Airplane headache: a neurologist’s personal experience.

We describe the airplane-related headache of one of the authors (Fa.M.) and offer a joint consideration of it. When the author in question was 7 years old, he had a first episode of acute frontal bilateral sinusitis with fever, and two further episodes at 14 and 22 years. Since then he suffered no further symptom of rhinitis or sinusitis. At the age of 29 years, he flew for the first time; it was November, and the flight was from Milan to Maldives Islands and lasted 10 h; it was very pleasant and he experienced no problems. Some months later, in June, during a short air journey from Verona to Neaples lasting about 1.5 h, while approaching the landing (the plane was approximatively 500 m above the airport), he experienced a sudden, sharp pain of very high intensity located in the right periorbital region, associated with profuse tearing, conjunctival injection and ptosis. He did not check for the presence of miosis in that instance. During the attack he was irritable and found it difficult to stay in his seat. He had to strongly press with his hand on the right fronto-orbital region, but found only very mild relief. After 5 min, the pain diminished and disappeared in 15–20 min; a light dysaesthesia persisted in the same area for 20 min. This was a very unpleasant experience, as the pain was really unbearable, and could be described as ‘thunderclap like’. Three days later, returning home by airplane, he took sodium naproxene 550 mg, one tablet, during take off and suffered no disturbance. Since then, every time he flies (about four times per year), 1 h before landing he takes a tablet of sodium naproxene 550 mg and has never experienced ‘airplane headache’ (1–3) again, until 2 years ago when, returning from a holiday spent in Greece, he forgot to take his naproxene: during landing, he then experienced the same signs and symptoms described above. Brain magnetic resonance imaging (MR and angio-MRI were normal. He has a personal and familial history negative for headache. The authors deem it worthwhile to share this personal experience with the readers of Cephalalgia for several reasons. It adds a new case (the second Italian case) to the limited series published up until now (1–4). With reference to the paper by Mainardi et al. (3), this experience confirms the fairly stereotyped presentation of ‘airplane headache’ as far as sex, age of onset, pain location, unilaterality, intensity, duration and onset at landing are concerned; however, vegetative symptoms of the trigeminal autonomic cephalalgia series and transient dysaesthesia of the area were also present, somewhat expanding the spectrum of the clinical presentation of this kind of headache (4). An inconsistent action of ibuprofen has been described (4). This is the first report of the apparent good effectiveness of naproxene in this condition: a very simple preventive therapy with this drug proved successful in avoiding further attacks. We expect this form of headache not being rare in the general population: it is probably underreported due to its short duration and spontaneous remission. Therefore, this simple therapeutic measure, if its efficacy is confirmed in other cases, could be of help, avoiding an unpleasant and worrying condition that could, as might have been in the present case, limit the use of air travel for many people.