Experiencing a headache while flying is a common and distressing phenomenon. This pain often occurs during the rapid ascent shortly after takeoff or, more frequently, during the descent as the aircraft approaches its destination. This specific discomfort has been formally classified by the International Headache Society as a “Headache attributed to airplane travel,” or “Airplane Headache.” Understanding the mechanics behind this pain is the first step toward managing it effectively.
Barometric Pressure and Sinus Barotrauma
The primary cause of severe in-flight headaches is a painful condition called sinus barotrauma, sometimes referred to as aerosinusitis. This occurs when the air pressure inside the body’s air-filled cavities, such as the paranasal sinuses and the middle ear, cannot equalize quickly enough with the changing pressure inside the airplane cabin.
As the aircraft descends, the cabin pressure increases, causing the air trapped within your sinuses to contract. If the narrow openings, or ostia, that connect the sinuses to the nasal passages are blocked—often due to inflammation from a cold, allergies, or a sinus infection—the air cannot move out to equalize the pressure difference. This creates a vacuum-like negative pressure within the sinus cavity.
The resulting force pulls on and damages the sensitive mucosal lining of the sinus, leading to pain, swelling, and sometimes even bleeding. The pain is typically felt as a sudden, sharp, and stabbing sensation, frequently localized above the eyes in the frontal sinuses or around the cheekbones in the maxillary sinuses. This localized pain during descent is the hallmark presentation of the specific “Airplane Headache” diagnosis.
Secondary Contributors to Flight Headaches
While barotrauma is the most dramatic cause, several environmental factors within the cabin can lower the pain threshold, making a traveler more susceptible to a general headache. The recirculated air in the cabin has very low humidity, which can lead to significant dehydration over the course of a flight. Dehydration is a well-established headache trigger, and this effect is often compounded by travelers avoiding water to limit trips to the lavatory.
The cabin environment also presents sensory triggers that can exacerbate headache tendencies. Constant engine noise, changes in light intensity, and the flicker from overhead reading lamps or in-flight entertainment screens can all contribute to sensory overload. Furthermore, the cabin is pressurized to an altitude equivalent of 6,000 to 8,000 feet, which results in a mild reduction in oxygen saturation, known as mild hypoxia. This reduced oxygen level acts as an additional physiological stressor that contributes to a background headache or fatigue.
Preventing and Managing Flight Headaches
Managing flight-related headaches involves preparation and in-flight techniques focused on pressure equalization. Hydration is key, requiring travelers to drink plenty of water in the 24 hours leading up to and during the flight. Limit alcohol and caffeine, which act as diuretics and promote fluid loss.
If you are prone to barotrauma, a preventative medication strategy can be effective. Taking an oral decongestant containing pseudoephedrine about 30 minutes before boarding helps shrink the nasal and sinus membranes, keeping the ostia open for better pressure equalization. Alternatively, a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, taken two hours before takeoff can reduce general inflammation and mitigate the pain response.
During the flight, especially during descent, active pressure equalization maneuvers are necessary to prevent a “sinus squeeze.” Techniques include:
- The Valsalva maneuver: Pinching your nose shut and gently blowing air into it to force air into the middle ear and sinuses.
- Swallowing or chewing gum to activate muscles that open the Eustachian tubes.
- Yawning to allow air to move freely.
- Using a topical nasal spray judiciously just before the descent to clear nasal passages if congestion is a known issue.