Most cases of airplane headache occur in males. Some people may have headaches with all or most flights while it may occur intermittently for others.
Features:
(1) recurrent episodes of headache while flying (at least 2 attacks)
(2) exclusion of other causes for the headache
Classification of Leon-Sarmiento et al for airplane headache:
(1) aeroheadache Type I (after Mainardi et al, with headache at any time during the flight)
(2) aeroheadache Type II (after Evans et al, with headache only during airplane descent)
Criteria of Mainardi et al, in addition to the 2 features of above:
(1) pain during an airplane travel, typically lasting < 20 minutes, that clears spontaneously
(2) 2 or more of the following:
(2a) severe intensity
(2b) jabbing or stabbing or pulsatile
(2c) strict laterality
(2d) located in the periorbital region or forehead
(3) absence of nasal congestion, nasal stuffiness or tearing
Some cases of airplane headache may be due to a combination of chronic rhinosinusitis and changes in barometric pressure. Prevention by use of antihistamines and nasal decongestants supports a diagnosis of sinonasal barotraumas.
The differential diagnosis is pneumocephalus associated with barotraumas but this is unlikely to be recurrent.
