migraine or are not sure, play it safe and find another way to safely indulge on your trip. How about a gentle massage after you arrive?

(24) Recuperate Upon Arrival

Give yourself time to decompress when you arrive at your destination. A gentle stroll outside in the sun with some fresh air can help you recalibrate to your new time zone and climate.

What To Do If You Have A Migraine Attack While Travelling

The above tips will put you in an excellent position to better control your condition while traveling. But we should still be prepared if an attack does occur.

If it occurs while traveling and we are not prepared, it can cause further stress, turmoil, and pain.

To prepare, utilize your emergency migraine kit (see tip no.5 above) and take your medication immediately. The sooner the medication is taken during a migraine attack the more effective it is likely to be. Timing is key which is why tip no. 5 is so important.

Overseas Hospitals

One of the worst places to have a migraine is the hospital. It’s often crowded, flooded with bright lights and you are often waiting for a long time surrounded by other sick or injured people.

Not to mention the potential cost or hassle of filling out a travel insurance claim.

Therefore as much as responsibly possible, we want to avoid the hospital. We can do this by having a strategy to abort a migraine when it arrives and, if possible, returning to the hotel room early. A dark quiet room with our medication, ice, bed or couch to lay down is going to be the most conducive environment to recover from an attack.

If for some reason the treatment fails or the attack lasts longer than usual then we should have a backup plan in place. A second line of treatment may be employed in this scenario. This treatment is different from the first line abortive treatment. Both options should be discussed before you leave with your doctor.

Rescue medication is not designed for use with every attack but only for the most severe or unresponsive attacks. These are designed to keep you out of the hospital. For example instead of taking the oral Sumatriptan you might take the more expensive but also far more effective format of Sumatriptan which is an injection to help relieve your attack.

If you are traveling with friends or family who offer help, let them. Delegate responsibility if appropriate. Let them bring you a fresh towel or ice and make them feel useful rather than helpless.

With forward planning, we can manage many of the triggers and prepare for attacks if they do occur. We can’t expect perfection and shouldn’t be frustrated if an attack does occur. All we can do is our best.

Travel can be a wonderful experience that offers an entire world of adventure, culture, and experience. It can also give us a new appreciation for our home, family and to be grateful for what we have. That is all something worth striving for.

What strategies do you find the most helpful when you travel? Let me know in the comments below.

16 Dec Ask the Expert: Flying Triggers Migraines

Posted at 22:06h in Ask the Expert by headache

Q. When I fly, I usually end up with a migraine. This is not a good way to start a fun, relaxing trip. Is there any way to prevent migraine while flying?

A. Migraine headaches triggered by flight may be related to the relative pressurization that occurs in commercial jet aircrafts. At standard flight altitudes, the condition in the passenger compartment is equivalent to being at between nearly 5000 feet of altitude (similar to Denver) and nearly 8000 feet. At 8000feet, the relative oxygen concentration in the blood is about 93% of normal. This may contribute to developing altitude sickness or at least a migraine.

The drug acetazolamide, which is a mild diuretic and used to treat altitude sickness, may help prevent migraine induced by flying. I recommend that it be taken at a dose of 250 mg twice a day starting the day before flying. Transient numbness or tingling sensations are common. Another side effect is that it can make carbonated beverages taste odd.

Frederick Freitag, D.O.
Diamond Headache Clinic
Chicago, IL

Suffer an ‘Airplane Headache’ When Flying? You’re Not Alone

As for why airplane headaches occur, scientists think “it’s due to an imbalance between the air pressure in the cabin and those in the frontal sinuses,” says lead author Dr. Federico Mainardi.

In some people, their sinuses may have difficulty equalizing the increase in barometric pressure that occurs when a plane is landing and this may cause pain, suggests Mainardi, a neurologist at SS Giovanni e Paolo Hospital in Venice, Italy.

The exact cause of airplane headaches remain unclear, but it’s likely due to several factors such as the shape of the sinuses, as well as the speed of the aircraft, cabin pressure, and even the maximum altitude reached.

While most of the sufferers in this study had their first airplane headache while they were in their 30s, the attacks don’t appear to happen every time people fly.

Airplane headache was first described in the medical literature in 2004, and it was viewed as a rare occurrence. But now experts aren’t so sure. “We suppose it’s a common condition,” says Mainardi, but they’ve yet to collect the data to back that up.

There can be other reasons for flight-related headaches: Air travelers may get a migraine or tension-type headache from a lack of sleep, stress, or holding their neck in an awkward position during a long flight.

And more than half the participants in this study also appeared to suffer from another type of headache. This raises the possibility that being prone to other kinds of headaches helps activate the pain pathways linked with airplane headache.

Mainardi hopes that airplane headache will become recognized as a new form of headache and included in the International Headache Society Classification, which currently includes more than 200 different types of headaches.

