10.1.2 Headache attributed to aeroplane travel


Headache, often severe, usually unilateral and periocular and without autonomic symptoms, occurring during and caused by aeroplane travel. It remits after landing.

Diagnostic criteria:
  1. At least two episodes of headache fulfilling criterion C
  2. The patient is travelling by aeroplane
  3. Evidence of causation demonstrated by at least two of the following:
    1. headache has developed during the aeroplane flight
    2. either or both of the following:
      • a) headache has worsened in temporal relation to ascent following take-off and/or descent prior to landing of the aeroplane
      • b) headache has spontaneously improved within 30 minutes after the ascent or descent of the aeroplane is completed
    3. headache is severe, with at least two of the following three characteristics:
      • a) unilateral location1
      • b) orbitofrontal location2
      • c) jabbing or stabbing quality3
  4. Not better accounted for by another ICHD-3 diagnosis4.
  1. Side-shift between different flights occurs in around 10% of cases.
  2. Parietal spread may occur.
  3. Pulsation (throbbing) may also be noted.
  4. In particular, sinus disorder should be excluded.

A recent Scandinavian survey has indicated that up to 8.3% of air-travellers experience 10.1.2 Headache attributed to aeroplane travel. It occurs during landing in more than 90% of cases.

Accompanying symptoms are reported in up to 30% of cases. Most frequent are restlessness and unilateral tearing; other localized parasympathetic symptoms, nausea or photo/phonophobia have been described in fewer than 5% of cases.

A proportion of subjects experiencing 10.1.2 Headache attributed to aeroplane travel report similar headache during free snorkelling and/or rapid descent from mountains, suggesting these headaches are due to imbalance between intrasinus and external air pressures.