By Dr. Frans Cronje, M.D., President & Medical Director, DAN Southern Africa
DAN gets many inquiries regarding headaches and diving. Probably very few divers who dive regularly have not left the water at least once with some cranial discomfort. This piece reviews the common causes of headaches in diving and offers some simple advice that should solve the problem in most cases.
Finding the cause of a headache is probably unnecessary if it only happens once or twice, occurs in the absence of any other symptoms and clears spontaneously or with only mild analgesics. However, a few divers complain of frequent and more troublesome headaches, and it is for these individuals that the following considerations and suggestions are intended.
One way to find the cause of a headache is to run through a checklist of possible causes and eliminate them one by one. While not an exhaustive list, these may include:
By simply looking at the list, one can already see that the origins of headaches are truly diverse. However, important clues can usually be found in the history taken from someone who develops headaches regularly. These five key questions may provide an answer to the causes of headaches:
Migraine, a relative contraindication to scuba diving, requires expert assessment. Headaches may also result from tension, large caffeine intake and menstrual changes, among other reason.
A bad-fitting mouthpiece can also cause headache: Some regulators are quite heavy in the water and require a constant "bite" to stay in place. Swapping regulators or trying different mouthpieces may spell the end of a continuous string of headaches. In the end, it is always better to own your own equipment once you have found what works for you.
Divers with previous neck or upper back problems or injuries are very prone to develop headaches underwater or even as a result of a bumpy boat trip. The underlying bony problems lead to muscle spasms, which in turn cause the headache. A medical specialist such as an orthopedic surgeon should assess these problems. Physiotherapy and muscle strengthening exercises are often of value. Some report improvement after visiting a chiropractor. Back surgery is usually a last resort.
The only way to effectively reduce breathing requirements without building up carbon dioxide is to reduce underwater exercise, ensure adequate thermal protection and to relax; take slow deep breaths (better gas exchange - good rinsing) rather than shallow ones. A healthy breathing pattern is the key to solving many headaches.
Some quick-fix solutions that may be useful (and are good diving practice anyway) include:
1) Loosen your mask strap to avoid pressure on the nose, forehead or cheekbones. If necessary, change your mask to a more comfortable one.
2) Relax during your dives. After all, you are on holiday.
3) Take slow deep breaths. These relax you and provide a more efficient way of removing carbon dioxide.
4) Relax your neck during dives. Even though it spoils your trim momentarily, rotating the body rather than the head to look at objects underwater may avoid the strain and the discomfort of hyperextending the neck.
5) Stay in shape. Exercise reduces the incidence of headaches.
6) Avoid caffeine and tobacco with diving.
7) Always follow safe diving practices. Spend three to five minutes at a safety stop at 3-5 meters (10-15 fsw) below the surface. It is relaxing (weather and conditions permitting) and allows time to reduce the carbon dioxide built up from finning to the surface.
8) Wear adequate thermal protection.
9) Go for regular dive medical examinations: at least every two years for those younger than 40, and annually for those older than 40.
Headaches can spoil a dive trip or vacation and detract from the wonderful underwater experience. Fortunately, once the cause has been determined, many headaches are simple to cure. Those who experience frequent, severely incapacitating, or chronic headaches may require an intensive evaluation by a physician to determine the underlying problem.
Remember, it is always better to go for a check-up unless the headache is trivial or can be explained. Call DAN if you need additional advice or assistance in determining if your headache is a cause for concern.
This article appeared in Alert Diver, November / December 2003.