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Migraines (and Medical Forms)

DAN discusses how migraine headaches can affect diving.I just took members of my most recent open-water class out for their first certification dives. A young woman diver developed a bad headache on the bottom at 20 feet / 6 meters. I turned her over to the assistant instructor and continued with the remaining divers.

She went ashore and immediately headed to her gear bag for migraine medication. Ten minutes later, she vomited. Since we had concerns about her symptoms, we called an ambulance. We thought she could have an embolism. For that reason, she was taken to the local hospital for a medical evaluation.

As it turns out, she had a history of migraine headaches and took medication to control them. None of this was on her medical evaluation form. She received medication for both nausea and pain. This was followed by a computerized axial tomography (CAT) scan. After two hours, the emergency department discharged her.

Later in a conversation with her, I found out two things: she had a migraine headache a couple of weeks before this headache, and she said her migraines are associated with exercise. It is frustrating to try and safely teach scuba when students won't tell the truth about their medical history.

We'll discuss two issues: first, the student diver did not fully disclose pertinent medical information on the student medical form (unfortunately a common occurrence); second, how migraine headaches can affect diving.

The Medical Form

Many nationally known physicians, including many DAN physicians, have developed a medical form that assists doctors unfamiliar with diving medicine in the evaluation medical fi tness for scuba diving. Divers who do not reveal current medications or medical conditions defeats its purpose, which is to protect their health and well-being.

In our collective experience at DAN, this omission of medical information by divers occurs for a couple of reasons: some simply don't understand the significance an illness may have during a dive; or, some older divers advise beginners they don't need to put down everything. One individual may tell a new diver: "I dive with migraines, and I don't have any problems." The uninitiated diver is likely to believe a "more experienced" voice at the expense of the instructor's directions.

Honesty on the medical form begins with trust. If you're an instructor or retailer who trains students, a good way to start out with new students is to hand out The DAN Guide to Health and Fitness in Scuba Diving brochure. This brochure explains why a student should complete the medical form thoroughly.

Some divers may simply not want to divulge a personal medical condition. Instructors should let students know that their information is confidential and make themselves available to speak in private with divers about medical issues. And remember, the DAN medical team is always available to speak with the student, the instructor or the student's physician.

Migraine Headaches

Migraine headaches can pose problems similar to the one the instructor discusses here. They can be triggered by certain foods or smells, alcohol, stress, immersion in water or exertion. Sometimes they can produce neurological symptoms such as visual loss and numbness, which may be indistinguishable from neurological decompression illness. Severity can range from mild head pain to disabling discomfort with nausea and vomiting.

Some of the medicines used for migraine treatment and prevention can cause drowsiness, and could exacerbate nitrogen narcosis. Individual evaluation is required: while some migraine sufferers can dive safely, others may be advised against it.