BERLIN – Reports from airline passengers who experience sudden onset, severe, and short duration headaches – primarily during landing – contain enough common and unique features to support a new, distinct form of headache, according to a study.
"There are some peculiar, common characteristics," Dr. Federico Mainardi said at the International Headache Congress, which was sponsored by the International Headache Society and the American Headache Society. A total of 63 people who responded to a questionnaire cited the common factors of strict unilateral presentation, absence of companion symptoms, and spontaneous resolution once they were on the ground and at the airport.
Sinus conditions sometimes cause severe headaches in migraine patients, Dr. Mainardi said, but only two participants reported concurrent sinusitis. This and other physiologic explanations were ruled out for the remainder, including a subset who underwent MRI and sinus CT scanning, said Dr. Mainardi, a neurologist at the Headache Centre at S.S. Giovanni e Paolo Hospital, Venice, Italy.
Because 60 of the 63 participants had at least one attack occur during the landing phase, Dr. Mainardi suggested that patients with a history of these attacks should take nonsteroidal anti-inflammatory drug prophylaxis either before takeoff on a short flight or during a longer flight. Some respondents reported that this strategy prevented subsequent attacks. He reminded clinicians to rule out organic pathology when a patient reports one of these in-flight headache attacks.
A majority of the participants (46) did not experience a "headache attributed to airplane travel" during their first experience flying. Many people experienced repeat attacks, including 15 patients who reported attacks on more than half their flights and 9 who suffered an attack each time they flew.
Dr. Mainardi described his first case and, together with seven other cases published in the literature, he and his colleagues devised specific criteria for these headaches (J. Headache Pain. 2007;8:196-9). The criteria include repeated attacks, occurrence during airplane travel, duration up to 20 minutes, and fronto-periorbital location.
Dr. Mainardi said that after the publication of the criteria he and his associates received e-mails from people worldwide experiencing the same kind of headache. "This is not an infrequent condition."
Of these 69 contacts, 63 returned a completed questionnaire in which they described and rated their experience. Their mean age was 37 years, and 41 (65%) of the respondents were men. Using International Classification of Headache Disorders (ICHD-II) criteria on the questionnaire, 35 (56%) had a concomitant primary headache, including 15 who reported tension type headaches, 11 who reported migraine with aura, and 3 who met criteria for probable tension type headache. Six reported more than one primary headache type. No participant suffered from cluster headache.
All patients rated their attacks as "severe" or "very severe." These headaches negatively influenced the decision to fly in the future for 44 respondents (70%). This reflects the severity of the pain, Dr. Mainardi said.
All patients denied alcohol consumption prior to the attacks and none gained relief from measures such as chewing, swallowing, or performing a Valsalva maneuver. The duration of flight was not a factor associated with the headache attacks, Dr. Mainardi said.
New cases continue to come forward, and he and his colleagues had identified 74 cases at the time of the congress. Based on more recent experience, he suggested two modifications to the criteria proposed in 2007: an increase in duration up to 30 minutes and expansion of the anatomic location of these attacks to include the parietal region.
Headache attributed to airplane travel is not included in the ICHD-II. Therefore, Dr. Mainardi said, "This should be proposed as a new entity in the forthcoming edition of the ICHD-III."
He said that he had no relevant financial disclosures.