Comment on ‘Headache attributed to airplane travel’

Dear Sir,

We read with interest the article by Berilgen and Müngen regarding ‘Headache attributed to airplane travel’ (1). We believe that form of headache should be included in the forthcoming revision of the International Classification of Headache Disorders. Due to the large increase in our personal case series, we reviewed the diagnostic criteria we had previously proposed in 2007 (2) and that were presented in a platform talk during the 15th International Headache Society Congress, held in Berlin in June 2011 (3). On that occasion we recommended that ‘Headache attributed to airplane travel’ be considered as a novel, properly validated diagnostic entity, with distinctive and specific characteristics, to be included in the group of secondary headaches, in the section ‘Headache attributed to disorder of homoeostasis’. In the paper we have submitted, up to 95% of 75 patients fulfilled such criteria, in particular with regard to unilateral pain, absence of accompanying symptoms, severe intensity, short-lasting duration of the pain, and involvement of the fronto-orbital (in most cases) and fronto-parietal regions (4). We believe that restrictive diagnostic criteria should be recommended in order to properly diagnose this new form of headache. From this perspective, the criteria proposed by Berilgen and Müngen seem to be too broad. In our opinion, these criteria do not completely incorporate the peculiarities of ‘Headache attributed to airplane travel’, leaving some potential differential diagnostic challenges with other forms of headaches, in particular in the group of trigeminal autonomic cephalalgias (TACs), still open.