Airplane Headaches: What the Research Says

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Airplane headaches (AHs) are brought on by airplane travel and afflict some travelers. For a number of reasons, it is difficult to assess how prevalent AHs are. It is possible that patients prone to AH may make lifestyle modifications-such as reducing the number and frequency of flights-to reduce the incidence of the headaches. And, because of the short duration relative to other types of headaches, it is likely that many people who experience AH do not mention it to their doctors.

Diagnosis

AHs share several features. In addition to the obvious connection with air travel, they are generally associated with landing, tend to be very painful and throbbing, are usually unilateral, and often resolve after approximately 30 to 60 minutes.

The causative mechanism has not been well established. They are believed to be caused by one of several mechanisms related to physiological responses to the atmospheric pressure changes induced by air flight, including: reversible barotrauma, inflammation, or fluid pressure.

Characteristics of AH sufferers

Interestingly, large systemic studies point to a surprisingly low association between AHs and other diagnoses, such as migraine headaches, tension headaches, and chronic sinus allergies.¹ There is also no documented association between AHs and any adverse health risks.

Some patients are especially prone to AH. A study in Denmark² replicated the AH experience by asking volunteers to enter a pressure chamber, that was set to a similar environment as that of an airplane flight. The volunteers who regularly experienced AHs had the same symptoms when they entered a pressure chamber, while the volunteers who had never experienced AHs did not have symptoms when they entered the pressure chamber.

The study itself was performed for the purpose of identifying biomarkers for AHs. It turned out that the volunteers who had AH-like attacks also had measurable increases in their salivary prostaglandin levels, changes in cortisol levels, and mild changes in oxygen saturation, while the non-headache volunteers did not have these changes.

Treatment and prevention

The majority of AH sufferers do not regularly have headaches, so they do not typically carry headache medication with them when they are not traveling by air. This means that their physician must prescribe or recommend over-the-counter medication specifically for times of travel.

There are no well established or standardized approaches to treatment and prevention of AH. Due to the short duration of these events, medical therapy is generally used within a few hours of the flight. Use of anti-inflammatory medications, triptans, and steroid medications have all been found helpful, based on anecdotal accounts.

This article was originally published on January 25, 2018 and has since been updated.

References:

1. Bui SBD, Gazerani P. Headache attributed to airplane travel: diagnosis, pathophysiology, and treatment - a systematic review. J Headache Pain. 2017;18:84.

2. Bui SBD, Petersen T, Poulsen JN, Gazerani P. Simulated airplane headache: a proxy towards identification of underlying mechanisms. J Headache Pain. 2017;18:9.