In the meantime, he says that in some cases, taking a non-steroid anti-inflammatory drug, such as ibuprofen or naproxen, along with using a nasal decongestant spray about 30 to 60 minutes before landing, may help relieve or prevent pain.

This article originally appeared on

Headaches attributed to airplane travel: a Danish survey

The present study showed that up to 8.3 % (n = 21) of our study population suffered from AH. There might have been a skewed gender distribution due to the possibility of a mainly young audience using Facebook. Despite this, close to 40 participants were aged 60+, the average age was 38.2 years ± 15.8 (range 18–76). Although, larger population-based studies would be required to give a more precise estimate of the prevalence of AH in Northern Europe (i.e., Denmark). However, our findings are in line with findings from Southern Europe . Based on the current ICH’s classification, AH is short-lived – usually around 30 min experienced when ascending or descending – with severe stabbing pain, usually on one side of the head, near the eye. Although, the clinical symptoms reported in our population is consistent with this classification; we also found 68 participants that claimed that they suffer from AH, however, we could not classify them based on the diagnostic criteria of AH, but noted that their headache occurred only while flying. Whether or not this group or some individuals in this group can still be identified as AH is not clear now, due to inadequate information.

However, the pain in AH-group (n = 21) was experienced as stabbing in only 29 % of the cases. The grading of severity was moderate and the onset of the attacks was equally divided between take-off and landing. Five participants experienced headache during the cruising, but the onset of the headaches could potentially have started after the take-off phase. Our findings in the AH group are not completely in accordance with the literature, where the headache is usually rated as severe, with a jabbing, stabbing or sometimes pulsating quality, and mostly occurs during the landing phase .

To identify potential risk factors of AH, we asked if the participants had experienced a cold or any other nasal congesting syndrome (that can be a cofounding factor). Two AH-participants noted cases of cold, however they indicated having AH is independent of cold.

The participants were also asked to note if they suffered from any chronic diseases to identify co-morbidities. Two chronic diseases, asthma and epilepsy, were listed by the participants in the AH group. Based on our data gender does not seems to be a risk factor for AH, although our data indicate a higher female AH-ratio, which is in contrast to previous studies suggesting a male dominance . A skewed gender distribution is known from previous studies with a higher incidence in men than in women. A skewed gender distribution is also known from other types of headaches, such as tension type headache, where males have a higher risk than females . However, the risk of migraines is three times higher in females than in males (18 % F, 7 % M) .

According to our findings AH primarily occurred during take-off, and landing. This is consistent with the previous findings and the ICH’s criteria for AH . Changes in cabin pressure when an airplane is ascending or descending could affect those passengers with a highly sensitive baroreflex . One study has demonstrated that migraine patients may have a highly sensitive baroreflex compared with healthy controls . If a similar sensitivity exists in AH, this might pose a possible pathway for the development of AH. Sensitive baroreceptors and the link with migraine remains to be properly proven . Another mechanisms might be through trigeminal nerve stimulation of the mucosal tissue. Cabin pressure may also affect cranial arteries, causing vasodilatation and headache. The vasodilatation might be caused by an imbalance between internal and external air pressure . Cabin pressure may also affect hypersensitive cranial arteries, possibly cerebral arteries, thereby causing vasodilation and headache . Based on our results, HAH is a risk factor for AH. HAH is short lasting condition, that may occur during changes in altitude (primarily; ascending over 2500 meters), and often seen in activities such as mountain climbing . HAH is felt on both sides of the head with an intensity ranging from mild to moderate different from AH, which is unilateral and severe in intensity . A previous study has shown that the intensity of HAH increases at higher altitude . Several studies have measured changes in cabin pressure during a flight , and a linear coherence has been shown between altitude and cabin pressure . Cabin pressure would normally decrease with around 8 hPa for each 300 meters, until the plane reaches an altitude of 2500 m, at which, the cabin pressure stabilizes at an average of 846 hPa (≈0.85 bar) for the rest of the flight . The decreased pressure might lead to different degrees of hypoxia and changing pressure in body tissues and cavities . As such, these changes might contribute to the development of HAH and AH in the ascending phase. A study has recently shown a possible relation between AH and “mountain descending headache”, which is a condition with common symptoms comparable with AH . We therefore speculate that both headaches are triggered by increasing atmospheric pressure during the descending phase, which will result in expanding the air in the cavities and thereby inducing the headache in the aforementioned phase. However, the mechanism(s) underlying HAH, mountain descending headache and AH remains to be identified .

Five participants of the AH group used medication (24 %) (prior to their flight) in an effort to prevent AH. One individual self-medicated with paracetamol and four took triptans. These medications were reported effective to prevent AH. Our results are in line with a former study that examined the effect of triptans by analyzing 5 flight travelers with AH who all used triptans during a flight, they all reported complete pain relief for the duration of the flight . Triptans are reported to be the most effective when taken 30 min before a flight .

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