Is there a dive medic in the house?
December 21, 2014 7:05 PM   Subscribe

Blindingly painful headaches upon surfacing after scuba dives. I know it isn't related to dehydration, mask being too tight, or trouble equalizing as I have been addressing these potentialities methodically to no avail. More relevant details inside.


I've been on twelve ocean dives (all between 40 and 85 feet down) and every time I feel a dull ache in the back of my skull while I'm underwater, which, upon surfacing, turns into a splitting headache-- the worst in my life. The headache goes away within thirty minutes of surfacing.

Maybe it's something to do with breath control? But I've been working on making sure I have deep inhales (count of three) and long slow exhales (count of six) -- and it was terrible today too.

I have a prescription face mask but I don't think that's the issue as I snorkel with it with no problem. I'm very careful to drink plenty of water before and after diving. I eat a light breakfast. I'm not hungover when I dive. I suspect it has something to do with either pressure or breath but I equalize perfectly and I am careful not to breathe shallowly.

Any thoughts or things I can try? I'm on a dive vacation right now so this would be the time to try to unravel this mystery. If I can't figure this out I may stop diving as the headaches just take the fun out of the experience, and that would be a shame. So I'm kind of desperate. Many thanks in advance.
posted by egeanin to Health & Fitness (9 answers total)
I feel a dull ache in the back of my skull

Your sinuses go around the back of your head. Does it resolve with a decongestant?
posted by Lyn Never at 7:16 PM on December 21, 2014

Headaches can be a symptom of decompression sickness (specifically type 2/neurologic DCS).

I also found some evidence that migrainous headaches could be precipitated by diving aside from their relation to DCS: "An elevated level of carbon dioxide in the blood, which occurs with decreased ventilation and breath-holding / hypoventilation, can theoretically precipitate a migraine headache because carbon dioxide (CO2) causes vasodilation in the brain. Increased levels of oxygen in the blood (which occurs in diving as well as in hyperbaric chambers) has been used with variable success to treat severe migraine, because it is a powerful brain vasoconstrictor." (sorry for the lack of literature cites there but the page looked legit and it was the best online explanation I came across).

You can look through the 'headaches' section of the AAFP article in the first link for more ideas. Bottom line, you really ought to see a doctor about this as there are a number of serious causes for headache during/after dives, although there are benign causes as well. The number for the Divers' Alert Network is in the article and the hotline is apparently staffed 24 hour hours a day to answer medical questions about diving. They can also direct you to the nearest recompression facility (hyperbaric chamber). Depending on the cause of your headache, as noted above, a hyperbaric chamber might be able to treat and resolve it.
posted by treehorn+bunny at 8:08 PM on December 21, 2014 [6 favorites]

I get them too, have always thought it was related to dehydration.
posted by amaire at 8:27 PM on December 21, 2014

I wonder if there is some place in your sinuses where the air pressure isn't quite equalized as you descend. Does the ache start as you descend, during the dive, or as you ascend? It maybe that you need to just hang out a little bit more as you are descending. (I'm not sure what 'eqalizing perfectly' means. It's a process and if you've only done 12 open water dives you're a relatively new diver and there's always room for improvement, everyone's body is different, every dive is different, etc. etc.) I've noticed for myself that sometimes my sinuses need a little more time than usual to get squared away. I've never tried ti but a decongestant might help.

Are you drift diving? That can be difficult b/c there is sometimes pressure to get down as quick as possible and stay with the pack. And it's always that first 15 feet that are the toughest, I remember having an excruciating headache on one my earlier dives, as I'm thinking about it w/more experience behind me I wonder if it wasn't some sort of sinus thing.
posted by snowymorninblues at 9:46 PM on December 21, 2014

Best answer: I just came back from doing 20 dives in Grenada. The first 6 were followed by exactly that type of pain but the was no pain from dive 7 onwards. It may have to do with the shock of diving after a long break (several years in my case, sadly) and the stress and tension in your body coming from having to do so many weird and different things at the same time during the dive.

I don't have problems equalising and I drop down like a rock upon entry. All my dives were under 30m AND Nitrox.
posted by Parsnip at 11:31 PM on December 21, 2014 [1 favorite]

Best answer: Have you called DAN for advice? You don't need to be a member.
posted by ktkt at 2:38 AM on December 22, 2014

Have you tried loosening your mask? When I first started diving, I wore my mask really tight, thinking it would be less likely to fill with water, and it definitely gave me a headache. Especially on deeper dives, the mask can really build up some intense suction, so it doesn't have to be super tight at the surface.

