10.1.3 Diving headache

Coded elsewhere:
  1. Migraine, 2. Tension-type headache, 4.2 Primary exercise headache, 4.5 Cold-stimulus headache, 4.6.1 External compression headache and 11.2.1 Cervicogenic headache can occur during a dive. In these instances, diving should be considered a precipitating factor rather than the cause, and the headache should be coded as these disorders accordingly.

Diving has been known to cause cervical carotid or vertebral artery dissection. Headache occurring as a result should be coded to 6.5.1. Acute headache or facial or neck pain attributed to cervical artery dissection.


Headache caused by diving to a depth greater than 10 metres, occurring during the dive but often intensified upon resurfacing, in the absence of decompression illness. It is usually accompanied by symptoms of carbon dioxide (CO2) intoxication. It remits quickly with oxygen or, if this is not given, spontaneously within 3 days after the dive has ended.

Diagnostic criteria:
  1. Any headache fulfilling criterion C
  2. Both of the following:
    1. the patient is diving at a depth >10 metres
    2. no evidence of decompression illness
  3. Evidence of causation demonstrated by at least one of the following:
    1. headache has developed during the dive
    2. either or both of the following:
    3. a) headache has worsened as the dive is continued
    4. b) either of the following:
    5. headache has spontaneously resolved within 3 days of completion of the dive
    6. headache has remitted within 1 hour after treatment with 100% oxygen
    7. at least one of the following symptoms of CO2 intoxication:
      • a) mental confusion
      • b) light-headedness
      • c) motor incoordination
      • d) dyspnoea
      • e) facial flushing
  4. Not better accounted for by another ICHD-3 diagnosis.

There is evidence that hypercapnia in the absence of hypoxia is associated with headache. Hypercapnia (arterial pCO2 >50 mm Hg) is known to cause relaxation of cerebrovascular smooth muscle, leading to intracranial vasodilatation and increased intracranial pressure. 10.1.3 Diving headache is the best clinical example of headache attributed to hypercapnia. Carbon dioxide (CO2) may accumulate in a diver who intentionally holds his or her breath intermittently (skip breathing) in a mistaken attempt to conserve air, or takes shallow breaths to minimize buoyancy variations in the narrow passages of a wreck or cave. Divers may also hypoventilate unintentionally when a tight wetsuit or buoyancy compensator jacket restricts chest wall expansion, or when ventilation is inadequate in response to physical exertion. Strenuous exercise increases the rate of CO2 production more than 10-fold, resulting in a transient elevation of pCO2 to >60 mm Hg.

10.1.3 Diving headache usually intensifies during the decompression phase of the dive or upon resurfacing.