Basic HTML Version
Chapter 32 — 4
Air emboli and bubble development in the brain can cause brain injury and
swelling which often presents as headache. This may start within a short time
after surfacing, or may be delayed for several hours. Headache followed by
confusion or loss of consciousness is very suggestive of this dangerous
disorder. The dive profile is helpful in diagnosing headaches of this type (see
Chapters 11 and 15).
Sinus Barotrauma
This condition usually affects the various sinuses located around the eyes, or
the maxillary sinuses in the cheek bones. Sharp pain in the affected sinus
may be experienced during descent or ascent, or a more dull pain in the
region of the sinus may be felt after the dive (see Chapter 10). A more serious
and difficult-to-diagnose sinus headache can develop in the sphenoidal
sinuses, a deep and central headache. The barotrauma headache is not
usually long lasting.
Pain may be referred from the sinus to the upper teeth or behind the eyes.
After minor barotrauma, an infection (
sinusitis
) can develop hours or days
after the dive, causing a headache in similar sites to those mentioned (see
Chapter 28).
Migraine
This condition can be a worrisome problem in divers. It is common in the
general population.
Clinical features.
These
may include an "aura" before the onset of the headache, with visual
effects ranging from flashes of light, shimmering lines, partial loss of a visual
field to mild blurring of vision. A severe headache aggravated by bright lights,
usually accompanied by nausea and vomiting, and sometimes numbness,
tingling, weakness or paralysis of the limbs, most often follows the visual
aura.
Migraine headaches can be trivial or can be associated with vomiting, severe
incapacity and neurological symptoms (visual disorders, numbness or
'tingling sensations' in arms or legs etc.). These more severe symptoms lead
to diagnostic confusion with air embolism and decompression sickness and
may result in an emergency evacuation and inappropriate treatment.
A severe migraine developing during a dive can incapacitate the diver or
induce vomiting underwater with subsequent drowning.
For reasons which are not well understood, mild migraine sufferers can
sometimes have very severe and unusual migraine attacks precipitated by