Other than that... maybe the pressure on your deeper dives is distorting your eyeballs just enough so that the prescription in your mask is causing eyestrain?
posted by ananci at 8:05 AM on December 22, 2014 [1 favorite]

I too would assume that this is a sinus issue. Your ears may be equalizing just fine, but your sinuses may not be. You could be building up pressure in there that isn't escaping when you come back up, which I'm told is both common and painful. (Some people also get nosebleeds.)

Try taking a sudafed before your next dive, to help open things up in there. If that fixes the problem then there you go.
posted by Anticipation Of A New Lover's Arrival, The at 2:03 PM on December 22, 2014

Best answer: IANAD, but I am a scuba instructor. My first piece of advice would be: speak to the instructor(s) and dive guide(s) you are diving with on this vacation, explain the problem you're having, and ask them for advice. Unlike me, they have seen you underwater and should have a pretty good handle on what you might be able to do to fix this problem. Failing that, here are my own $0.02:

This is almost certainly an equalisation issue, so I'll talk about that first, and then deal with some other less likely causes afterwards.

If you have logged 12 dives so far then you have almost certainly not yet learned how to equalise perfectly. Some statistical outliers manage to equalise without problems straight away, but for the rest of us (myself definitely included) it is more akin to a technique that has to be learned and gradually perfected, like buoyancy or trim, than to a simple binary right/wrong behaviour (like, say, breathing through your mouth rather than your nose while on scuba). The frontal sinuses (just above/behind the eyebrows) are a common problem area for trainees, as they tend to require an extra 'push' to equalise after the ears are clear. The dives you have done (max depth in the 15–25m range; apologies for metric) are fairly shallow; counterintuitively, perhaps, this is the area in the water column where equalisation problems are most prevalent. Remember that the ambient pressure doubles in the first 10m of depth. Even a loss of buoyancy at the safety stop and a brief unequalised drop from 5m to 10m is enough to cause sinus squeeze and pain after the dive.

Most of my possible remedies for this parrot your open-water training: begin equalising before you leave the surface, and equalise on a regular schedule (every 1–2m) rather than when you begin to experience discomfort. Request the use of a shotline or anchor-line to descend. This may not be possible if you're diving over coral or other sensitive seafloors; if not, ask to be buddied with someone who can manage their descent rate so that you can have a visual reference and don't drop too rapidly. It's all too easy to do a blue-water descent in 25 metres without equalising properly on the way down. A folk remedy is snorting sea water at the surface before descent; I know people who swear by this but I don't know of any scientific support for it.

I should probably insert the standard advice here that mixing decongestants with diving is not recommended by most diver training agencies, because of the risk of a reverse block (AKA "reverse squeeze") on ascent if the decongestant wears off during the dive. Reverse blocks are rare but can be problematic, because you have no choice but to ascend at the end of a dive. Of course, you would certainly not be the first person to pop sudafed on a dive trip that had cost them a lot of money; this happened once to, er, a friend of mine.

OK, onto other possibilities. If you find that you're consistently getting out of breath on the dive, then you may be experiencing carbon dioxide build-up, which can manifest as headaches both during and after the dive. The fix for this is easy: stop finning, signal to your buddy that you're out of breath, and get yourself relaxed and breathing steadily before you continue. Dive guides occasionally forget that not everybody spends their working life finning into currents underwater; I've been taken on a few forced marches around sites before.

Much, much less likely: if everybody else on your vacation is experiencing the same headaches, there might be a problem with the compressor. Carbon monoxide toxicity is really rare in diving these days (particularly now that electric compressors are almost ubiquitous) but it's not completely unheard of and it wouldn't be silly of you to ask around, just in case.

It's massively unlikely that you're experiencing decompression sickness. A decompression injury much more typically (a) presents (up to 24 hours) after surfacing and (b) gets worse after that, which is the opposite of what's happening to you. Your reported depths and likely profiles (I assume you're not incurring mandatory decompression stops at these depths) also suggest that DCS is not the cause. At the same time, it's never, ever foolish to consider DCS when you experience pain after a dive. The suggestions above to contact DAN are very good ones. I have spoken to them (in Europe) in the past and they were happy to be contacted over what turned out to be a false alarm.

Again, though, the pros and the other experienced divers on your boat are worth talking to. Grizzled old divers are founts of lengthy, unsolicited wisdom. (This is also the case with, er, a friend of mine.)
posted by Zeinab Badawi's Twenty Hotels at 3:35 PM on December 22, 2014

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