Headaches and Diving

Headaches at Depth

CO2 Retention

Due to skip breathing, gear malfunction, rebreather failure. Causes a “sick headache” type of generalized pain and can be associated with nausea and vomiting. The tendency to retain CO2 may be suspected in divers who frequently experience post-dive headaches or pride themselves on low air-use rates.

Tempero-mandibular joint syndrome

Caused by poorly fitting regulator mouthpiece, TMJ arthritis, stress with clamping of teeth. Pain can be located in jaw, temporal areas posterior cervical neck, or referred to other areas of the face and head. May be associated with tinnitus (ringing in the ear).

Gear pressure

-Snorkel pressure when placed under the mask strap.
-Mask squeeze with pain in and around the eyes.
-Pressure from the tank valves on the neck.
-Choking from a dry suit neck seal that is too tight (as from a neck seal in a diver who has gained significant weight) and has obstructed or blocked neck veins. The arterial supply would continue with buildup of venous pressure from obstruction of the jugular vessels.

Neck position (cervical arthritis)

This is seen more frequently in older divers who have any significant arthritis of the neck. Because of the prone horizontal position, the neck is continually extended (looking up position and this can cause severe neck pain with occipital radiation (radiating into the back of the head).

Contaminated air (CO and hydrocarbons)

Associated with nausea, malaise and vomiting, this headache is another “sick headache” that only gradually goes away with ascending and breathing uncontaminated air or oxygen. It is usually associated with more serious signs and symptoms of hypoxia and decrease of consciousness.

Headaches on Ascent

Continuation of the headaches at depth

Reverse sinus and middle ear squeeze

Sinus and middle ear swelling, edema and blood accumulation act to block the openings to the nose and as the diver ascends, there is an enlargement of any air pockets with severe pain – usually experienced by the diver as a boring localized headache that often is referred to the entire face and head.

Exertional headaches, Swimmer’s migraine, Swimmer’s vascular headache
These headaches are reported in the literature and are generally thought to be due to combinations of cold, immersion and vascular dilation.


Migraine can be brought on by diving and can mimic headaches caused by other things – mainly decompression accidents.

Decompression accidents

Headache is not a prominent symptom of neurologic decompression illness but can be associated with cerebral syndromes related to paresthesias of cranial nerves.

Headaches Post-dive

Any of the above; most often sinus and CO2 retention.


Ernest S. Campbell, M.D., FACS

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