Abstract
I read with great interest the article about aeroplane headache (AH) published recently in Cephalalgia. AH is described as a stereotypical frontal pain which appears exclusively in relation to airplane flights, in particular during the landing phase (1). Sinus barotraumas may affect any paranasal sinus (frontal, ethmoid, sphenoid or maxillary). Maxillary sinus barotraumas, for example, will lead to cheek pain and occasionally epistaxis. As the headache is described at the frontal location and it is unilateral, frontal sinus barotrauma is the most likely condition.
As precisely illustrated by the author’s personal experience, sinus barotraumas are not readily relieved by maneuvers to open the Eustachian tube (2). This is because the obstructed ostia of the sinuses, particularly the frontals and ethmoids, which the authors are referring to, are not related to the Eustachian tube. Such maneuvers, for example, the Valsalva technique, are beneficial for otitic barotraumas.
AH is not related to the distance of travel and occurs almost exclusively during descent, because its pathophysiology is pressure changes. A similar clinical condition can be seen in scuba diving (3). The more sudden the pressure change, the more pain the patient will suffer.
Sinus barotrauma is closely related to the degree of patency of the sinus opening (ostium). The blocked ostium will disturb the pressure equalization mechanism between the sinus cavity and the external environment. Thus, the prevention of sinus barotrauma is accomplished by relieving the obstruction, by either medical or surgical intervention. Nasal allergy, chronic rhinosinusitis, as well as early polypoidal changes of the nasal mucosa can be treated with oral or intranasal medications. Structural obstruction, for example, severe deviated nasal septum or well-formed nasal polyp, will benefit from nasal surgery.